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Case management & care coordination

One of the advantages of being an Santa Clara Family Health Plan Cal MediConnect Plan (Medicare-Medicaid 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. You can decide not to participate in case management and care coordination, if you wish.

Frequently asked questions

What is a case manager?

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 works with you, with SCFHP Cal MediConnect, and with your care team to help make a care plan and coordinate the services you need. 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
  • 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 Care Plan?

Care Team
Do you need help getting the care you need? A care team can help you. A care team may include your doctor, a case manager, or other health person that you choose.

A case manager is a person who is trained to help you manage the care you need. You will get a case manager when you enroll in SCFHP Cal MediConnect. This person will also refer you to community resources, if SCFHP Cal MediConnect does not provide the services that you need.

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.

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 needs. 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 Facilities (NF)
    • Facilities that provide 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 Cal MediConnect 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 CBAS (Community-Based Adult Services), 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 a case manager?

To contact a 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 Customer Service for help.

If you speak a language other than English, language assistance services, free of charge, are available to you. Call 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 01/08/2020

H7890_15083W Accepted