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Enhanced Care Management (ECM) and ALW: can a member have both?
Enhanced Care Management (ECM) is care management through a Medi-Cal managed-care plan under CalAIM. ALW pays an assisted-living home for care. What to ask the plan and your agency.
Ask the plan and your agency, because the answer sits with them. Enhanced Care Management (ECM) is care management that a Medi-Cal managed-care plan provides under CalAIM, reached by asking the plan. The Assisted Living Waiver (ALW) pays a licensed assisted-living home for care, with its own care coordination by a Care Coordination Agency. DHCS's written rule about not receiving two things at once is about the plan's Assisted Living Facility Transitions support and ALW, not ECM. Beta ALW is a Care Coordination Agency.
Important: What each plan offers under CalAIM can change, and the plan decides who gets ECM. The California Department of Health Care Services (DHCS) decides ALW eligibility after a nurse assessment and releases openings in priority order. Beta's ALW team is a Care Coordination Agency (CCA). It can't promise eligibility, an opening, a date or a room, and it does not decide ECM.
ECM and ALW, side by side
The ECM column says what this site's CalAIM comparison already says and nothing more; the DHCS CalAIM page has the rest. The ALW column comes from DHCS's ALW pages. "Your agency" means your CCA.
| Question | ECM | ALW |
|---|---|---|
| What it is | Care management through the member's Medi-Cal managed-care plan under CalAIM. You ask the plan for it. | Medi-Cal paying a licensed assisted-living home for care, plus care coordination by a CCA. |
| Who decides | The plan, under DHCS's CalAIM policy. | DHCS, after a nurse assessment by the CCA. |
| Who does the care management | A care manager from an ECM provider the plan works with. | A care coordinator from your CCA, who writes the care plan with you and visits every month after move-in. |
| Where you live | Wherever you live; ECM is not a place. | A licensed assisted-living home that takes ALW, in one of the fifteen ALW counties. The state licenses these homes as a Residential Care Facility for the Elderly (RCFE) or an Adult Residential Facility (ARF). |
| What it pays for | Care management, as the plan defines it. | Care in the home, and care coordination. You pay room and board (the room and meals). |
Can you have both?
DHCS's written rule that this site can cite is about a different CalAIM piece: a person can be eligible for both ALW and the plan's Assisted Living Facility Transitions support, but cannot receive that support and ALW at the same time, and DHCS tells plans to coordinate with ALW providers and with CCAs. That comparison. For ECM, this page states no rule, because the question is the plan's and your agency's. Ask both, in writing:
- Does the plan offer ECM to this member, and would it continue after an ALW move-in?
- If the member has ECM and an ALW opening is released, who tells whom, and by when?
- Who holds the care plan once the person lives in the home under ALW?
Note who you spoke to and when. Tell your agency if ECM starts, and tell the plan the ALW enrollment date.
What ALW care coordination covers
Under ALW, a registered nurse from your agency does the assessment, the agency writes the care plan (the Individualized Service Plan) with you, helps you compare homes while leaving the choice to you, sends the enrollment package to DHCS, and after move-in visits every month and checks Medi-Cal each month. What a Care Coordination Agency does. That is not the same thing as a plan's ECM, and it is why both sides need to know about each other.
If you're a case manager or ECM provider
Verify the member's plan and the current CalAIM policy first. If an ALW opening is released for a member you manage, tell the plan and the CCA and confirm the effective dates. To refer someone, call with professional context only: your organization and role, a callback number, the person's county and setting, and the general need. Send no records. Beta's ALW team names the route for records once you are in touch. How health plan teams coordinate care with Beta's ALW team.
What people ask
Is ECM the same as ALW care coordination?
No. ECM is care management the member's Medi-Cal plan provides under CalAIM. ALW care coordination is done by the Care Coordination Agency the person chose, under DHCS's ALW rules, and it includes the nurse assessment, the care plan and monthly visits.
Can a person on the ALW waitlist get ECM?
A place on the ALW waitlist is not enrollment, and ECM is the plan's decision. Ask the plan. Tell your agency if ECM starts.
Who do I call first?
The member-services number on the plan card for ECM and Community Supports, and your Care Coordination Agency for ALW. Not sure? Request a callback.
About this informationReviewed October 26, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and reviewed by Sergio B., Program Coordinator, against the official sources this page lists; facts checked through October 26, 2026. Where this page and an official source differ, the source controls.
This page gives general California ALW information. DHCS decides eligibility after the nurse assessment and releases openings. Each home decides its own admissions. Nothing here is an eligibility decision or a promise of enrollment, and it does not guarantee a place in a home. You may choose any Care Coordination Agency listed by DHCS and any participating home.
Something out of date? Tell Beta's ALW team.