Care Management

What is Care Management?

Care management is a set of activities to improve patient care, reduce unnecessary need for additional medical care, avoid duplication of care, and help patients and their caregivers more effectively manage their health conditions. "Case managers" are assigned to patients and are typically social workers or RNs.

Remember: the underlining goal of care management is to make patients as independent as possible to prevent excessive healthcare costs to the state. You will be interviewed and assessed for independence often.

Examples of care management activities:

Act as coordinators between primary care provider and specialists
Help patients register with Medicare/Medicaid and other social services
Locate and contact healthcare providers in your insurance network
Work with your insurance to facilitate procedures and appointments
Help provide transportation to and from appointments
Work to prevent in-patient hospital stays
Manage your transfer out of in-patient stays
Advocate for patients during appointments
Help locate affordable and accessible housing
Help patients find appropriate employment
Connect patients with other social programs

What to Know About Care Management?

Care management should always be free through insurance. Never pay out-of-pocket for care management.
Many care management agencies are covered by Medicaid in systems called Health Homes.
When possible, it is good to have a primary care provider or mental health provider help you fill out application or referral forms. This can help expedite the process.
In NYS, care management has the following eligibility criteria:
- - Two or more major chronic conditions*, OR
  - One serious mental illness, OR
  - HIV/AIDS diagnosis, OR
  - Sickle Cell Disease
*Not all of the chronic conditions on the comprehension list count as "major" chronic conditions.
What counts as a serious mental illness?
- - Common examples: General Anxiety Disorder, Panic Disorders, Major Depression, OCD, PTSD, Bi-Polar, Schizophrenia

Where to Find Care Management?

Below are a few NYS social services that provide care management.
Check with your insurance company to find other local agencies in your area.
Call 211 to find care management services and other programs in your area.
Ask your health care provider about local options.
If you live outside NYS, check with your state's Department of Health to find Medicaid-sponsored Health Homes.

Office for People with Developmental Disabilities

"The New York State Office for People With Developmental Disabilities (OPWDD) is responsible for coordinating services for New Yorkers with developmental disabilities, including intellectual disabilities, cerebral palsy, Down syndrome, autism spectrum disorders, Prader-Willi syndrome and other neurological impairments. It provides services directly and through a network of approximately 500 nonprofit service providing agencies, with about 80 percent of services provided by the private nonprofits and 20 percent provided by state-run services."

Developmental Disabilities is loosely defined as a disability that causes a child to develop more slowly, or to have physical difficulties and limitations, or have trouble learning and growing, and continues throughout the person’s life.
If the disability begins and causes impairment later in life (egs. bi-polar or schizophrenia), it is not a developmental disability and does not qualify. It must specifically impact childhood developmental stages. Physical disabilities, mental disabilities (depression and anxiety), sensory disabilities (deaf and blindness), and mild forms of cerebral palsy do not qualify alone.
- A list of example disabilities that qualify:
  - Intellectual Disability (ID)
  - Autism Spectrum Disorder
  - Cerebral Palsy
  - Epilepsy
  - Familial Dysautonomia
  - Prader-Willi Syndrome
  - Neurological Impairments (injury, malformation or disease involving the central nervous system)

New York State AccessVR (Vocational Rehabilitation)

List of State Vocational Rehabilitation Agencies (For All States)

"Adult Career and Continuing Education Services-Vocational Rehabilitation (ACCES-VR) starts with the presumption that all individuals with disabilities can benefit from vocational rehabilitation services and should have opportunities to work in jobs integrated within their communities. Vocational Rehabilitation Counselors guide individuals through service programs they need to reach their employment goal."

They help qualified (disabled) individuals pay for post-secondary education, including vocational programs, trade school, college, and university.
State funding is typically limited to SUNY or CUNY schools.
Fully recommend having a case manager or trusted medical professional help you through the process.

New York State Department of Health Medicaid Health Homes Program

"In New York State, many people get their health benefits through the Medicaid Program. Most people are generally healthy, however, others may have chronic health problems. Many are unable to find providers and services, which makes it hard for people to get well and stay healthy. New York State´s Health Home program was created with these people in mind. The goal of the Health Home program is to make sure its members get the care and services they need. This may mean fewer trips to the emergency room or less time spent in the hospitals, getting regular care and services from doctors and providers, finding a safe place to live, and finding a way to get to medical appointments."

List of Health Homes in NYS

Other Care Management Options

(You will have to double-check eligibility criteria and availability in your area.)