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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) 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.

SCFHP Cal MediConnect 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 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

What is a case manager?

When you enroll in SCFHP Cal MediConnect, a case manager will be offered to help you. A case manager is a clinician or other 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
  • 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.

What is a care team and a care plan?

Care team
A care team can help you reach your health goals. A care team may include your doctor, a case manager, family, friend, or other health professionals that you choose. A care team works together to create your care plan.

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 long-term services and supports (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 health care goals
  • A timeline for when you should get the services you need

After 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.

What are long-term services and supports (LTSS)?

Long-term services and supports (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
  • Multipurpose Senior Services Program (MSSP)
    • Care management with connection to home and community-based services that help seniors aged 65+ live independently
  • 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 SCFHP—Health Risk Assessment (HRA)

When you first join the plan, you will get a health risk assessment (HRA) within the first 90 calendar days for low-risk members or 45 calendar days for high-risk members.

We are required to complete an HRA for you. This HRA is the basis for developing your individual care plan (ICP). The HRA will include questions to identify your medical, long-term services and supports (LTSS), and behavioral health and functional needs.

We will reach out to you to complete the HRA. The HRA can be completed by an in-person visit, telephone call, or mail.

We will send you more information about this HRA.

If you are receiving In-Home Supportive Services (IHSS) or participating in the Multipurpose Senior Services Program (MSSP) or Community-Based Adult Services (CBAS), your case manager will work with these organizations to complete your HRA and care plan.

How do you request case management and care coordination?

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.

How do you contact your case manager?

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.

Accessibility

You can ask for published materials for free in other formats, such as large print, Braille, or audio. Call SCFHP Cal MediConnect Customer Service for help.

If you speak a language other than English, language assistance services, free of charge, are available to you. Call SCFHP Cal MediConnect Customer Service at 1-877-723-4795 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. The call is free.

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.

Enrollment in Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid Plan) (SCFHP Cal MediConnect) depends on contract renewal.

Last updated 12/30/2020

H7890_16035W Accepted