Medi-Cal Enhanced Care Management and Community Supports (CalAIM)

Enhanced Care Management (ECM) and Community Supports are two Medi-Cal benefits created under the CalAIM initiative. ECM gives people with complex needs a lead care manager. Community Supports are optional services that health plans may offer, such as help moving out of a nursing home or help paying for assisted living services. It sits alongside our California Long-Term Care Medicaid guide, which covers the nursing home rules.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Item	Details
Type of program	Managed long-term services and supports (managed care)
Who runs it	California Department of Health Care Services (DHCS), through Medi-Cal managed care plans
Age	Varies by group (adults and children)
Care need	Members in defined groups of focus, including people at risk of or living in a nursing facility
California 2026 income rule (long-term care)	No fixed cap for nursing home care (income above allowances goes toward the cost of care)
California 2026 asset limit (single applicant)	$130,000 in countable (nonexempt) property
Waiting list	Depends on plan capacity

ECM and Community Supports in brief

To sum up, California Department of Health Care Services (DHCS), through Medi-Cal managed care plans oversees ECM and Community Supports. Its target group is varies by group (adults and children); on care need, the rule is: Members in defined groups of focus, including people at risk of or living in a nursing facility. On waiting lists, the current picture is: Depends on plan capacity. Each of these points is covered in more depth below, alongside the general California rules from our state guide. Families weighing ECM and Community Supports against other California options can use the related pages at the end to compare programs side by side.

What the program is

ECM and Community Supports are delivered through Medi-Cal managed care plans. ECM is a statewide benefit for members in defined “populations of focus,” which include adults living in the community at risk of long-term institutional care and nursing facility residents who want to move to the community. Community Supports are services plans choose to offer instead of more costly care; the selection varies by plan and county. Two that matter most for long-term care are Nursing Facility Transition/Diversion to Assisted Living and Community Transition Services/Nursing Facility Transition to a Home.

ECM and Community Supports works through managed care: instead of paying each provider directly, California pays health plans, which arrange care at home, in residential settings and in nursing homes. The member chooses a plan from those offered in their area, and the plan assigns a care coordinator or case manager. The plan must follow the state’s eligibility and coverage rules, and members keep the right to appeal decisions they disagree with. See Managed long-term services and supports.

Who qualifies in 2026

In California, the basic requirements for ECM and Community Supports are that the person:

Has Medi-Cal and is enrolled in a Medi-Cal managed care plan
Fits an ECM population of focus or the criteria for a specific Community Support
Lives in an area where the plan offers the Community Support requested

The money test. The person must have Medi-Cal and be enrolled in a managed care plan. Medi-Cal’s rules are explained in our California guide. Figures shown above are the 2026 California long-term care limits from our state guide. The home (up to the equity limit, when the person or a spouse lives there or plans to return), one vehicle, belongings and a small burial fund are generally not counted by Medi-Cal. Married couples get extra protection in California: the spouse at home keeps a share of assets and may get some of the applicant’s income. See Spousal impoverishment rules.

What the care test means in practice. The care test looks at how much help a person needs with everyday activities such as bathing, dressing, eating, using the toilet, moving around and taking medicines, and at memory problems and supervision needs. For ECM and Community Supports, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Families should describe the worst days honestly and bring a list of conditions and medicines. See Nursing home level of care and Activities of daily living.

What services it can pay for

What a participant receives under ECM and Community Supports follows the care plan. Possible services include:

A lead care manager who coordinates medical, behavioral and social services (ECM)
Nursing facility transition or diversion to assisted living (Community Support)
Community transition services and one-time moving costs (Community Support)
Personal care and homemaker services (Community Support)
Respite for caregivers (Community Support)
Environmental accessibility adaptations (Community Support)
Medically tailored meals (Community Support)

Not every participant gets every service; the plan reflects assessed need and the help family already gives. A change in health is a reason to request a reassessment.

How to apply

There are two tracks, a financial one and a care one, and both must say yes. The usual path for ECM and Community Supports is:

Contact your Medi-Cal managed care plan’s member services to request ECM or a Community Support.
A provider, hospital or nursing home social worker can also refer you.
The plan checks whether you meet the criteria and assigns a lead care manager or provider.
The care manager helps arrange services and any transition.

Our documents checklist and Applying for a waiver guide list the paperwork.

Waiting lists

ECM is a benefit for people who qualify, but plan and provider capacity can limit how fast services start. Community Supports depend on what each plan offers in your county.

See Waiver waiting lists for general tips.

How it relates to nursing home Medicaid

CalAIM supports are designed to keep people out of nursing homes or help them leave. The assisted living transition support can pay for care services in assisted living for people who meet a nursing facility level of care, which can be an alternative to the ALW waitlist. Medi-Cal’s financial rules (see our California guide) apply.

Rules shared with nursing home Medicaid. As in nearly every state, California’s financial rules for home and community programs follow its nursing home rules closely. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. After death, estate recovery can reach services paid from age 55 on. Under ECM and Community Supports, income above an allowance may go toward the cost of care each month.

Income in a nursing home. In 2026, California lets a nursing home resident keep $35 a month for personal needs; the rest of their income mostly pays toward care. The state guide explains the nursing home side.

Tips for families

Begin before it is urgent. Every step of ECM and Community Supports takes time, and an early request protects your place.
Keep a paper trail: copies of forms and notices, plus the names and dates of every call to Medi-Cal.
Use your appeal rights. Notices that deny or reduce services explain how to request a fair hearing; acting quickly can protect current services.
Report changes promptly, including income, assets, a move or a new living arrangement.
Plan for renewals. Medicaid and the care assessment are both renewed, usually once a year. See Renewals.
Get help with complex ECM and Community Supports cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how California’s rules fit a family’s situation.

Common questions

Is ECM the same as a waiver? No. ECM is a managed care benefit, not a waiver, and it does not have a fixed number of slots.

Does every plan offer the assisted living Community Support? No. Plans choose which Community Supports to offer, so they vary by plan and county.

Do I have to change plans? No, but the supports available depend on your plan and county.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.