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What is a care manager?

A Care Manager works to coordinate all of the physical and behavioral healthcare needs of a child and their family. They do this by connecting the child/family to healthcare providers such as doctors, counselors (mental health and substance abuse), pharmacists, physical therapists, specialty care practitioners, among others. While care managers are not responsible for transporting children/family members to the appointments they will assist in ensuring that transportation is set up for appointments via Medicaid taxis and public transportation.

The Care Manager is responsible for the following:

  1. Comprehensive care management: Using a comprehensive health risk assessment, a comprehensive and individualized plan of care is created to meet to meet physical, mental health, chemical dependency, and social service needs.
  2. Care coordination and health promotion: The care manager will ensure that the care plan is followed by coordinating, monitoring, and re-evaluating the child/family and their care.
  3. Comprehensive transitional care: Prevention of avoidable readmissions to inpatient facilities and oversight of proper and timely follow-up care.
  4. Patient and Family Support: Individualized care plan must be shared with child and family members or other caregivers. Patient and family preferences and cultures are always considered.
  5. Referral to Community and Social Supports: Referrals that align with an individual’s plans and needs.
  6. Use of Health Information Technology (HIT) to Link Services: All of the child’s providers are able to communicate with one another electronically to ensure the provision of services.

What are the goals?

  1. Improve care and health outcomes
  2. Reduce preventable emergency room visits and hospitalizations
  3. Lower Medicaid costs

Eligibility:

The child or adolescent must be enrolled in Medicaid and have:
One single qualifying condition of:

  • Serious Mental Illness (SMI) / Serious Emotional Disturbance (SED) or
  • HIV/AIDS

Two or more chronic conditions, such as:

  • Alcohol and substance Use
  • Mental health condition
  • Cardiovascular disease (e.g. hypertension)
  • Metabolic disease (e.g. diabetes)
  • Respiratory disease (e.g. asthma)
  • Obesity (85th percentile for children of the same age and gender) or
  • Complex Trauma (http://tiny.cc/complextrauma)
    1. The term complex trauma incorporates at least:
      1. Infants/children/or adolescents’ exposure to multiple traumatic events, often of an invasive, interpersonal nature
      2. The wide-ranging, long-term impact of this exposure.
  • Nature of the traumatic events:
    1. Often is severe and pervasive, such as abuse or profound neglect
    2. Usually begins early in life
    3. Can be disruptive of the child’s development and the formation of a healthy sense of self (with self-regulatory, executive functioning, self-perceptions, etc.)
    4. Often occur in the context of the child’s relationship with a caregiver; and can interfere with the child’s ability to form a secure attachment bond, which is considered a prerequisite for healthy social-emotional functioning.

Contact:
Anne Marie Montijo, LCSW
Deputy Director for Strategic Initiatives
amontijo@mhaw.org
631-471-7242 x1432

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