Case management & care coordination
One of the advantages of being a Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect Plan) member is having a case manager lead your care team. Your care team works with you to create and coordinate an individual care plan designed to meet your needs. Case management services are available to all SCFHP Cal MediConnect Plan members.
SCFHP Cal MediConnect Plan offers different types of case management programs. These programs can help you understand your covered medical, pharmacy, dental, and vision benefits, access health education classes, and connect you to community resources. We work with you to determine which program is best for you. You will be assigned to a case manager to help you work with your doctors to meet your personalized health goals.
SCFHP Cal MediConnect Plan members are eligible for these no-cost services upon enrollment. You can opt-out of these services at any time—just tell your case manager. Opting out does not affect your coverage or benefits. You can change your mind at any time.
Connect to a case manager by calling SCFHP Case Management toll free at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.
Frequently asked questions
When you enroll in SCFHP Cal MediConnect Plan, a case manager will be offered to help you. A case manager is a clinician or other highly trained person who provides care coordination services for you, especially during care transitions and hospital discharges. This is a person who will work with you and with your care team to create an individual care plan. For example, your case manager can help you:
- Coordinate your health care (doctor visits, home health, behavioral health, therapy)
- Get medical equipment and/or supplies
- Coordinate your long-term services and supports (LTSS)
- Schedule interpreters
- Identify doctors and specialists within your network
- Choose or change a doctor
- Arrange transportation to and from medical appointments
- Understand your health plan benefits
- Get health care services that are covered by SCFHP
- Find community resources and educational programs
- Help with care transitions
- Get any required prior authorization requests for care, equipment, or supplies
- Understand the difference between “emergency” and “urgent care”
- Schedule health screenings
To contact your case manager, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.
A care team consists of you, your primary care doctor, your care coordinator, and any other individual that supports your health; this may include family, friends, or other health professionals that you choose. A care team works together to create your care plan.
A care plan tells you and your doctors what services you need and how you will get them. It includes your medical, behavioral health, and LTSS needs. Your care team will work with you to come up with a care plan. Your care plan will be made just for you and your needs.
Your care plan will include:
- Your personalized health care goals
- A timeline for when you should get the services you need
- A self-management plan
- Any actions you will need assistance with
After you complete your health risk assessment, your care team will meet with you. They will talk to you about the services you need. They will also tell you about services you may want to think about getting. Your care plan will be based on your needs. Your care team will work with you to update your care plan at least every year.
LTSS are services that help improve a long-term medical condition. Most of these services help you stay in your home so you don’t have to go to a nursing home or hospital. LTSS includes the following:
- Community-Based Adult Services (CBAS)
- Health and social services provided at a licensed, community-based health center
- Nursing Facility (NF)
- A facility that provides care for people who cannot safely live at home but who do not need to be in the hospital
Your case manager will help you understand each program. To find out more about any of these programs, contact SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.
When you first join the plan, you will get an HRA in your new member packet. It will come with a postage paid envelope so you can return it to SCFHP at no cost to you.
This HRA is a questionnaire you fill out according to your understanding of your health. It is the basis for developing your individual care plan (ICP). The HRA will include questions to identify benefits or services that you may need such as LTSS, and behavioral health and functional needs.
A care coordinator will reach out to you to complete the HRA. The HRA can be completed by an in-person visit, telephone call, or mail.
Members, their doctors, family members, caregivers, hospital discharge planners, etc. may request case management and care coordination. To make a request, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.
To contact your case manager, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m. When a case manager is assigned to you, you will get a phone number to call him or her directly.
You can ask for published materials for free in other formats, such as large print, Braille, or audio. Call SCFHP Cal MediConnect Plan Customer Service for help.
If you are more comfortable speaking a language other than English, Santa Clara Family Health Plan can help you. Whether you are contacting SCFHP or visiting a doctor, we have interpreters available. Tell your doctor you would like an interpreter for your visit.
Know your rights
- You can get an in-person or telephone interpreter at no cost to you. This includes American Sign Language.
- When you go to the doctor, interpreters are available 24-hours a day.
- You can ask for SCFHP Cal MediConnect Plan materials in English, Spanish, Simplified Chinese, Tagalog, and Vietnamese.
How can you get an interpreter?
Tell your doctor’s office you would like one. You can do this when you call to set up your next visit. You can also ask us for an interpreter or for translated materials.