ABOUT MONROE PLAN'S CARE MANAGEMENT AGENCY  

 

Monroe Plan’s Health Home Care Management Agency (CMA) was initiated in 2013 and currently serves 24 counties and approximately 3000 members. Monroe Plan’s CMA contracts with 8 Health Home hubs and has earned a reputation for providing effective, high quality care management to qualified Medicaid recipients in the counties we serve. Building on our 50-year history of partnering with providers, community-based organizations, and the members themselves, our care managers are uniquely qualified to help Medicaid members navigate complex health care and community service networks to be sure they get the care and services they need. Every day, person by person, Monroe Plan’s team puts the care in care management.

 

WHAT IS A HEALTH HOME?

 

Health Homes provide Care Management services to Medicaid and Dually Eligible Medicaid/Medicare recipients who meet the qualifying criteria. The goal of Health Homes is to optimize the quality and effectiveness of each patient’s care by ensuring that all clinical and community service providers involved in an individual’s care are working together. Health Home Care Managers help coordinate medical, mental health, and substance use services, and equally as importantly, assist with addressing the social service needs of the individual as well.

 

HOW IS HEALTH HOME CARE MANAGEMENT DIFFERENT FROM OTHER CARE MANAGEMENT PROGRAMS?

 

The care management support provided is driven by the goals of the individual. Care Managers can provide linkage to housing and legal assistance, support the person in becoming more socially connected, and facilitate access to medical and mental health services. One key advantage of the Health Home CMA program is that Health Home Care Managers can meet with members in person (*limited during the pandemic). The in-person visits allow the Care Manager to better assess the individual and their environment and build the necessary supports in to their care management plan.

 

WHO IS ELIGIBLE FOR HEALTH HOME CARE MANAGEMENT SERVICES?

 

Health Home Care Management Qualifying Criteria and Conditions

Adult and youth Medicaid recipients AND individuals who have both Medicaid and Medicare, including those who are already members of a managed care organization, who meet one of the following conditions:

ADULT  CHILDREN

 

  • With two or more chronic health conditions, such as asthma, diabetes, heart disease, mental health condition or substance use disorder or 
  • With a significant mental illness or 
  • Who are living with HIV/AIDS AND
  • Have one or more significant risk factors such as: Homelessness or risk of homelessness, lack of social/family support, non-adherence to treatments, learning or cognitive issues, deficits in activities of daily living. 

 

  • With two or more chronic conditions or 
  • HIV/AIDS or 
  • Complex trauma or 
  • Serious emotional disturbance AND 
  • Have a significant behavioral, medical, or social risk factor(s) which can be addressed through care management.  

 

 

 

 

MONROE PLAN FOR MEDICAL CARE

PUTTING THE CARE IN CARE MANAGEMENT

If you would like to make a referral or learn more, please contact 866.255.7969 or email triage@monroeplan.com.