CalAIM
Supporting Whole-Person Care
Our whole-person care approach focuses on addressing social drivers of health – such as housing stability and access to essential services – for individuals with complex health and social needs and promote lasting well-being.
What makes our CalAIM services different?
Too often, individuals with complex health and social needs struggle to navigate disconnected systems of care.
We understand that improving outcomes requires more than referrals—it requires consistent coordination, strong relationships, and a whole-person approach.
EA works closely with members and partners to deliver responsive, individualized support that promotes stability and long-term well-being.
Individualized care coordination tailored to each member’s health, behavioral, and social needs
Dedicated Lead Care Managers who provide consistent guidance and support
Whole-person care approach connecting medical, behavioral health, and social services
Proactive engagement and follow-up to support progress and reduce gaps in care
Strong partnerships with managed care plans, providers, and community organizations
Housing-focused Community Supports that promote stability and long-term housing success.
Who qualifies for CalAIM?
Services are offered to eligible Medi-Cal members who meet specific populations of focus, as defined by the CalAIM program.
Populations of focus include:
Homeless families or individuals experiencing homelessness
Individuals at risk for avoidable hospital or emergency department utilization
Individuals experiencing serious mental health and/or substance use disorder needs (SMI)
Individuals experiencing Substance Use Disorder (SUD)
Children/youth involved in child welfare
Eligibility is determined by Medi-Cal managed care plans and authorized referral partners based on program criteria.
How referrals work
CalAIM referrals are typically made through Medi-Cal managed care plans, healthcare providers, county agencies, or other authorized partners. EA Family Services works closely with referring partners and managed care plans to review referrals, confirm eligibility, and coordinate services.
Members & families
Medi-Cal members can inquire about eligibility through their:
Medi-Cal managed care plan
Primary care provider
Care team
Partners & providers
Healthcare providers, managed care plans, and community partners may:
Submit referrals to calaimintake@ea.org or
Contact us for guidance on referral pathways and available services.
Services & Supports
EA Family Services provides intensive care coordination and housing supports for Medi-Cal members with complex health and social needs through two core service categories: Community Supports and Enhanced Care Management.
Community Supports (CS)
Community Supports address social drivers of health and help Medi-Cal members maintain stable living environments.
The CS Program offers three housing services:
Housing Transition Navigation Services
Housing Deposit Services
Housing Tenancy and Sustaining Services
Housing Transition Navigation Services
Provides assistance with obtaining housing. This may include assistance with searching for housing or completing housing applications, as well as developing an individual housing support plan.
Housing Deposit Services
Provides funding for one‑time services necessary to establish a household, including security deposits to obtain a lease, pre-selected items medically necessary to occupy the household, and first month’s coverage of utilities.
Housing deposits are available for members in housing navigation and housing tenancy if there is a need and all county resources have been expended. Exact fiscal and item limitations are established by the authorizing Managed Care Plan provider.
Housing Tenancy and Sustaining Services
Provides assistance with maintaining stable tenancy once housing is secured. This may include interventions for behaviors that may jeopardize housing, such as late rental payment and services, to develop financial literacy.
Enhanced Care Management (ECM)
The goal of ECM is to improve the member’s health and social outcomes. ECM provides seven core services to enrolled members:
Outreach and engagement
Comprehensive assessment and care management plan
Enhanced care coordination
Health promotion
Comprehensive transitional care
Member and family support
Coordination of and referral to community and social support services
ECM Lead Care Managers work collaboratively with each member and a multidisciplinary team to develop a personalized care plan with Specific, Measurable, Achievable, Relevant, and Timely (SMART) goals. The care plan addresses healthcare and supportive service needs, including:
Coordination of primary and specialty medical care
Dental, mental health, and substance use services
Behavioral health support
Job training and vocational services
Long-term services and supports, including housing resources
Care team and client/family team meetings
Housing navigation and supportive housing coordination
Life skills development and education support
Appointment reminders and transportation assistance
Accompaniment to critical appointments