Medicaid Case Management in Wisconsin

                                                Jon S. Matthew
                                                 August, 2004
I.  A framework for case management
            A.  Purpose of case management
                        1.  Promote group process --Bringing people together to do as a group what they cannot do as well individually
                        2.  Expanding the vision:  go beyond ad hoc, go beyond conventional approaches, go beyond doctrinaire approaches, go beyond using 
                              available resources
                        3.  Create intellectual, emotional, and environmental resources for the child
                        4.  Seek alignments and opportunities for concerted action that are meaningfully related to the child’s behavior
                        5.  Focus on strengths while working on weaknesses
                        6.  Make the plan a living working document and make it comprehensive
                        7.  Make people accountable to one another through connections
            B.  Models of case management
                        1.  The ecological view:  structure, pattern, process
                        2.  Dimensional approach: connections on the team, connections within and among agencies, connections between formal and 
                             informal providers, connections with the child, moral and ethical values                          

                        3.  Available resources and levels of integration
                                    a.  rationing
                                    b.  matching needs with interventions
                                    c.  “breaking through” bureaucratic red tape
                                    d.  developing resources and then coordinating them
                        4.  Comparison of brokering model with active community treatment model
            C.   Medicaid model of case management
                        1.  Purpose
                        2.  Design:  structure, pattern, process
                        3.  Structural features
                        4.  Patterns of activity
                        5.  Process of creating and sustaining actions
II.  Connection of the Medicaid model to integrated services
            A.  Medicaid case management as a support for integrated services
                        1.  Promotes a “systems” approach
                        2.  Supports the values and principles of integrated services
                        3.  Compatible with a strength-based approach
                        4.  Applicable to the team approach
                        5.  Reinforces system change
                        6.  Brings together formal and informal support systems (VOA)
                        7.  Increases funding for integrated services
            E.  Medicaid case management weaknesses in the state of Wisconsin
                        1.  Conflict with Title IV-E
                        2.  Minimalist interpretations of purpose
                        3.  “Lone ranger” case managers
                        4.  Guidelines and requirements are complex and often arcane
                        5.  County departments often cut corners
III.  Child welfare, Medicaid case management, and integrated services
            A.  Child welfare worker serving as Medicaid case manager
                        1.  Traditionally performed many of the same functions
                        2.  Gaps in child welfare worker training
                        3.  Limitations induced by the court perspective
                        4.  Operational definitions of Medicaid covered activities and Title IV-E activities
            B.  The odd couple:  State as “billing provider” and county as “performing provider”
                        1.  Strange dilemmas
                        2.  Two different billing systems:  the state RMTS and fee-for-service
                        3.  Are the federal dollars being maximized and distributed equitably
            C.  Impact on integrated services
                        1.  Enrolled children are often in the child welfare system
                        2.  Court orders and integrated services
                        3.  Impact of the Court bureaucracy
IV.   Operating a Medicaid case management service in Wisconsin
            A.  Credentialing case managers
            B.  Setting up authorization procedures
            C.  Case management progression
            D.  Linking assessment, plan, and ongoing activities
            E.  Covered services
            F.  Non-covered services
            G.  Employee time-keeping
            H.  Linking program operations with fiscal operations
            I.  Training new workers
            J.  Tracking program operations
            K.  Doing triage
            L.  Using professional service coordinators
            M.  Maintaining records
            N.  Monitoring compliance with WMAP requirements