Executive Summary
The Enhanced Care Management Program (ECM) is a pivotal component of California’s CalAIM initiative. It is designed to improve healthcare outcomes for the state’s most vulnerable populations, including those with complex needs such as serious mental illness and substance use disorder (SUD). With proposed federal Medicaid funding cuts threatening the future of ECM, it’s critical to advocate for the continuation and expansion of this essential service. ECM not only improves health outcomes but also reduces overall healthcare costs by addressing the root causes of poor health. This article explores the value of ECM, its impact, and why it must be preserved amidst federal funding uncertainty. Insights from broader population health strategies further underscore the relevance of ECM in creating sustainable healthcare systems.
California’s Commitment to Enhanced Care Management
California has demonstrated a strong commitment to expanding and enhancing its healthcare initiatives, particularly through the CalAIM framework. Notably, the state has recently increased funding for ECM, a program designed to provide comprehensive care management for Medi-Cal enrollees with complex needs. In the 2025–26 state budget, funding for ECM has been raised by 7.5%, totaling approximately $956 million in total funds, a significant increase from the previous year’s budget. This funding boost reflects the state’s recognition of the crucial role ECM plays in improving health outcomes, reducing reliance on emergency services, and ultimately lowering healthcare costs.
Dr. Pouya Afshar, CEO of Presidium Health, underscores the importance of these efforts, saying,
“California’s commitment to Enhanced Care Management represents a forward-thinking approach to healthcare—one that prioritizes long-term health outcomes over short-term fixes. The state’s investment in ECM and community supports services is crucial to ensuring that our most vulnerable populations receive the care they need to thrive.”
In addition, California has allocated $231 million for Community Supports, a key component of CalAIM, which addresses the social determinants of health by offering services like housing support and nutritional assistance. This 5% increase highlights California’s ongoing efforts to integrate social services and health promotion into the broader healthcare system.
Despite the challenges posed by proposed federal Medicaid cuts, California’s commitment to expanding ECM remains unwavering. The Department of Health Care Services (DHCS) has assured stakeholders that ECM and other community supports services under CalAIM will remain fully operational through the end of the current waiver period in December 2026. This commitment, alongside the state’s proactive efforts to advocate for the continuation of federal funding, ensures that the most vulnerable populations will continue to receive the care they need.
As California continues to lead the way in population health management, these investments in comprehensive care management are critical for addressing the state’s most pressing healthcare challenges and advancing health equity for all.
The Importance of ECM under CalAIM
California’s CalAIM initiative is a transformative effort aimed at improving healthcare for the state’s most complex populations. ECM providers play a central role by offering intensive care coordination for individuals dealing with challenges such as homelessness, serious mental illness, and chronic conditions. Care teams manage treatment plans and collaborate to provide community supports services, ensuring a comprehensive service infrastructure.
“ECM and other programs under CalAIM are not just an investment in healthcare—they’re an investment in the long-term well-being of our most vulnerable populations, delivering better health outcomes while reducing costs.”
Addressing Social Determinants of Health (SDOH)
ECM addresses social needs such as housing instability and access to mental health care. Dr. Afshar notes, “Programs like CalAIM and ECM address the root causes of poor health, focusing on social determinants of health—issues that, when left unaddressed, lead to higher healthcare utilization and worse outcomes.” By tackling these systemic issues, ECM reduces the reliance on emergency departments and hospitals, leading to improved outcomes and cost savings.
Insights from the article The Future of Population Health also reinforce this approach, stating that “population health management frameworks, such as ECM, focus on integrating types of services to manage not only health conditions but the broader social context that affects health.” This underscores the need for programs like ECM, which take a holistic approach to care plans by addressing both medical and social factors to improve long-term health outcomes.
The Risk of Federal Medicaid Cuts
The proposed cuts to federal Medicaid funding present a significant threat to ECM. If enacted, these cuts could lead to a reduction of up to $880 billion in Medicaid spending over the next decade, which would likely impact ECM and similar services. California, which depends on both state and federal funding for CalAIM, could face a $30 billion loss annually if these cuts go through.
“If ECM services are cut, patients will be forced back into the overutilization of emergency departments, leading to poor outcomes and higher total healthcare spending—putting a massive strain on our already overburdened healthcare system.”
