The ECM Team

When someone is experiencing a mental health diagnosis, trying to secure stable housing, navigating immigration paperwork, and keeping up with medical appointments, even small tasks can feel overwhelming.

For many in our community, it is not just one challenge. It is several, happening at the same time. And often, the process of searching for help can feel just as difficult as the challenges themselves. Finding services in your language, explaining your story to new providers, and navigating unfamiliar systems can take energy that many simply do not have.

Enhanced Care Management, or ECM, was created to respond to that reality.

Launched almost a year ago, ECM is a Medi-Cal benefit available to eligible youth and adults enrolled in the San Francisco Health Plan who are living with serious mental health or substance use challenges. The program provides individualized care coordination, helping participants access medical services, mental health care, housing support, income assistance, and other essential resources.

“In simple terms, Enhanced Care Management helps people find resources, feel more stable in their lives, and access the medical and mental health care they need,” said Renatto Guerrero, ECM Program Manager.

Participants often come to ECM with limited access to mental health services, unstable housing or income, legal or immigration concerns, or situations involving domestic violence or child abuse. All of these needs are, in most cases, interconnected and require uninterrupted support.

Many of the people benefiting from ECM are already connected to IFR through our other programs. For them, this new component has been especially meaningful. Instead of starting over in an unfamiliar place, they are able to receive additional care coordination within a setting they already trust, with staff who understand their language, culture, and lived experience. That continuity reduces barriers and makes it easier to accept support.

The ECM team works as part of a multidisciplinary network to coordinate care in a way that feels practical and consistent. Care managers assist with scheduling and accessing medical appointments, supporting medication management, connecting participants to housing and income resources, and advocating on their behalf when systems feel difficult to navigate.

They also collaborate closely with other IFR programs, receiving referrals and coordinating services when clients need additional mental health or substance use support. This integrated approach strengthens the overall circle of care and ensures that participants do not have to repeat their story or navigate systems alone.

Unlike short-term interventions, ECM is designed to build stability over time. Care plans are created in partnership with each participant, focusing on personal goals and long-term well-being. The team provides ongoing guidance, follow-up, and education so that individuals can build the skills and confidence needed to access resources independently in the future.

The ECM team began onboarding in January 2025 and started providing direct services in March. In this first year, one thing has stood out clearly: the level of need in the community is significant, and consistent care changes outcomes.

Participants have shared that they feel heard and supported. Some have successfully moved through housing processes with advocacy from their care manager. Others have gained access to medications and mental health services that once felt out of reach.

That impact can look different for each person. In one case, the ECM team supported an older adult who was at risk of losing stability at home due to health challenges and limited support. Through steady coordination and advocacy, the participant was able to remain safely in their home and stay connected to ongoing medical care. What might have become a crisis instead became a pathway to stability.

As ECM continues to grow, the team hopes to expand its reach and serve more members of our community. Strong partnerships with health plans and care coordination teams have helped shape the program during its first year, reinforcing the importance of communication, flexibility, and collaboration.

Enhanced Care Management provides steady, individualized support to those navigating complex health and life challenges. It strengthens access, builds stability, and ensures that community members can receive care in a place that feels familiar, culturally responsive, and rooted in trust.