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County staff report duplication across Enhanced Care Management contracts; public health program not financially sustainable
Summary
Interim healthcare services director reported overlapping Enhanced Care Management (ECM) services across county programs, estimated 5% client duplication, grant-funded positions through 2027, and concerns about reimbursement and program sustainability.
In an information item, the interim healthcare services director reported that San Joaquin County is seeing duplication among Enhanced Care Management contracts run by public health, the hospital and county clinics, and she urged a coordinated review to avoid billing errors and sustain services.
The director said the overlap affects multiple DHCS-defined ECM target populations and estimated about 5% duplication of members across programs. She said the public health ECM effort is not breaking even on current revenue and that grant funding supports some positions through 2027. The director explained that ECM billing requires a minimum of two hours of case management per beneficiary each month to be billable and said handoffs between teams have meant some clients do not meet that threshold, creating revenue shortfalls.
The director contrasted ECM billing with California Children’s Services and with housing-navigation services (CSS), which reimburse at higher rates. She said the county is exploring options including shifting some public health ECM work into behavioral health, and recommended an offline, county-wide mapping of populations and delivery sites to reduce overlap and improve financial sustainability.
Committee members noted that a January mandate requires anyone released from jail or juvenile hall to be linked to an ECM provider, increasing the need to maintain a reliable, sustainable ECM program. The director said reimbursement rates vary by negotiated agreements with health plans and that clinics or hospitals may receive higher reimbursement than public health; she did not provide specific per-hour rates at the meeting.
The discussion concluded with direction to convene stakeholders to analyze program overlap, billing practice and sustainability, and to return with financial options and a proposed alignment of which county teams should serve which target populations.
