Care & Disease Management
CareSource offers care and disease management programs. These programs can help you learn about your health and how you can better manage your specific health conditions. Our goal is to make sure you have the right tools to stay as healthy as possible. These programs are available to you at no cost.
CareSource has nurses, social workers, and community health workers who can work with you one-on-one to help coordinate your health and non-health care needs. They can contact you by phone:
- If your doctor requests one to contact you
- If you request a phone call
- If our Care Management staff feels their services would be helpful to you or your family
Our staff is trained to help you and your family with any special medical problems like asthma, cancer, pregnancy, depression, being medically frail or with other medical conditions. We can also work with you if you need help figuring out when to get medical care from your doctor, an urgent care center or the emergency room.
For more information about Care Management or to talk with a staff member, call Member Services at the number below.
CareSource offers disease management programs for:
- Coronary Artery Disease
- Congestive Heart Failure
- Chronic kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Hepatitis C
- Human immunodeficiency virus (HIV)
- Attention-deficit/hyperactivity disorder (ADHD)
- Autism/pervasive developmental disorder
These programs can help you learn about your health and how you can better manage your specific health conditions. Our goal is to make sure you have the right tools to stay as healthy as possible. These programs are available to you at no cost.
Goals of our programs include:
- Helping you understand how to take good care of yourself
- Helping you adopt a healthy lifestyle
- Working with your doctor to reach your health goals
If your doctor, pharmacy or other health care provider tells us that you would benefit from one of these programs, we will send you information about the program. You can also ask to be in our Disease Management programs.
If you believe you could benefit from our Disease Management programs or if you would like additional information, please call 1-844-438-9498 (TTY: 1-800-743-3333 or 711).
If at any time you choose to not participate in the program, you may opt out by contacting us at 1-844-438-9498.
Women and Children’s Wellness
This program provides clinical information for staying healthy during pregnancy and managing children’s diseases. Topics include asthma, diabetes, obesity and women’s health and wellness. Materials include information for children, teens and parents. For more information on this program, click here.
Medically Frail and HIP Benefits
Individuals with complex physical or behavioral health conditions, called “medically frail,” are eligible to receive a benefit package called the State Plan, which is more appropriate for their health care conditions. Please contact CareSource or visit the Indiana HIP website for information on these additional benefits.
An individual may be medically frail if he or she has been determined to have one or more of the following:
- Disabling mental disorder
- Chronic substance use disorder
- Serious and complex medical condition
- Physical, intellectual or developmental disability that significantly impairs the individual’s ability to perform one or more activities of daily living
- Disability determination from the Social Security Administration
CareSource may confirm that you have one of these conditions based on the medical care you receive. You may also contact Member Services at the number below to report a condition that qualifies as medically frail. If CareSource confirms your status as medically frail, you will receive HIP State Plan benefits. You have the right to appeal if CareSource does not determine your status as medically frail.
Medically Frail and HIP POWER Account Payments
You must make your POWER Account payments in order to access HIP State Plan Plus benefits. If you do not make your POWER Account payment, your benefits will fall under HIP State Plan Basic. This means you will need to make copays when getting health services.
However, if you earn more than 100 percent of the poverty level, you are medically frail and you do not make your POWER Account Contribution, you will keep your HIP State Plan Plus benefits but will need to make copays when getting health services. In addition to copays, you will be billed for your monthly POWER Account Contribution. And, you will need to make copays for health services received until your POWER Account Contribution balance is paid to date.
You must contact us in order to confirm your health condition. If your health condition cannot be confirmed, you will still receive full benefits including coverage for vision and dental through HIP Plus as long as you continue to make your monthly POWER Account payment. However, the HIP State Plan benefits will not be available to you.
Note: to learn if your condition is medically frail, call Member Services at 1-844-607-2829 (TTY: 1-800-743-3333 or 711) to ask about next steps.
Right Choices Program
CareSource will review the types of medical and pharmacy services you receive as part of your care. After our review, you may be enrolled into the Right Choices Program (RCP). The goal of the RCP is to provide quality care through health care management and coordination, ensuring that the right service is delivered at the right time and in the right place for you.
Your enrollment in the RCP may last up to two years. You may be assigned to receive services from a single pharmacy, a single primary medical provider or a single emergency department provider or a combination of these. During RCP, you will work with a Case Manager to make sure the care you receive best meets your needs.
Disease Management for Kids and Teens
Kids and teens may need help if they are dealing with a chronic condition like asthma. Visit the KidsHealth page to find out more!
Member Services: 1-844-607-2829 (TTY: 1-800-743-3333 or 711)
Members age 18+ can log in to learn how to get and stay healthy, take a health assessment, make a wellness plan and track your progress!
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