Health and wellness programs

The Healthy Adults program promotes health screenings and wellness programs to improve your health.

Our goal is to increase the number of adult annual wellness visits and recommended preventive health and wellness screenings, like:
 

• Breast cancer
• Cervical cancer
• Chlamydia
• Colorectal cancer
• High blood pressure 

We’ll send you health info and reminders in the mail. You may be able to earn rewards for doing certain healthy activities, like health screenings.

Here are some other ways we promote wellness:
 

• Health courses
• Community health fairs
• Community physical and mental health centers
• Education conferences
• Faith-based events
• Other opportunities in collaboration with community agencies 

Learn about rewards

We offer rewards for healthy adults. Learn how you can start earning rewards today. You can:

• Visit Aetna Better Care Rewards Program
• Call us at 1-855-772-9076 (TTY: 711)

Keep your child well. You can do so with Early and Periodic Screening, Diagnostic and Treatment (EPSDT). This is a federal benefit for children eligible for Medi-Cal from birth up to age 21.

Children get checkups for health issues early and regularly. Your child can get regular screenings based on their health needs. And you can earn rewards for completing screenings and well-child visits.
 

Your provider can give these well-child visits. Or check with your state health department.

Here are the benefits of EPSDT:
 

• Early: Assessing and finding problems early
• Periodic: Checking children’s health at periodic, age-appropriate intervals (physical exams)
• Screening: Providing physical, dental, vision, hearing, mental health, developmental and other comprehensive screening exams and tests to find problems
• Diagnostic: Performing diagnostic tests to follow up when a risk is found (lab tests, X-rays)
• Treatment: Controlling, correcting or reducing health problems found (referral for health education, referral to specialist, medication)

Schedule well-child visits regularly
 

Schedule well-child visits to help protect your child’s health and future. These are regular checkups. How often? That usually depends on your child’s age. Your doctor will want to see your baby every month or so for a while. For an older child, yearly checkups may be enough.

Why keep up with well-child visits?

 

• They let your doctor see how well your child is growing.
• They give you a chance to talk with your doctor about anything that’s on your mind. That’s hard to do if you wait until your child is sick.
• They ensure that your child is up to date with immunizations (shots).

Here are immunization schedules from the Centers for Disease Control and Prevention (CDC):
 

• For children from birth to age 6: English (PDF) | Spanish (PDF)
• For children ages 7 to 18: English (PDF) | Spanish (PDF)

Learn about rewards

We offer rewards for healthy kids. Learn how you can start earning rewards today. You can:
 

• Visit Aetna Better Care Rewards Program
• Call us at 1-855-772-9076 (TTY: 711)
   

We can also help you find a provider or schedule your child’s next checkup.

No-cost services for children's health
 

Medi-Cal for Kids & Teens outlines no-cost services for your child to stay healthy. Some health services for kids and teens from birth to age 21 include but aren't limited to:
 

• Yearly check-ups
• Health screenings
• Recommended/scheduled immunizations
• Treatments for mental and physical health

The Department of Health Care Services (DHCS) has created materials about these services in multiple languages. Visit DHCS Medi-Cal for Kids and Teens Resources Materials to look at the resources provided. 

We want to improve your health during pregnancy. So we’ve created a program to manage key health topics for moms, including high-risk pregnancy and possible problems linked with low birth weight. Our Care Management maternal health team includes nurses and coordinators to support you during and after pregnancy. They can help with:
 

• Calling you to answer questions and offer support
• Scheduling appointments
• Providing resources
   

We work with these community groups to improve your health:
 

• WIC
• SNAP
• Homeless shelters
• Community centers
• School systems
• Other agencies, including domestic violence centers
   

You get support before and after the birth of your child. You can also choose to opt out (decide not to take part) at any time.  Learn more about maternal health.

Maternal health booklets - English (PDF) | Spanish (PDF)
 

Learn about rewards

We offer rewards as part of Maternity Matters for new parents. Use your rewards to buy baby supplies such as diapers, baby food and more. Call us to learn more at 1-855-772-9076 (TTY: 711).

Our NAS program offers care for moms and infants who need it. NAS is a form of drug withdrawal in newborn babies. It can happen when a mom uses certain medicines or drugs during pregnancy. 

We connect moms at risk with a case manager, who’ll help them get special care during pregnancy. And special care for the baby after birth. Need to learn more? Just call us at 1-855-772-9076 (TTY: 711). 

What is ECM & Who is Eligible?

The Aetna Better Health of California (ABHCA) Enhanced Care Management (ECM) program is for Members who are experiencing:

• Homelessness with complex health and/or behavioral health needs
• Frequent hospital visits
• Short-term assisted living
• Emergency room visits

Extra Help

We know that some health conditions like diabetes, hypertension, or substance use can be hard to manage in your life.

Aetna Better Health of California (ABHCA) can offer help through ECM services.

How can Aetna Better Health of California (ABHCA) help?

If you qualify for ECM, you will get a care team at no cost to you which will include a lead care manager that organizes all your care needs. 

