A dedicated care team that coordinates across doctors, therapists, and community resources
Help addressing the root causes of instability—housing, food, and transportation
Consistent follow-up so patients don’t feel lost or forgotten
Experiencing homelessness or at risk of losing housing
Living with serious mental illness (SMI) or a serious emotional disturbance (SED)
Living with substance use disorder (SUD) and needing recovery support
Managing multiple chronic conditions, such as diabetes, heart disease, or COPD
A child or youth with complex medical needs, requiring care from multiple specialists
A high-risk pregnant or postpartum individual, needing extra support for maternal and infant health
Recently released from jail, prison, or institutional care, and working to reintegrate into the community
The support you receive depends on your situation, but ECM can provide or connect you with services such as:
Finding stable housing and navigating applications
Assistance with housing deposits and moving costs
Coaching and support to prevent eviction and build stability
Coordinated care across multiple providers
Nursing facility transitions into a home or assisted living setting
Ongoing support for chronic conditions and recovery needs
Accessibility improvements like ramps, widened doorways, and roll-in showers
Environmental health changes such as air purifiers, pest control, and mold removal
Emergency alert systems for safety and independence
Medically tailored meals designed by dietitians for chronic conditions
Help with cooking, cleaning, grocery shopping, or attending medical appointments
Respite services for caregivers who need temporary relief
Proactively engage patients who might not seek help on their own
Address root causes of instability — like housing, food, and transportation
Leverage data-driven insights to improve participation and outcomes
Extend impact beyond therapy to help patients thrive long-term
If you think you or a loved one might qualify for ECM, the first step is simple: connect with our Outreach Engagement Team.
Step 1
This first step is about connection. If you don't have all the answers, that's what our Outreach Engagement Team is here for. What we'll do:
Listen to your story and understand your unique needs
Explain what ECM could look like for you or your family
Answer your questions about how the process works
Step 2
While we cannot promise specific funding until this step is complete, we can promise we’ll go through it with you, side by side. If it sounds like ECM might be a fit, we’ll guide you through the eligibility process. This includes:
Walking you through what qualifies someone for ECM
Helping you with forms or questions that come up
Making sure you feel supported, not lost in paperwork
Step 3
Once you’re enrolled, you’ll be matched with a Lead Care Manager (LCM). This will be your personal guide through the health system. From here, they’ll:
Coordinate your care across doctors, therapists, and community services
Check in with you regularly
Help you tackle challenges like housing, transportation, or other social needs
Stay with you long-term, so you’re never left to figure it out alone
