Strategy: Build ECM Caseload Now Before Dec 2026 Waiver Expiration — Window Is Closing
With CalAIM's 1115 waiver expiring Dec 2026 and a hostile federal environment for SDOH-focused Medicaid programs, FQHCs must maximize ECM enrollment now. Revenue strategy: (1) Screen every Medi-Cal patient for ECM eligibility (7 populations of focus including HIV+, SMI, SUD, homelessness, justice-involved). (2) Layer ECM on grant-funded programs — Ryan White clients on Medi-Cal (not MCWP waiver) can be ECM-enrolled. (3) Cross-train CHWs for both ECM care coordination and Ryan White case management. (4) Build data infrastructure showing ECM outcomes (reduced ED visits, improved engagement) to justify renewal. (5) Join CPCA and NACHC advocacy for waiver renewal with full ECM/Community Supports authority.
Key takeaways
- Screen every Medi-Cal patient for ECM eligibility — 7 populations of focus including HIV+, SMI, SUD, homelessness, justice-involved
- Ryan White clients on Medi-Cal (not MCWP waiver) can be ECM-enrolled — layer revenue on grant-funded programs
- Cross-train CHWs for both ECM care coordination and Ryan White case management
- Build data infrastructure showing ECM outcomes (reduced ED visits, improved engagement) to justify waiver renewal
- Join CPCA and NACHC advocacy for waiver renewal with full ECM/Community Supports authority
Primary source
DHCS CalAIMFQHC Talent. (2026, March 4). Strategy: Build ECM Caseload Now Before Dec 2026 Waiver Expiration — Window Is Closing. Primary source: DHCS CalAIM. Retrieved April 28, 2026, from https://www.fqhctalent.com/intel/strategy-ecm-volume-urgency
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