Case Management

Case Management

Mental Health Targeted Case Management

Mental Health Targeted Case Management works to enable an individual to improve or maintain emotional or behavioral functioning. The goal is to reduce the need for and reliance upon out-of-home placements and furnish the opportunity for less intrusive methods mental health care..

Service we provide

Targeted Case Management services are coordinated services designed to help the individual and his/her family obtain appropriate support, including mental and physical health services, social and educational services, vocational and recreational services, and other related support such as volunteer services, advocacy, transportation, and legal services.

Our services include:

  • conducting functional assessments
  • developing service plans
  • assisting clients in obtaining mental health and other services
  • ensuring the coordination of services
  • monitoring and evaluating the delivery of services

Eligibility

All Medicaid recipients who meet the following criteria may receive mental health targeted case management services:

  • Not receiving case management services under a home and community-based service waiver.
  • Not in a hospital, nursing home, intermediate care facility for the developmentally disabled or institution for mental diseases.
  • 17 years of age or younger and require advocacy for and coordination of services to maintain or improve level of functioning, or
  • 18 years of age or older and require advocacy for and coordination of services to maintain or improve level of functioning, or
  • 18 years of age or older and resides in the community and, due to mental illness, exhibits behavioral or symptoms that could result in long-term hospitalization if frequent interventions for an extended period of time were not provided.

For Sunshine Health Members

Long Term Care Case Management

 LTC Case Management involves promoting client independence through implementation of the plan of care and goal setting, including locating services, recruiting and/or developing services and by monitoring the delivery of services. Responsibilities also includes monitoring the clients condition for the purpose of ensuring clients continuing eligibility, ensuring the meeting of health, safety and welfare needs, and providing feedback to adjust the plan of care. LTC Case Management is performed under general supervision and is reviewed for overall program effectiveness and for compliance with state and federal standards.

 Service we provide

 LTC Case Manager will work with you, your care giver, and doctor to create a person centered plan of services. A care plan is developed based on your health needs, home setting, own goals, community actions and the amount of support you receive from your family and friends. Your LTC Case Manager will review your case with you over time and make changes to your care plan.

 Our services include:

  • conducting functional assessments
  • developing care plans
  • assisting clients in obtaining services to address their medical needs
  • ensuring the coordination of services
  • monitoring and evaluating the delivery of services
  • promote independent living and total wellness working with people with disabilities and elder populations.
  • identify and attain personal goals necessary to promote good health and enhance their ability to live independently in the community.

Eligibility

Individuals enrolled in the Long-term Care program must be:

  • 65 years of age or older AND need nursing facility level of care; or
  • 18 years of age or older AND eligible for Medicaid by reason of disability AND need nursing facility level of care

Or:

  • 18 years of age or older with a diagnosis of cystic fibrosis AND have a hospital level of care.

Long Term Case Managers will setup Long Term Care services for you.  Most of the services listed in Services Covered by Sunshine Health section are setup by the Case Managers.

Services Covered

•Adult Companion
•Adult Day Care (Adult Day Health Care)
•Assistive Care Services
•Assisted Living Facility Services
•Attendant Care
•Behavior Management
•Caregiver Training
•Case Management
•Home Accessibility Adaptation
•Home Delivered Meals
•Homemaker
•Hospice
•Intermittent and Skilled Nursing
•Medical Equipment & Supplies
•Medication Administration
•Medication Management
•Nursing Facility Care
•Nutritional Assessment and Risk Reduction
•Occupational Therapy
•Personal Care
•Personal Emergency Response System
•Physical Therapy
•Respiratory Therapy
•Respite Care
•Speech Therapy
•Transportation