Care Coordination Services

Guiding Clients Through Complex Systems, One Step
at a Time

Care coordination connects the essential systems of life, including housing, healthcare, recovery, and legal support. We provide hands-on guidance that makes sustainable progress possible, especially when life feels overwhelming.

As part of our life development community in Northern CA, care coordination ensures individuals are not left navigating fragmented services alone.

Care coordination brings clarity, stability, and compassionate guidance to individuals whose lives involve multiple systems that often do not communicate with one another.

Our team helps make sense of what’s required, what’s next, and how to keep moving forward when the process feels unmanageable.

The Connection
That Holds Everything
Together

Care coordination is not a standalone service. It is the connective process that helps individuals stay on track with plans, appointments, and progress.

Think of it as a personalized, hands-on guide for navigating complex systems and following through when life becomes overwhelming. Whether someone is moving between jail and a hospital, recovering from addiction, applying for housing, or managing benefits paperwork, our coordinators help make it all work together in real time.

Care Coordination vs. ECM

While care coordination and Enhanced Care Management (ECM) share similarities, they differ. ECM is a structured, state-funded Medi-Cal benefit. Meanwhile, care coordination is more flexible and deeply embedded in the whole-life development services we offer in Northern CA.

Care Coordination

  • Directly offered to eligible clients
  • Provides broader support and coordination needs beyond medical
  • May be provided informally alongside housing or other services
  • Driven by real-time client needs

ECM

  • State-funded Medi-Cal program
  • Focuses on clients with high medical complexity
  • Requires formal enrollment and documentation
  • Managed by a care plan

In short, ECM is a formal benefit. Care coordination is the everyday, hands-on work that ties programs together and keeps people moving forward.

Support for Complex
and Overlapping
Needs

  • Clients enrolled in NLDP housing or recovery programs
  • Individuals recently discharged from jail, rehab, or hospitals
  • People managing multiple service requirements
  • Families supporting loved ones in crisis
  • Agencies seeking a consistent point of contact

You don’t need to know which services you need. We’ll figure it out together.

Our Role

Hands-On,
Persistent Support

  • Scheduling and attending appointments
  • Gathering documents for Medi-Cal, SSI, or housing
  • Completing complex forms and applications
  • Explaining next steps clearly
  • Coordinating communication across agencies
  • Problem-solving when issues arise
  • Showing up in person when it matters most

We walk through systems side-by-side with our clients, not just behind a desk.

“Without my coordinator, I would have given up after the third office visit. She made the impossible feel manageable.”
— Care Coordination Client, New Life Discovery

Why Care Coodination Matters

Most individuals we serve are not failing. They are overwhelmed.

When systems don’t connect and communication breaks down, even the most motivated person can hit a wall. Care coordination provides a central point of contact, a clearer path forward, and the emotional capacity to focus on healing, recovery, or stability.

Agencies refer to us not just because we provide services, but because we ensure next steps actually happen.

How to Access Care Coordination

Care coordination may be available to individuals who are:

  • Participating in NLDP housing or recovery programs
  • Receiving ECM through New Life Discovery
  • Referred by hospitals, jails, or agency partners

If care coordination is the right fit, we’ll assign a coordinator right away.

FAQ

Is this the same as ECM?

No. ECM is a formal Medi-Cal program focused on highly complex medical issues. Care coordination, on the other hand, is broader and more flexible. We offer it as part of our life development services in Northern CA.

What kind of support do care coordinators provide?

We assist with scheduling, transportation, communication across agencies, benefit paperwork, and day-to-day problem-solving. We’re the hands-on help that connects fragmented services.

Do I need to be in housing to receive care coordination?

Not necessarily. While we often pair care coordination with our housing or ECM programs, we may be able to support you independently. Please call us so we can assess your needs.