The Long-Term Value of ECM
ECM provides long-term value by helping patients manage complex health conditions and social needs. As Dr. Afshar puts it,
“ECM helps patients manage complex needs and social services, which empowers them to stay out of emergency rooms and hospitals, ultimately saving money and improving quality of life.” By addressing these challenges early, ECM reduces the need for costly hospital readmissions and emergency department visits, which in turn lowers overall healthcare expenditures of eligible members.
The most medically complex 5% of populations are responsible for more than 50% of healthcare expenditures. By effectively managing their care through programs like ECM, we can not only lower these costs but also enhance patient outcomes. As Dr. Afshar emphasizes,
“Addressing the needs of this top 5% through ECM allows us to reduce costs significantly while improving both care and results.”
A Call to Action for Policymakers and Health Plans
It is vital that both policymakers and health plans recognize ECM’s transformative role. Dr. Afshar stresses that ECM is not just a program, but a fundamental shift in healthcare delivery: “Health plans and policymakers must recognize that ECM isn’t just a program, it’s a fundamental shift in how we deliver care—one that’s focused on long-term outcomes rather than short-term fixes.” This shift in focus is essential for maintaining the sustainability of healthcare systems and ensuring that vulnerable populations receive the care they need.
“We have to start wrapping our minds around the idea that these are not extra services, they are essential services that have financial, ethical and moral justifications for continuation.”
The Future of ECM
Dr. Afshar remains optimistic about the future of ECM, believing that its success will eventually secure its widespread adoption: “When the government understands the importance of addressing the needs of our most medically complex populations, ECM will naturally become a scalable solution that significantly reduces overall healthcare costs.” By demonstrating ECM’s positive impact on reducing hospital visits, improving outcomes, and lowering expenditures, the program is poised for growth.
Conclusion
In conclusion, ECM under CalAIM is an essential innovation in California’s healthcare system. The proposed federal Medicaid cuts threaten to undermine the progress made in addressing the needs of the state’s most vulnerable populations. As Dr. Afshar concludes, “If we don’t maintain ECM, we risk pushing our most vulnerable populations back into a cycle of dependency on emergency services, exacerbating the very problems we’ve worked so hard to address.” Advocating for ECM is crucial to ensuring better outcomes for California’s high-risk populations.
About Dr. Pouya Afshar
Dr. Pouya Afshar is the CEO of Presidium Health, leading a value-based wraparound care model for the 1% highest utilizers within Medicaid. His leadership focuses on addressing the complex needs of vulnerable populations, particularly those with high healthcare utilization. Dr. Afshar has been a key advocate for Enhanced Care Management services, emphasizing comprehensive care coordination and patient empowerment. His work aligns with California’s CalAIM initiative, striving to improve health outcomes and reduce healthcare costs. A CHCF Member with both an MD and MBA, Dr. Afshar’s vision promotes holistic, patient-centered approaches that reduce hospitalizations and foster long-term health.
References
- California Governor’s Office. (2025, May 20). Press Release: Projected Impact of House-Proposed Medicaid Cuts on California. Retrieved from gov.ca.gov.
- CalMatters. (2025, March–April). Health Policy News: Looming Medicaid Cuts and Their Potential Impact on California’s Vulnerable Populations. Retrieved from calmatters.org.
- Berkeley News – UC Berkeley Labor Center. (2025, May 23). Analysis of Potential Medicaid Cuts and Their Effects on California’s Low-Income Communities. Retrieved from news.berkeley.edu.
- National Health Law Program. (2025, February). Protecting Medi-Cal Funding in 2025: The Impact on People with Disabilities. Retrieved from healthlaw.org.
- California Department of Health Care Services (DHCS). (2025, April 14). Stakeholder Update: Continued Commitment to CalAIM and ECM Services Despite Federal Uncertainty. Retrieved from dhcs.ca.gov.
- Legislative Analyst’s Office. (2025). 2025–2026 Budget Proposal: An Increase in ECM Funding for California.Retrieved from lao.ca.gov.
- Hayatdavoudi AB. The Future of Population Health. Popul Health Manag. 2023 Aug;26(4):193-194. doi: 10.1089/pop.2023.0099. PMID: 37590065.
