Case Management & Care Coordination
Case Management & Care Coordination
One of the advantages of being an SCFHP Cal MediConnect member is having access to a Care Coordinator as a part of your care team. Your care team, including your Care Coordinator, works with you to develop 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.
You will have support from a Care Coordinator and a care team by phone, mail, online, or in person. Your Care Coordinator and care team helps you coordinate your care and services, including self-management support and health education. Your Care Coordinator works with you, any of your family members or friends which you may select, your PCP, and other providers to make sure you get the medical, behavioral health, and Long-Term Services and Supports that are best for you. Your Care Coordinator can help you:
- Coordinate your health care (doctor visits, home health, behavioral health, therapy, medical equipment)
- 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
- Assist 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
The SCFHP Care Coordinator is a licensed professional or other trained person who supports you to get the care you need, especially during care transitions and hospital discharges. When you enroll in SCFHP Cal MediConnect, your health needs will be assessed and a Care Coordinator will be assigned.
Do you need help getting or coordinating the care you need? Your care team can help you. Your care team may include your doctor, Care Coordinator, any family members or friends that you may select, or other providers that you choose. A Care Coordinator is a person who is trained to help you manage the care you need.
A Care Coordinator will be assigned to you when you enroll in SCFHP Cal MediConnect. This person will also refer you to community resources, if SCFHP does not provide the services that you need. To contact your Care Coordinator directly, call SCFHP Case Management 1-877-590-8999, Monday through Friday, 8:30 a.m. to 5:00 p.m. TTY/TDD users should call 1-800-735-2929 or 711.
A care plan is the outline of any health care and behavioral health services, and Long-Term Services and Supports you need and how you will get them. Your care team will work with you to come up with the care plan. Your care plan will be made just for you and will be updated as your needs and goals change.
Your care plan will include:
- Your short-term and long-term health care goals
- A timeline for when you should get the services you need.
Your care plan is shared with you, your providers, and other care team members to make sure that you get the care and support you need to meet your goals.
Long-Term Services and Supports (LTSS) are services that are provided over a long period of time. You may need LTSS if you need help with daily activities such as bathing, dressing, meal preparation or housekeeping.
Medi-Cal LTSS benefits include:
- Multipurpose Senior Services Program (MSSP)
- Care management with connection to home & community-based services that help seniors aged 65+ live independently
- Community Based Adult Services
- Health and social services provided at a licensed, community-based health center
- Long-Term Care in a nursing facility
When you join SCFHP Cal MediConnect, you will receive a Health Risk Assessment (HRA) questionnaire within the first 90 calendar days for low-risk members, or 45 calendar days for high-risk members.
We're required to have a completed HRA on file for you. The HRA must be completed soon after your enrollment date and updated each year. This HRA is the basis for developing your care plan. 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 by telephone and also by mail to help you complete the HRA. The HRA can be completed by phone, mail, or an in-person visit.
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 Care Coordinator will work with these organizations on your assessment and care planning.
Members, their physicians, family members, caregivers, hospital discharge planners, etc. may request care coordination. To request a Care Coordinator, call SCFHP Case Management 1-877-590-8999, Monday through Friday, 8:30 a.m. to 5:00 p.m. TTY/TDD users should call 1-800-735-2929 or 711.
To contact a Care Coordinator, call SCFHP Case Management 1-877-590-8999, Monday through Friday, 8:30 a.m. to 5:00 p.m. TTY/TDD users should call 1-800-735-2929 or 711. Once a Care Coordinator is assigned to you, you will get a number to contact him/her directly.
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, Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 1-800-735-2929 or 711. The call is free.
(8:00 a.m. - 8:00 p.m.
Monday - Friday)
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. For more information contact the plan or read the Member Handbook.
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 12/31/2018