What a case management agency actually does
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An EDWP case management agency works out what someone needs to stay at home, writes it into a care plan, arranges the provider agencies who deliver each service, and then checks every month that it is actually happening. Medicaid pays the agency directly. No bill for case management reaches the member or the family.
The work, in order
Case management is not one appointment. It is a cycle that starts before enrollment and then repeats for as long as someone is on the waiver.
1. The assessment
Someone comes to the home and works out what help the person actually needs on an ordinary day — bathing, dressing, meals, medication, getting around, staying safe. That is also where the level-of-care determination gets documented, using the DON-R, alongside the DMA-6 medical form. What happens at the in-home assessment.
2. The care plan
The assessment becomes a written plan: which services, how much of each, who delivers them, and what each one is for. The plan has to be approved and the level-of-care need attested. Under General Services §602.11 that can be done by the member’s own physician or by the case management agency’s medical director. We have one on staff, which means that step does not depend on getting time with someone else’s doctor.
3. Arranging the providers
Each service on the plan is delivered by a separate provider agency — the personal support provider, the meal provider, the adult day center. We arrange them, authorize the service, and make the introductions. You have a choice among providers for each one, and §1834.13 prohibits any agency from steering all of a member’s services to a single company.
4. The monthly check-in
Every month, contact with the member. Is the helper turning up. Are the meals arriving. Has anything changed. This is the part families notice most, and it is the part the field’s loudest complaint is about — “my case manager never calls back.” It is also the part that catches problems before they become hospital admissions.
5. When something changes
A fall, a new diagnosis, a caregiver who can no longer cover, a hospital stay. The plan gets revised; it does not wait for the annual review. How to get the care plan updated.
6. The annual reassessment
Once a year the whole thing is reviewed: level of care, financial eligibility, and whether the plan still matches the person. What the reassessment involves.
Who does this work here
Georgia’s case management manual (§2038) requires the Lead Case Manager at an EDWP agency to be a Georgia-licensed registered nurse. Ours is Cathy Nisbett, RN, CCM. The staffing model the manual sets out also includes a case management RN, a social services worker, an ADRC screening specialist and an LPN.
What we are not
We are not a home care agency, a nursing agency, or a placement service. We do not employ the person who comes to the house. If you are trying to work out which kind of organization you are looking for, the difference is worth two minutes.
Questions people ask about this
Does case management cost anything?
No. Medicaid pays the case management agency directly for EDWP case management. No bill for case management reaches the member or the family. Some members owe a cost share toward their care overall, which the State determines, but that is separate from case management.
Do you send the person who helps my mother?
No. We arrange for a provider agency to send them, and we monitor whether the service is being delivered as the plan says. A case management agency and a home care agency are two different things.
How often will we hear from our case manager?
The program requires regular contact, including a monthly check-in, and a full reassessment each year. If needs change in between, the plan can be revised — you do not have to wait for the annual review.
Can we choose a different case management agency?
Yes. Under §1894 the member has the right to choose their Traditional or Enhanced EDWP provider, and can change later. We publish that right in full, including how to complain about us.
Related questions
- Case management vs home care A case management agency arranges, coordinates and monitors waiver care. A home care agency employs and sends the helper. Two different jobs, two different contracts.
- 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.
- Applying How to apply for Georgia's Elderly and Disabled Waiver: who to call first, the two eligibility tests, the DON-R assessment, and how long each stage takes.
- Choosing your provider Georgia waiver rules give a member the right to choose their EDWP provider, oblige the case manager to tell them what is available, and forbid bundling all services with one company.