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ECK, short for Enhanced Care Coordination, is a Medicaid waiver program in New York State designed to provide complete, integrated healthcare services to individuals with complex medical and behavioral health needs.The program aims to reduce avoidable hospitalizations and improve health outcomes by offering coordinated care through designated Lead Health Plans (lhps).
What is the Enhanced Care Coordination (ECK) Program?
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the Enhanced Care Coordination (ECK) program is a managed care initiative within New York State’s Medicaid program, specifically targeting individuals enrolled in Medicaid who have chronic conditions and require significant healthcare services. It’s a key component of New York’s Delivery System Reform incentive Program (DSRIP) and Value-Based Payment (VBP) reforms.
Detail: ECK focuses on providing care coordination services to Medicaid beneficiaries with complex health needs, including those with chronic illnesses, mental health conditions, and substance use disorders. The program emphasizes a person-centered approach, tailoring care plans to meet individual needs and preferences. Care coordination services include health risk assessments, care planning, care management, and linkages to community-based services.
Example or Evidence: As of January 2024, approximately 250,000 New Yorkers were enrolled in ECK programs, demonstrating the program’s reach and impact. New York State Department of Health DSRIP Reports detail enrollment and performance metrics.
who is Eligible for ECK?
Individuals must be enrolled in Medicaid and meet specific criteria related to their health conditions and care needs to be eligible for the ECK program.
Detail: Eligibility generally includes individuals with at least two chronic conditions,a history of frequent hospitalizations or emergency department visits,or a significant behavioral health need. The New York State Department of Health (NYSDOH) establishes the specific eligibility criteria,which may be updated periodically. Individuals are typically identified as potentially eligible through data analytics and outreach efforts by managed care organizations.
Example or Evidence: According to NYSDOH ECK Program Guidance (January 2023), eligible individuals must have at least one of the following: (1) two or more chronic conditions; (2) a history of three or more emergency department visits or hospitalizations in a 12-month period; or (3) a diagnosed behavioral health condition requiring intensive services.
What services Does ECK Provide?
ECK provides a range of coordinated care services designed to address the holistic needs of enrollees, going beyond traditional medical care.
Detail: Core services include comprehensive health risk assessments, individualized care planning, care management, and coordination of medical, behavioral health, and social services. Care managers work with enrollees to develop and implement care plans,connect them with appropriate resources,and monitor their progress. Services are delivered through a network of providers, including hospitals, physicians, behavioral health providers, and community-based organizations.
example or Evidence: The NYSDOH ECK Service Definitions (February 2023) outlines specific service components, including care management, health promotion, and transitional care services. For example, transitional care services help individuals transition smoothly from hospital to home, reducing the risk of readmission.
Lead Health Plans (LHPs) and ECK
Lead Health Plans (LHPs) play a central role in the ECK program, responsible for coordinating care and managing the program’s implementation.
Detail: LHPs are selected through a competitive procurement process by the NYSDOH. They are responsible for enrolling eligible individuals,providing care coordination services,and managing the network of providers. LHPs are held accountable for achieving specific performance targets related to health outcomes, cost savings, and member satisfaction. Currently, several LHPs operate ECK programs across New York State.
Example or Evidence: As of December 2023, the designated LHPs include UnitedHealthcare Community Plan, EmblemHealth, and Fidelis Care, among others. The NYSDOH website lists all participating lhps and their service areas.
Recent Updates and Breaking News (as of 2026/01/21 20:18:51)
As of January 21, 2026, there have been no major breaking news developments regarding the core structure of the ECK program. Though, ongoing monitoring of the program’s performance and adjustments to payment models continue.
