At the Alliance, we offer Case and Disease Management (CMDM) programs to our members at no cost. You may benefit from these programs if you have a health condition or concern, or need help with getting health care or community services. These programs are voluntary, and you may opt out at any time.

Care Coordination

The Alliance Care Coordination Program has health navigators, nurses, and social workers to provide short-term help for members.

Who is Eligible

All Alliance members who require support or help with:

  • Coordination with multiple health care providers.
  • Finding providers in the Alliance network.
  • Self-care to manage health conditions.
  • Finding community resources.

How to Enroll

  • You can work with your doctor to see if you qualify for this program. Your doctor can refer you.
  • The Alliance may contact you to find out if you would like to enroll.
  • You may also self-refer by calling:

Community Based Adult Services (CBAS)

Alliance members can receive Community Based Adult Services (CBAS). CBAS is a program that provides nursing care, social services, therapeutic activities, personal care, family and caregiver training and support, and meals and transportation.

Who is Eligible

  • Alliance members 18 years of age or older.
  • Alliance members who have problems with their memory or have complex health conditions and need help caring for themselves.

How to Enroll

  • Your doctor must refer you. Please work with your doctor to find out if you qualify for this program.
  • After we receive your doctor’s referral, an Alliance nurse will interview you to find out if you are eligible for CBAS.

Community Supports (CS) Services

Alliance members can receive Community Supports (CS) Services.  The Alliance currently offers the following Services:

  • Housing Transitions Navigation Services
    • Assists members with obtaining housing.
  • Housing Deposits
    • Assists members with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a member to establish a basic household (that do not constitute room and board).
  • Housing Tenancy and Sustaining Services
    • Assist members with providing tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured
  • Recuperative Care (Medical Respite)
    • Short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable environment.
  • Medically Tailored Meals/Medically-Supportive Food
    • Meals provided/delivered to the home that meet the unique dietary needs of those with chronic conditions, immediately following discharge from a hospital or nursing home.
  • Asthma Remediation
    • Physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable to individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization.
  • (Caregiver) Respite Services
    • Assist members (and their caregivers) by providing relief support to caregivers, while continuing to serve members who live in the community and are compromised in their activities of daily living (ADLs).
  • Personal Care & Homemaker Services
    • Assist individuals who are approved (or in process) for In-Home Supportive Services
  • Environmental Accessibility Adaptations (Home Modifications)
    • Assist members who require physical adaptations to a home that are necessary to ensure health, welfare and safety of the individual, without which the member would require institutionalization.

Starting January 1, 2024, the Alliance will go live for the following Community Supports Services:

  • Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Facilities for Elderly and Adult Residential Facilities
    • Assist individuals to live in the community and/or avoid institutionalization when possible.
  • Community Transition Services/Nursing Facility Transition to a Home
    • Helps individuals to live in the community and avoid further institutionalization.
  • Sobering Centers
    • Alternative destinations for members who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency room or jail.

For more information, to see if you are eligible, or would like to refer to any of the above programs please call:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251.9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Complex Case Management (CCM)

The Alliance Complex Case Management (CCM) Program can work with you and your doctor to improve your health. This program is designed for members who are dealing with complex health conditions and who often visit the emergency room or hospital.

If you qualify for this program, our team of nurses, social workers, and navigators can help you:

  • Schedule doctor appointments – for your physical and mental health
  • Understand your medications
  • Learn about community services and resources
  • Coordinate services and supplies you need at home
  • Provide tools to take better care of yourself
  • Help you reach health goals

Who is Eligible

Alliance members with many health concerns

How to Enroll

  • You can work with your doctor to find out if you qualify for this program. Your doctor can refer you.
  • The Alliance may contact you to find out if you would like to enroll.
  • You may also self-refer by calling:

Disease Management

The Alliance Disease Management Program offers support for our members who have asthma and diabetes. This program offers support for services and resources to help you carry out your doctor’s advice and treatment.

