Improving the Continuity of Care

Placer County is using Providing Access and Transforming Health (PATH) funding to develop and maintain Enhanced Care Management (ECM) and Community Supports linkages for clients with complex health care and social needs. The county currently serves several ECM populations of focus, including individuals and families experiencing homelessness, and provides housing deposits, transition, and tenancy Community Supports services.

Placer County is pleased to share the following story about their client, “Jason”, whose real name has been changed to protect his privacy.

Jason is a 60-year-old male who was referred to ECM in May 2022 by his Placer County Clinic Services mental health case manager. Prior to accessing services, he was incarcerated for 17 years and had been struggling with substance use, chronic street homelessness, and mental and physical health issues. He experienced difficulty with managing healthy relationships and had a payee in place to manage his finances. In addition, he had been diagnosed with cancer.

In June 2022, Jason was linked to Community Supports services. Within two months, Jason was housed in a permanent supportive housing program in Placer County. Upon receiving ECM and Community Supports services, and with the stability gained from permanent supportive housing, he was able to receive follow-up treatment for his cancer diagnosis and is now in remission. He has maintained his physical and mental health, learned interpersonal skills living with roommates, is managing his finances, and was linked to the California Department of Rehabilitation for part-timework. He no longer has a payee in place to manage his finances and was recently housed in his own apartment.

Jason is grateful for the ECM/Community Supports linkages provided by Placer County. He continues to be motivated to make positive changes now that he is stably housed and is managing his physical and mental health.

Jason is just one of many examples of how PATH Capacity and Infrastructure Transition, Expansion, and Development (CITED) funding is helping Placer County make the investments required to build, scale, and maintain coordinated ECM and Community Supports linkages that serve the whole person.


Have you applied for funding to support your organization’s workforce, vendor contracting, IT, community assessment and other Medi-Cal needs necessary to deliver ECM and Community Supports?


Have you joined your local network of CalAIM stakeholders working together to implement quality Enhanced Care Management (ECM) and Community Supports services for members?