The Care Coordination Program (CCP) is an outreach and short-term care coordination program. The Care Coordination mission, as detailed by Maryland's Medicaid Managed Care Program known as HealthChoice, is to outreach and provide community-based, client focused services to the following groups: Non-Compliant Medicaid recipients, Pregnant and postpartum women, Newborns and children under age 2, Children and Adults with Special Health Needs, and Family Planning Recipients.
The Care Coordinator provides education and reinforcement about Medicaid benefits and system navigation, assistance with addressing barriers to healthcare and linkage to their HealthChoice Managed Care Organization, Primary Care Provider and Specialty care.
- Home and telephone assessments conducted to provide linkage and coordination to primary care, dental care, specialty care, preventive health screenings, lead screenings and immunizations.
- Assessment, triage and referral of pregnant women and infants to Baltimore City Home Visiting Programs for long term case management services.
- Health education provided regarding prenatal care, newborn care, EPSDT guidelines, chronic disease management, preventive health screenings, dental care and mental health services.
- Consult with other community agencies to identify potential resources for resolving client's health, psychosocial or financial problems.
- Deploy various methods for locating referred clients that are difficult to locate; establishing liaisons with DSS, PCP's, neighbors, churches, and other community groups.
- Assistance with the removal of barriers to healthcare including: housing, addiction treatment, domestic violence services, Energy Assistance, emergency funds, Medical Assistance Transportation.
- Educate on access to low-cost/ no-cost health care services in Baltimore City as well as linkage to all the Maryland Medical Programs (MCHP, MAF, and the Maryland Family Planning Program).