Who is Eligible

  • Children (5– 11 years of age) diagnosed with asthma
  • Adults (over 18 years of age) diagnosed with diabetes
  • Other members who need support with their asthma or diabetes

How to Enroll

  • You can work with your doctor to find out if you qualify for this program. Your doctor can refer you.
  • The Alliance may contact you to find out if you would like to enroll.
  • You may also self-refer by calling:

Enhanced Care Management (ECM)

The Alliance Enhanced Case Management (ECM) Program is a Medi-Cal benefit that provides extra care coordination to members with highly complex needs.

In ECM, you will have your own care team with a care coordinator. This person will talk to you, your doctors, and others involved in your health care to get you the care you need.

Your ECM care coordinator can help you:

  • Find doctors and get appointments for health care services you may need.
  • Better understand and keep track of your medications.
  • Set up a ride to get to your doctor visits.
  • Find and apply for community services based on your needs, like housing supports or healthy food.
  • Get follow-up care after you leave the hospital

Who is Eligible

ECM will be offered to members who meet at least one of the ECM Populations of Focus definitions described below. The Alliance may contact you about ECM if you qualify. You can also call the Alliance or your health care provider to find out whether and when you can receive ECM.

Populations of Focus:

  • Individuals Experiencing Homelessness:
    • Adults without depend children/youth living with them experiencing homelessness
    • Homeless families or unaccompanied children/youth experiencing homelessness
  • Individuals at risk for avoidable hospital or ED utilization (Formerly know as ‘High Utilizers’)
  • Individuals with serious mental health and/or SUD needs
  • Adults living in the community and at risk for long-term care institutionalization
  • Adult nursing facility residents transitioning to the community
  • Children and youth enrolled in California’s Children Services (CCS) or CCS Whole Child Model (WCM) with additional needs beyond the CCS condition
  • Children and youth involved in child welfare
  • Birth equity population of focus

How to Enroll

  • You can work with your doctor to find out if you qualify for this program. Your doctor can refer you.
  • The Alliance may contact you to find out if you would like to enroll.
  • You may also self-refer by calling:

Health Information Form/Member Evaluation Tool (HIF-MET)

The Health Information Form/Member Evaluation Tool (HIF-MET) is a survey that Alliance members fill out.

Why is it important?

This tool helps you share your health concerns with your doctor. It also helps us learn what other services you may need to stay healthy.

What should I do with it?

Please complete the form and return it to us in the pre-paid envelope. After we receive your form, we will mail you and your doctor a care plan with community and health resources. The Alliance Case Management Program may also contact you to find out if you need more support.

Health Risk Assessment (HRA)

The Health Risk Assessment (HRA) is a survey that seniors or persons with disabilities (SPDs) fill out each year.

Why is it important?

This tool helps our members share their health concerns with their doctor. It also helps us learn what other services they may need to stay healthy.

What should I do with it?

Please complete the form and return it to us in the pre-paid envelope. After we receive your form, we will mail you and your doctor a care plan with community and health resources. The Alliance Case Management Program may also contact you to find out if you need more support.

Transitional Care Services (TCS)

The Alliance provides Transitional Care Services (TCS) to members who are transferring from one setting or level of care to another. A single point of contact will help members during their transition.

Who is Eligible

Transitional Care Services will be offered to members who meet criteria.  The Alliance may contact you about TCS if you qualify. You can also call the Alliance or your health care provider to find out when you can receive TCS.

How to Enroll

  • The Alliance may contact you to find out if you would like to enroll. You may also self-refer by calling:

Alliance Case and Disease Management Department
Monday – Friday, 8 am – 5 pm
Phone Number: 1.510.747.4512
Toll-Free: 1.877.251-9612
People with hearing and speaking impairments (CRS/TTY): 711/1.800.735.2929

Your satisfaction is important to us! If you have a problem with the Alliance, or the CMDM program or staff, you have the right to make a complaint. To learn more, please view our Grievances & Appeals process.