CARE COORDINATION FOR CHILDREN

Care Coordination provides integrated health service care for low, moderate to high risk children with health challenges. To qualify, the child must be enrolled in Medicaid and have a documented clinical need.

Medicaid members eligible to be enrolled in a Health Home must have: two or more chronic conditions (e.g., Substance Use Disorder, Asthma, Diabetes) or one single qualifying chronic condition, such as HIV/AIDS or a Serious Emotional Disturbance (SED) or Complex Trauma.

Services include: completing comprehensive health risk assessment, formulating care coordination plans, linkages to and for preventive care and appropriate community-based treatment to prevent and avoid unnecessary hospitalizations, ER visits and maintaining community stabilization. Psycho-education is offered to assist members in developing positive habits towards overall good health, wellness, prevention and recovery.

• Core elements for children’s care coordination include - creating a comprehensive care management plan and using a comprehensive health risk assessment and individualized plan of care to meet the physical, mental health, chemical dependency and social service needs.
• Care coordination and health promotion - One care manager will ensure that the care plan is followed by coordinating, monitoring and re-evaluating the patient and their care.
• Comprehensive transitional care - Prevention of avoidable readmissions to inpatient facilities and oversight of proper and timely follow-up care.
• Patient and Family Support - Individualized care plan must be shared with patient enrollee and family members and/or other caregivers. Patient and family preferences are considered.

For more information call:

WellLife Network Children & Family Services Tel: 631.920.8302