Care will include:

• Primary Care
• Behavioral Health
• Community-based long-term services and supports (LTSS)
• Developmental Health
• Oral Health
• Social Services

Who’s on YOUR Team? You will have access to:

• Nurse Care Managers
• Behavioral Health Care Managers
• Care Coordinators
• Community Health Workers

Your TEAM will be right by your side and help you throughout the program.  You can receive support by phone or in-person.

What ABHCA ECM plan has included for you is:

ABHCA ECM program won’t change any benefits you have now.

You can get help to find doctors and get an appointment for: 
 

• Physical
• Mental
• Substance use health needs
   

Keep all your Providers fully updated

• Set up transportation to your doctor visits
• Get follow-up services after you leave the hospital
• Manage all your medicines
• Get help with local resources such as food or other social services

If you qualify, ABHCA may call you.

Asthma Remediation Services, also known as Asthma Trigger Remediations

Physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the member or enable the member to function in the home while reducing acute asthma episodes that could result in the need for emergency services and hospitalization. Lifetime cap is $7500.

Community Transition Services/Nursing Facility Transition to a Home or Assisted Living Facility

Non-recurring set up expenses for members who are transitioning from a licensed facility to a living arrangement in a private residence or assisted living facility where the member is directly responsible for his or her own living expenses. Allowable expenses are those necessary to enable the member to establish a basic household that does not include room and board.

Day Habilitation

Provided in home or out-of-home, non-facility setting. Programs designed to assist the member in acquiring, retaining, and improving self-help, socialization, and adaptive skills to remain in their natural environment.

Environmental Accessibility Adaptations (EAA), also known as Home Modifications

Physical adaptations to a home that are necessary to ensure the health, welfare, and safety of a member, or enable the member to function with greater independence in the home, without which the member would require institutionalization. Lifetime cap is $7500.

Housing Deposit Services

Identification, coordinating, securing, or funding one-time services and modifications necessary to enable the member to establish a basic household. Funding to support security deposits, set-up fees/ deposits for utilities, first months and deposit, services necessary for member’s health and safety, and goods/medically necessary adaptive aides to preserve the member’s health and safety in the home. Does not include provisions beyond first and last month’s rent. Lifetime maximum of $5000.

Housing Tenancy and Sustaining Services

Services to maintain a safe and stable tenancy once housing secured. Services can include the identification and intervention of behaviors that jeopardize housing, education on role/rights/ responsibilities of tenant and landlord, coaching on maintaining and developing landlord/property managers, assistance with landlord/neighbor disputes, advocacy/linkage to community resources, benefits advocacy, assistance with annual housing recertification

Housing Transition Navigation Services

Does not include room and board. Includes tenant screening and housing assessment, housing support plan, searching for housing, assistance with securing housing (applications/documentation), benefit advocacy, identifying/securing resources for rent subsidy and expenses, assisting with reasonable accommodations, landlord education/engagement, ensuring living environment safety/ move-in readiness, advocacy with landlords, move-in support, housing support crisis plan, transportation resources, and environmental modifications as necessary.

Medically Supportive Food/Meal/Medically Tailored Meals

This service provides up to three meals per day and/or medically supportive food (for example, a voucher) and nutrition services for up to 12 weeks or longer if medically necessary.

Nursing Facility Diversion Services to an Assisted Living Facility

This service is for members residing in the community, who are at risk of imminent need for nursing facility level of care and are willing to reside in an assisted living facility as an alternative to long term placement in a nursing facility. Allowable expenses are those necessary to enable a person to establish a community facility residence that does not include room and board.

Personal Care and Homemaker Services

Assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, ambulation, or feeding. Can include assistance with Instrumental Activities of Daily Living (IADLs) such as meal preparation, grocery shopping, and money management. Homemaker or chore services include help with tasks such as cleaning, shopping, and laundry. Services aid members who could not remain in their homes. May request urgent/expedited review

Recuperative care or medical respite care

Short-term residential care for members who no longer require hospitalization, but still need to heal from an injury or illness and whose condition would be exacerbated by an unstable living environment. At a minimum, includes interim housing with bed and meals and ongoing monitoring of the members medical or behavioral health condition. Limited to continuous 90 day stay.

Respite Services

Respite services for non-paid caregivers of members only. Provided on a short-term basis due to the absence or need for relief of those persons who normally care for and/or supervise them and are non-medical in nature. Services can be provided in the home or a facility. May request urgent/expedited review

Short-term Post Hospitalization Housing

This service provides housing for members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical, psychiatric, or substance use disorder recovery immediately after exiting one of the following:

• Inpatient hospital
• Residential alcohol or drug abuse recovery or treatment facility
• Residential mental health treatment facility
• Correctional facility
• Nursing facility
• Recuperative care

Sobering Centers
 

Sobering Centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering Centers provide these individuals, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment in which to become sober.

The member must also be receiving housing navigation services. May request urgent/expedited review. Lifetime benefit one-time and not to exceed duration of six months.

Please note that Members do not need to be eligible for ECM in order to be eligible to receive Community Supports.

