Case Management Services

Students with complex physical health needs may be eligible for medically necessary services under the Medicaid Health Plan managed by DHS. One of the health benefits under the Medicaid Health Plan is Case Management Services for certain children with complex physical health needs.

Section 1905(a)(19) and 1915(g)(2) of the Social Security Act define Case Management as services which will assist an individual eligible in gaining access to needed medical, social, educational, and other services. Activities commonly understood to be allowable include:

• assessment of the eligible individual to determine service needs.
• development of a specific care plan.
• referral and related activities to help the individual obtain needed services.
• monitoring and follow-up.

There are various types of Case Management Services within DHS for children with complex physical health needs, which include:

• Medically Fragile Case Management Services are for Medicaid eligible children, birth through 20 years of age, who are able to reside safely in the community. These children have a tracheostomy and/or ventilator or complex medical/health conditions and need coordination of several multiple agencies and services. There are specific agencies who are Medicaid Providers and certified to provide Medically Fragile Case Management Services. These agencies are:
  1. Responsive Caregivers of Hawaii,
  2. Aloha Care Services, Oahu,
  3. Supporting Exceptional Children of Hawaii (SECOH), Oahu,
  4. Blue Waters Resources, LLC, Oahu,
  5. Hilo Medical Center Home Care Services, Hawaii, and
  6. Public Health Nursing Branch, statewide.

  The agency assigned to provide the Medically Fragile Case Management Services is the primary case manager for the child and is responsible to collaborate with public health nurses, physicians, and other community providers in coordinating the care the child will need when he/she is in the home. These services also include collaboration and coordination of non-health care services such as educational and recreational services.

• Community-Based Waiver Programs for Children with Special Health Needs are under the DHS. Children must be eligible for Medicaid. (Parent’s income is NOT considered when making determination for Medicaid eligibility). Additionally, the child must be determined to be at a subacute or skilled nursing care facility level of care and can be cared for safely and cost effectively outside of a medical facility. Refer to the following summaries of waiver programs (see Appendix B).

• Community-Based Waiver Program for Children and Adults with Diagnosis of Mental Retardation/Developmental Disabilities under the DOH. Clients must be Medicaid eligible.

In addressing the comprehensive needs of the child, the DOE staff and Public Health Nurse (PHN) working with the child during the school day should include the case manager of the case management agency involved with the child and family. DOE staff and/or PHNs should work with the family to ascertain if any case management agency is involved and providing services to the child and family.