What is the difference between Traditional and Enhanced EDWP case management?
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Traditional and Enhanced are the two tiers of case management billed under Georgia's EDWP waiver. Traditional case management coordinates the home services in a care plan. Enhanced is the higher-touch tier for members whose care needs closer coordination with a physician. The waiver services themselves are the same either way.
What the two words actually refer to
Traditional and Enhanced are not two programs and they are not two service packages. They are the two tiers of case management billed under Georgia’s Elderly and Disabled Waiver Program.
Case management is the work of assessing what a person needs, writing it into a care plan, arranging the providers who deliver it, and then watching whether it is actually working. Traditional case management, sometimes written TCM, is that work at the standard level. Enhanced case management, sometimes written ECM, is the same work at a higher-touch level, for members whose care needs closer coordination with a physician.
The waiver services underneath – a helper, meals, adult day health, respite, an emergency response pendant, nursing visits, home modifications, a stipend for a family caregiver who lives with the member – are the same list at either tier.
How the tiers differ in practice
| Traditional (TCM) | Enhanced (ECM) | |
|---|---|---|
| What it is | The standard tier of EDWP case management | The higher-touch tier of EDWP case management |
| Focus | Assessing needs, building and maintaining the care plan, arranging and monitoring providers | The same work, with closer coordination around the member’s medical care |
| Typical fit | Most members on the waiver | Members whose condition means the case manager needs to work closely with a physician |
| Waiver services available | The EDWP service menu | The same EDWP service menu |
| Cost to the member | None. Medicaid pays the agency directly. | None. Medicaid pays the agency directly. |
We are deliberately not publishing reimbursement rates for either tier. Rates are set by the Georgia Department of Community Health, they change, and a number on a family-facing page is more likely to mislead than to help.
How a member ends up on one tier rather than the other
It is not a preference a family states. It comes out of the paperwork.
The level-of-care assessment, done with the DON-R, describes what the person can and cannot do. The DMA-6 carries the medical picture. Under General Services §602.11 the plan of care and the attestation of the level-of-care need are approved either by the member’s own physician or by the case management agency’s medical director. Out of that assessment and that plan comes the answer about what tier of case management the member’s situation calls for, inside the rules the state sets.
That also means the tier is not permanent. A member whose health changes has their plan reassessed, and what was right last year may not be right now. A family who feels the support is not matching what is happening at home should say so and ask for a review.
What this means when you are choosing an agency
A member has the right to choose which Traditional or Enhanced EDWP provider serves them, and to change that choice later. When you are comparing agencies, the useful questions are not about the tier label. They are:
- Which tiers is this agency enrolled to provide?
- Who is the case manager, and who covers when that person is away?
- Is there a nurse in the chain of responsibility? Case Management §2038 requires the Lead Case Manager role to be held by a Georgia-licensed registered nurse.
- Does the agency have a medical director who can attest the level-of-care need, or will the family be chasing their own doctor’s office for signatures?
Where Apple Community Health Services sits
Apple Community Health Services is an approved EDWP case management agency on the Traditional and Enhanced track. It is a case management agency, not a home care agency and not a SOURCE site: it assesses, plans, arranges and monitors, and separate provider agencies deliver the hands-on services in the plan.
Cathy Nisbett, RN, CCM holds the Lead Case Manager role that Case Management §2038 requires to be filled by a Georgia-licensed registered nurse, and the agency has a medical director, which is the piece §602.11 allows to attest the level-of-care need without the family having to chase their own physician.
If you are not sure which tier applies to your family member, that is a normal question and it is worth asking directly of whichever agency is handling the enrollment. Nobody should be guessing at it from a website.
Questions people ask about this
Does Enhanced case management mean more services?
No. The tier describes the case management, not the waiver services. A member on Enhanced and a member on Traditional draw on the same EDWP service menu. What differs is how closely the case manager works with the member's medical care.
Do we pay more for Enhanced case management?
No. Medicaid pays the case management agency directly for case management at either tier. No bill for case management goes to the member or the family, and the tier makes no difference to that.
Can a member move from Traditional to Enhanced?
The tier follows the member's needs as recorded in the assessment and the care plan, so it can change when their situation changes. A family who thinks the current level of support is not matching what is happening at home should raise it with the case manager and ask for the plan to be reviewed.
Who decides which tier a member is on?
It is not something a family picks from a menu. It comes out of the level-of-care assessment, the medical documentation, and the care plan, within the rules the Georgia Department of Community Health sets for the waiver.
Is Traditional case management worse?
No. Traditional is the standard tier and it is the right fit for most members. Enhanced exists for a narrower group whose medical situation needs the case manager working closely with a physician. More contact is not better if it is not needed.
Related questions
- EDWP explained EDWP is Georgia's Medicaid waiver that pays for help at home instead of a nursing home. How CCSP, SOURCE and the case management tiers fit together.
- CCSP vs SOURCE CCSP and SOURCE are the two ways Georgia delivers the same waiver. What differs is your doctor, the income rules, and whether medical care is built in.
- The case manager's role What an EDWP case manager does month to month, and the Georgia rule that gives a member the right to choose their case management agency and to change it.
- Who decides level of care The DON-R assessment and the DMA-6 medical form decide nursing-home level of care in Georgia. Who administers them, and what they are actually looking at.