UMass Medical School’s Community Case Management program partners with the Massachusetts Medicaid program (MassHealth) to support children and adults with complex medical needs. We help individuals and families receive the care they need by identifying, obtaining, and maintaining the necessary supports and services. These services can vastly improve the quality of life for individuals with complex medical conditions and the families that support them; without them, more than a thousand children and adults in Massachusetts could be forced to leave their families and live in institutions to get the care they need.
Nurse Case Managers work with members to develop a care management plan based on individual needs that can be reassessed and altered as needed. We then connect members with any service they require for their health and well-being — such as physical therapy, medical equipment, medical specialists, and home/personal care support. UMass also coordinates the payment of services, and conducts third-party liability activities to identify insurers financially responsible for medically complex care. This supports care for members and reduces the overall cost of services for the state.
Since the Community Case Management program began in 2003, we have assisted more than 1,600 MassHealth members and currently work with nearly 700 Massachusetts residents and their families. By keeping children and adults out of institutional care and identifying third-party payers, we are not only able to improve the quality of life for those served by the program, but are also able to reduce overall medical costs for Massachusetts.
The Boston Globe highlighted the program in a February 2014 article about a nine-year-old boy named John, who has a rare genetic disorder that requires complex care. The CCM team cut through the red tape and made sure that John had the nurses, personal care attendants, and medical services he needed. Things improved for John, and today his parents use their experiences to help other families of children with special needs.