What is a case manager, and do I get to choose mine?

What a case manager actually does

A case manager is the person who holds the whole thing together. On the waiver, that means four kinds of work, repeated on a cycle.

Assessing. Sitting down with the member, and usually the family, and working out what the person can do, what they cannot do safely on their own, what the house is like, who is around, and what is already in place. In Georgia this is done with an assessment tool called the DON-R, and the medical picture comes in on a form called the DMA-6.

Planning. Turning that assessment into a written plan of care: which waiver services, from which providers, how often. Under General Services §602.11, the plan of care and the attestation of the nursing-home level of care are approved by the member’s physician or by the case management agency’s medical director.

Arranging. Contacting the provider agencies, getting the services started, and sorting out what happens when a provider cannot staff a shift or a piece of equipment does not arrive.

Monitoring. Checking, on the schedule the waiver sets, whether the plan is doing what it was meant to do. Is the helper turning up. Is the member losing weight. Has the family caregiver stopped sleeping. Has something changed that means the plan needs rewriting.

What a month looks like

Most months are quiet. There is a contact, there is a check that services are being delivered, and there is paperwork behind the scenes that the family never sees.

The months that are not quiet are the ones that matter. A hospital admission, a fall, a spouse who has become ill themselves, a provider agency that has stopped covering a shift – those are the moments where the case manager’s job turns into making phone calls until something is fixed. If you want one question to ask an agency, it is what happens on those days.

Case Management §2038 requires the Lead Case Manager role to be filled by a Georgia-licensed registered nurse. That matters most in exactly those situations, because the questions are often clinical ones.

Do I get to choose my case management agency?

Yes.

Georgia’s rules are explicit about this. §1894 gives the member the right to choose their Traditional or Enhanced EDWP provider. §1896 puts the matching obligation on the case manager: they must inform the member of the providers available in their area and let the member choose among them. It is not a courtesy and it is not a formality. It is the member’s decision.

Two things follow from that, and both are worth knowing.

The first is that you are entitled to be told your options. If a member is handed one name and no alternatives, that is not how the rule is meant to work, and it is reasonable to ask what else is available in the area.

The second is that the choice is not permanent. A member may change case management agencies. People do it for ordinary reasons: they move, the communication is not working, the person they trusted left. A member who wants to change should say so, and the transfer is handled between the agencies and the state so that services continue.

To be clear about our own position: this page is here because it is a question families ask and deserve a straight answer to, not as an invitation to move. If your current agency is working for you, there is no reason in this page to change anything. Deciding to leave one agency for another is your decision to make on your own reasons, and a good agency will tell you that.

What the case manager is not

The case manager does not provide the hands-on care. They do not bathe anyone, cook anyone’s dinner or drive anyone to an appointment. That is the provider agency’s work, and the distinction is explained in more detail on the difference between a home care agency and a case management agency.

They also do not make the eligibility decision. The assessment and the documentation go into a process that the state runs, and no agency can promise how it will come out.