Molina Healthcare staff will help coordinate your care
Living with health problems and managing them can be hard. We offer special services and programs for members who need extra help with a health problem. This can be any adult or child who is receiving health services for an ongoing health problem.
Molina Healthcare staff can help you:
- Access services that you are eligible to receive.
- Set up appointments.
- Set up transportation.
- Identify any gaps in care or healthcare needs.
- Access resources to help you with special health care needs and/or your caregivers deal with day-to-day stress.
- Coordinate the move from one setting to another. This can include being discharged from the hospital.
- Assessing eligibility for long-term care services and supports.
- Connect with community resources.
- Find services that might not be benefits. This includes community and social services programs.
- Set up services with a primary care physician (PCP), family members, caregivers and any other identified provider.
- Assist you in navigating the health care system.
- Assist you with medication needs.
- Assist you in understanding new diagnoses.
How do members enroll?
The Case Management programs are voluntary, but a member must meet certain requirements. You can also be referred to one of the programs through:
- Provider referrals
- Self-referrals
Members that qualify for the Care Management Program are referred to care management based on assessment of their needs and Risk Category.
Risk Category
Each member identified as being at risk is evaluated through our risk stratification process of assessing members to determine the appropriate level of intervention needed. Members are grouped based on factors such as age, medical history, current health status and specific health conditions. Molina Healthcare of Mississippi use four levels of intervention to identify Risk Categories: Health Management, CM, Complex CM, or Intensive Needs.
The Health Management Program is focused on disease prevention education, health promotion and member self-management. It is provided for members whose lower acuity chronic conditions, behavior (e.g., smoking or missing preventive services), or unmet needs (e.g., transportation assistance) put them at increased risk for future health problems and compromise their independent living.
The Care Management Program (CM) is provided for members who are at risk for re-hospitalization or with CM needs that may require more support than Level 1 HM and further assessment of their needs. CM is designed to improve the member’s health status and reduce the burden of disease through education and assistance with the coordination of care to collaboratively assess the member health needs, create Individualized Care Plans with prioritized goals, and facilitate services that minimize barriers to care.
The Complex Care Management Program (CCM) is provided for members who have experienced a critical event or diagnosis that requires extensive use of resources and additional support navigating the health care system.
LEVEL 4 – Intensive Needs
The Intensive Needs Program is provided for members with a need for stabilization and/or end-stage diagnoses. Interventions are designed to stabilize a member’s health status, improve their ability to cope with the severity of their conditions, and improve their quality of life. Care Managers monitor, follow-up and evaluate the effectiveness of the services provided on an ongoing basis.