Case Management paper

edgwow · Nov 12, 2008

I work in a large tertiary medical facility with greater than 5,000 beds.

We have a very large uninsured population. This is what the case manager is respponsible for in my specific facility.

The case manager has the patient and physician fill out an EAF Employment Assessment Eligibility Form

This form has a section on it that indicates why the pt feels they can not work, in patients own words, the physician fills out a section that states diagnosis and reasons why pt can not work and an inital time frame ie: less than 3 mos 3-6 mos, 6-12 mos, greater than a year. This form is faxed to the business office who in turns applies for emergency medicaid for the hospitalization to be covered. The pt, upon discharge takes this EAF form to the local county assistance office and is given the phone number prior to discharge and is expected to follow up immediately post discharge.

Now if the pt is compliant and does so and gets a form from the county assistance office, they can get a "pass", present it at the business office and to be able to come back and follow up at the medical physicians clinics until the permanent medicaid is processed.

The other thing the case manager in my town is responsible to do is to inform the pt where free health clinics are or district health centers. These are often able to allow you to see a doctor (walk in only) and get your scripts filled onsite for little or no money based on a sliding scale. The county department of Health should be able to direct you.

The case manager can not provide needed equiptment ie oxygen or CPAP machines until proof of insurance from the welfare(county assistance) office is obtained. Often this requires a family member to go to the welfare office, after the pt. making an application on the phone. The medical equiptment company will usually release supplies as long as the pt has proof that they applied. This is the role for the CM for the uninsured in my facility.

hikingRN · Nov 12, 2008

Thank you so much for responding! This gives me a great place to start!

Katie82, RN · Nov 15, 2008

I am working on a paper entitled "Case management of the uninsured population." Does anyone have any suggestions of resources used in this area? I need specifics as to what a CM does when dealing with the uninsured.
Thank you so much for you help!

I work for a state-sponsored program in NC. I work with the Medicaid Population and will soon be working with Medicare as well. Try:

http://www.newsobserver.com/news/v-print/story/1252194.html

Medicaid folks are not technically uninsured, but I have a tendancy to work with the entire family, many of whom are not on Medicaid. And many of my patients float in and out of elegibility, so knowing what's available in your area is a must. Good resources for you to check would be your State Health Department as well as your local county health department.

Faby · Nov 17, 2008

Hi: I'm not a CM yet (trying to break in), but let me suggest you to search for providers that may have free programs. I don't have the name right now, but there is a Home Care Service that would provide services which cost would be according to the patient's income ( it was offered to me recently when I was ill).Also I know of a Hospital in s Southern NJ that offers MD outpatient sevices for free on wenesdays. There might be others out there. I could look them up for you.

Faby

edgwow · Nov 18, 2008

Please share the name of the South Jersey Med team that sees pts on WED as I serve South Jersey as part of my pt base and would like to pass along the info.