Disease Management

The Disease Management Initiative was created to improve the health and quality of life of MediPass members who have certain chronic illnesses.  MediPass members are able to be in the program if they have a chronic illness covered by the disease management program and meet the requirements for enrollment.

Disease management is a free program.  The disease management program has nurse care managers that will contact you on a periodic basis and give you information about your illness.  Your disease management nurse will work with you and your doctor to develop a care plan that will identify the problems you are having with your illness and solutions to help you get better. The nurse will share this plan with your doctor so you can work together as a team to help you get healthy. 

You do not have to enroll in a disease management program, and you can leave the program at any time unless you have hemophilia.  If you decide you do not want to be in a disease management program, you can call your local Medicaid office and disenroll at any time (unless you have hemophilia).  You will be removed from the program. 

If you have hemophilia, you must enroll in the disease management program.  You can choose one of the two hemophilia disease management vendors in the program to obtain your disease management services. You have the right to change vendors at anytime and can do so by contacting your local Medicaid area office.

Who is Eligible?

Medicaid beneficiaries eligible for the Comprehensive Hemophilia Disease Management Program services include:

• All Medicaid eligible beneficiaries diagnosed with hemophilia who have been prescribed factor replacement products.
• MediPass beneficiaries, beneficiaries enrolled in a Provider Service Network, or fee-for-service Medicaid beneficiaries.
• Beneficiaries enrolled in both Medicare and Medicaid may voluntarily participate.

Hemophilia disease management enrollees may also be enrolled in other disease management programs if they meet eligibility criteria.

Medicaid beneficiaries eligible for HIV/AIDS Disease Management Program services include:

• MediPass beneficiaries and fee- for- service Medicaid eligible beneficiaries diagnosed with HIV or AIDS
• Beneficiaries participating in MediPass
• PAC Waiver Services (Project AIDS Care) recipients who have either MediPass, fee-for-service Medicaid, or Medicare, not enrolled in a Managed Care Organization (CMS, HMO, PSN, MPN) and not covered by a primary health insurance other than Medicaid
• Beneficiaries who are not enrolled in another disease management program with the exception of Hemophilia Disease Management