Cal MediConnect is Making a Difference
Cal MediConnect is Making a Difference
Sometimes staying healthy takes more than just a visit to the doctor’s office. The Santa Clara Family Health Plan (SCFHP) Cal MediConnect Plan (Medicare-Medicaid Plan) helps you manage all the services and supports you need to be well. Our team works with you and your providers, caregivers, and family to help you get the right care, in the right place, and at the right time. Read below how this coordinated approach is making a difference in the lives of our members*.
Help Getting Back Home
A 95-year old member spent nearly a year unhappily living in a nursing facility. It made her feel sad and depressed. With the help of an SCFHP case manager, the member was able to move to a senior independent living apartment and hire her daughter as her In-Home Supportive Services (IHSS) provider. The member wanted to change her primary care provider, and the case manager helped her find a new one. The member is also thankful that the case manager helped her find new specialists for her care. The member’s daughter is delighted that her mother is her old self again and not feeling sad or depressed.
Knowing the Options
A 77-year old member with mild dementia and arthritis was being cared for at home by her son and neighbors. After months of caregiving, her caregivers needed help. Then the member had a stroke, and she ended up in the hospital. The SCFHP case manager got to know the member and her son, and taught them about the care options they could use as the member’s health changes. They all agreed that moving the member to a skilled nursing facility would be the best option for her care. The member, son and neighbors are grateful for the case manager’s support in making this a smooth transition.
Understanding What Matters Most
A 53-year old member was an active, independent man who used a power wheelchair to ride the bus, get groceries, and go to the doctor. But the wheelchair no longer fit him and was causing problems with his feet. When the back of the chair broke, a friend attached a block of wood to prop it up. The member’s wheelchair was not safe. Although he had approval for the wheelchair repairs, the member did not know how and where to get the repairs completed. To make matters worse, the member became very sick and needed care in a nursing facility. This meant he lost his independent housing. Then an SCFHP case manager joined his team. The case manager arranged for the member’s wheelchair fitting to be completed in the privacy of his room, preserving his dignity and saving him the trip to the DME provider. Within a couple weeks, a new wheelchair was delivered. His case manager also referred him to organizations that can help him find housing that restores his independence.
Getting Case Management and Care Coordination
As a Cal MediConnect member, you have access to a case manager to help with transitions in care, coordinating your health services, community resources and other support, and making the most of your health plan benefits. You can contact your case manager directly when you need help. To request a case manager, call Santa Clara Family Health Plan at 1-877-723-4795, 8 a.m. – 8 p.m. TTY users should call 1-800-735-2929 or 711.
Is SCFHP Cal MediConnect right for you?
If you have Medicare and Medi-Cal and could benefit from this kind of care, SCFHP Cal MediConnect may be the right plan for you. One plan, one member ID card, one phone number to call for help.
For more information or to enroll, please call us at 1-888-202-3353, 8 a.m. to 8 p.m., 7 days a week. TTY: 1-800-735-2929 or 711. You may also call Health Care Options (HCO) at 1-844-580-7272 Monday through Friday from 8 a.m. to 5 p.m. TTY/TDD: 1-800-735-2922.
*Identifying information has been changed for privacy.
Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees.
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. Limitations, copays, and restrictions may apply. For more information, call SCFHP Customer Service or read the SCFHP Cal MediConnect Member Handbook. Benefits and/or copays may change on January 1 of each year. The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) depends on contract renewal. CMS (the Centers for Medicare & Medicaid Services) must approve SCFHP Cal MediConnect each year. You can continue to get health coverage as a member of our plan only as long as we continue to offer the SCFHP Cal MediConnect Plan for the year in question and CMS renews its approval of the plan. Even if SCFHP leaves the program, you will not lose health coverage. If SCFHP decides not to continue for the next calendar year, we must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.
Last updated 12/30/2016