You can also call us at 1-855-772-9076 (TTY: 711). Or, talk with your doctor to find out if you can receive ECM services.

Diabetes prevention is a program that may help you adopt healthy habits, lose weight and reduce your risk of type 2 diabetes. You can take part at no cost to you.

The program focuses on eating healthier, increasing your physical activity and managing the challenges of lifestyle changes.

Members work with a personal coach and small group support to focus on healthy food choices and more activity. You may also qualify for tools such as wireless scales or activity trackers.

To learn more, just visit the Solera website. Or call 1-888-913-4508 (TTY: 711). You can speak with someone at Solera Monday through Friday, 9 AM to 9 PM ET.

Did you know? People with diabetes have a higher risk of eye problems. The earlier we find problems, the easier they are to treat. So we’ve partnered with HealPros to provide in-home services for members with diabetes. Simple screenings can help us find eye problems earlier. It’s easy and part of your benefits. So there’s no extra cost.

HealPros provides a retinal eye exam to eligible members. You can also get a Hemoglobin A1C test if you’re due for a blood sugar screening. The best part? You can do it all in the privacy and comfort of home.

You and your primary care provider get the results. Want to learn more? Just call us at 1-855-772-9076 (TTY: 711).

Opioids are a type of medicine for short-term relief from severe pain, usually after:

• Surgery
• A major injury
• An illness that may cause pain, like cancer

Even if you have a prescription, opioids can cause serious problems, like:

• Overdose: taking too much medicine
• Dependence: feeling withdrawal symptoms when not taking the medicine
• Addiction: a brain disease that causes drug-seeking action, even though it’s harmful
• Misuse: taking medicine the wrong way, which can lead to dependence or addiction

To keep yourself and your family safe: 

• Use opioid medicines just as your doctor prescribes them 
• Store your medicine where others won’t find it 
• Talk with your doctor about other medicines you can use for pain, as well as other ways to manage pain besides medicine

This program can help you better manage opioids or stop using them. We can also help you:

• Find a doctor
• Understand the cause of your pain
• Provide other medicine options

You can start or stop the program any time. Want to learn more? Just call 1-855-772-9076 (TTY: 711). Then, ask to talk with a care manager.  

What is palliative care?

Palliative care is a way to improve quality of life for someone with a serious illness. To “palliate” means to ease symptoms like:

• Pain
• Nausea
• Vomiting
• Anxiety
• Constipation
• Sleeping problems
• Breathing problems

Emotional and spiritual support for patients and their loved ones is part of palliative care. It happens at the same time as standard medical care. Active treatment for the illness doesn’t stop. Patients and their families help lead the plan of care with the provider team.

Goals of palliative care

Ease symptoms that cause distress

Easing symptoms is the main goal. Symptoms can affect a person’s ability to eat, be active or spend time with others. Providers use medicines, as well as other ways to ease these symptoms. This gives people a better quality of life during treatment for an illness.

Coordinate care

This means that all the providers know the goals of care. The care team communicates regularly to ensure they can meet these goals.

Meet emotional and spiritual needs

The care team helps both patients and families cope with emotions. Illness can lead to stress, depression, anxiety and other issues. If desired, patients and families can set up meetings with a counselor or spiritual advisor.

Give info and help with decisions

Care providers can help people and their families get the info they need. They can also help with making care decisions.

Create an advance care plan

This plan includes legal documents with a person’s wishes for their future. When people can’t speak for themselves, providers and families can still carry out their wishes. 

Working with your palliative care team

A team of people give palliative care. They focus on the physical, emotional, and mental and social parts of a serious illness. The team may include:

• Palliative care providers or nurses
• Social workers
• Pharmacists
• Dietitians
• Counselors
• Spiritual advisors
• Others

To get the most of palliative care, both patients and their loved ones have a role.

What patients can do

Tell your health care provider that you’re thinking about palliative care. Ask what services you can get in your area.

To ensure the best care, learn what you can about your illness and the goals of your care. Are you having pain and other symptoms? Just ask your health care provider for a palliative care referral.

Treating these symptoms is best for your health and quality of life. If you need support in other ways, speak up. Your care team is here to help you get what you need.

What families can do

Talk with the palliative care team often. Do your best to understand your loved one’s illness and goals of care. When you need to act, do so based on your loved one’s wishes. And if you have a concern or question, speak up.

You can help ensure that your loved one has the best quality of life possible. Need to learn more? Just call us at 1-855-772-9076 (TTY: 711).

Our Care Management team can make a personalized care plan just for you. They’ll help you learn more about your condition. And coordinate with other agencies to make sure that you get the services and care you need. They can help if you have a chronic condition like:
 

• Asthma

• Congestive heart failure (CHF)

• Coronary artery disease (CAD)

• Chronic obstruction pulmonary disease (COPD)

• Depression

• Diabetes 

• High blood pressure

   

Learn about Care Management

Learn how Care Management can help you manage chronic conditions. Just call 1-855-772-9076 (TTY: 711).