Questions for current members
CINQCARE removes barriers to health by delivering comprehensive care and well-being. We are continuing the best aspects of CINQCARE while growing our offering in New York and across the country.
We aim to provide better care, with no cost to those who qualify.
CINQCARE serves everyone, particularly those who reside in predominantly black and brown communities.
You will continue to get the same quality care and care coordination services.
Your Health Navigator will not change, and they look forward to answering any questions you may have.
Health Home services
A health home network provides six services identified in section 2703 of the Affordable Care Act. A health home is qualified by the State and is responsible for the integration and coordination of primary, acute, behavioral health (mental health and substance use disorder) and long-term services and supports for high cost/risk persons with chronic illness across the lifespan. Health homes services cannot duplicate other care management or care coordination services provided under Medicaid. The following services are provided by health home care coordinators.
- Comprehensive care management
- Care coordination and health promotion
- Comprehensive transitional care and follow-up
- Patient and family support
- Referral to community and social support services
- Use of information technology to link services, if applicable
The health home care coordinator will use PRISM, health screening and engagement of the beneficiary to identify the root causes for inappropriate or gaps in health care utilization. The Health Home care coordinator assesses client activation levels through administering the Patient Activation Measure (PAM) tool. Information is used to work with the beneficiary in developing a person-centered health action plan that contains beneficiary driven goals to improve health and ability to self-manage chronic conditions. The health home is accountable for reducing avoidable health care costs, specifically preventable hospital admissions/readmissions and avoidable emergency room visits; providing timely post discharge follow-up, and improving patient outcomes by addressing health care needs.
The state will qualify health home networks which include the lead entity and community-based care coordination entities. The qualification process will be formalized through a “Request for Application.” The state expects to release the application in the fall.
The project will need to achieve performance outcomes to sustain health home services.
Health Home facts
No one enjoys going to the emergency room or being in a hospital. When people have multiple chronic health conditions, getting the care they need can be as challenging as assembling a jigsaw puzzle in the dark. This is especially true when people also have needs for mental health and chemical dependency treatment or require assistance with daily tasks such as taking medication, bathing, transportation, or work. They may have several doctors and care providers that each provide part of the help they need, but they may not communicate with one another about the care needs of the individual being served. We know that when the pieces of an individual’s healthcare puzzle fit together, they do better and their care costs less. We want New Yorkers with complex care needs to have the ability and supports to better manage their own health care, to get right services at the right time and place, and to improve their health and quality of life. Based on experience here in New York and in other states, we know how to make that happen.
Health Home services will be available to individuals with chronic illnesses and who are enrolled in Medicaid or both Medicare and Medicaid. Individuals must also be at significant risk for health problems that can lead to unnecessary use of hospitals, emergency rooms, and other expensive institutional settings such as psychiatric hospitals and nursing homes. New York uses a predictive risk modeling system called PRISM to identify individuals who are at significant risk.
- Conduct screenings to identify health risks and referral needs;
- Set goals that will improve beneficiaries’ health and service access;
- Improve management of health conditions through education and coaching;
- Make changes to improve beneficiaries’ ability to function in their home and community and their self-care abilities;
- Slow the progression of disease and disability;
- Access the right care, at the right time and place;
- Successfully transition from hospital to other care settings and get necessary follow-up care;
- Reduce avoidable health care costs; and
- Make health care decisions during evenings or weekends when the Health Home coordinator is not available.
Health Home services are provided by a Health Home coordinator who will often work at some place the individual already has a relationship with, such as their doctor’s office, community mental health agency, tribal clinic, area agency on aging, or similar community-based provider. The Health Home coordinator will be part of a larger network of services that can be called on to help meet an individual’s need for medical, mental health, chemical dependency, long term services, and supports.
Health Home member basics
No. But we strongly encourage you to participate. The Health Home program will help you with all of your health-related and social services needs, not merely treat a specific chronic condition.
You were selected for this new program based on your health needs and the providers that you use.
No, the Health Home care management services are free.
No. You will only be required to fill out and sign a Consent Form with your Health Home which will allow all of your doctors and other healthcare providers to share information on your health in order to plan and work together.
In most cases you will be seeing all the healthcare providers that you do now.
Yes. You will need to contact your health plan or the assigned Health Home you are in and let them know that you want to change.
The program is voluntary so you can decide not to be in a Health Home. To do so, you must contact your assigned Health Home within 30 days of receiving your letter. You should call them at the number provided on the letter.
You will continue to receive the services as you have in the past unless you already are in a case management program; in this situation you should contact your case manager
Contact your care manager. Health Homes are required to have crisis coverage 24 hours a day and 7 days a week.
Your care manager will help you with transportation if you need it.
As soon as the Consent Form is signed.
You were matched to this Health Home based on where you live and which providers currently care for you.
This is a trained person who will help you get access to necessary medical and behavioral health needs (including substance abuse and mental health), specialty care and social services.
Once enrolled in a Health Home, you will be contacted by your Personal Health Navigator