Special Healthcare Programs

Care Coordination Program

AmeriHealth Caritas Ohio’s Care Coordination Program addresses members’ healthcare needs while assessing for and addressing social needs and barriers and providing hands-on coordination. Care Managers and Care Connectors identify opportunities for health and connect members to needed healthcare and community-based services.

What can the Care Coordination Program do for me?

Managing your healthcare alone can be hard, especially if you are dealing with many health problems at the same time. If you need extra support to get and stay healthy, we can help. As a member of AmeriHealth Caritas Ohio, you may have a staff member of the care coordination team assist you as part of your healthcare team. 

The care coordination staff is specially trained to work with you and your doctors to make sure you get the right care when and where you need it. They can: 

• Help coordinate your appointments and help arrange for transportation to and from your doctor. 
• Support you in reaching your goals to better manage your ongoing health conditions. 
• Answer questions about what your medicines do and how to take them. 
• Follow up with your doctors or specialists about your care. 
• Connect you to helpful resources in your community. 
• Communicate with the OhioRISE Plan, the Care Coordination Entity (CCE), and other providers (e.g. PCPs, specialists, labs) to coordinate your care as needed. 
• Help members who may live in stressful situations or have certain health conditions or disabilities. 

To learn more about how you can get extra support to manage your health, talk to your primary care provider (PCP) or call AmeriHealth Caritas Ohio Rapid Response at 1-833-464-7768 (TTY 1- 833-889-6446).

Caregivers and providers can refer members to these Care Coordination Programs. You can also refer yourself. You do not need a referral from someone else to access the programs.

If we see from your health history that you might benefit from the program, we may send you information in the mail about enrolling in the program.

If you are a part of but no longer want to be in the Care Coordination Program, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Leaving the program will not change your benefits. It will also not change the way AmeriHealth Caritas Ohio or the Ohio Department of Medicaid (ODM) treats you.

AmeriHealth Caritas Ohio has integrated care management programs for members who have multiple special healthcare needs, behavioral health conditions, and chronic conditions such as diabetes, asthma, or high blood pressure. In this program, you will work with a Care Manager who will help you get the services and information you need to improve your health.

What can the Complex Care Management program do for me?

• Understand and manage your chronic health conditions.
• Identify your medical and non-medical needs.
• Understand your medications.
• Set goals to improve your health.
• Find the right doctors and specialists to manage your care.
• Connect to available resources in your community.

In this program, you will work with a Care Manager who will help you get the services and information you need to improve your health.

To join the Complex Care Management program, please call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Or, you can log in to the member portal and go to Enroll in a Special Program.

Your PCP (primary care provider), specialist, or other healthcare provider may also talk to you about becoming a part of the program. They can call us to have you join.

We may see from your health history that you might benefit from the program. We may send you information in the mail about enrolling in the program.

If you are a part of but no longer want to be in the Complex Care Management program, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Leaving the program will not change your benefits. It will also not change the way AmeriHealth Caritas Ohio or the Ohio Department of Medicaid (ODM) treats you.

Diabetes Program

AmeriHealth Caritas Ohio members with diabetes can join a special program to help them manage their condition.

What is diabetes?¹

Diabetes is a disease that affects how your body breaks down sugar. It causes your body to have too much sugar in the blood. It could also be that you do not have enough insulin. Insulin helps your body break down the sugar in the food you eat to give you energy.

If you do not have control of your diabetes, it can:

• Cause you to go blind, get kidney disease, and have foot problems.
• Make it easier to get infections and/or wounds that will not heal.
• Put you at a higher risk of getting heart disease or having a stroke.
• Cause you to have nerve damage.
• Make you feel tired, thirsty and have to go to the bathroom much more than usual.

What can the diabetes program do for me?

The diabetes program can help you:

• Understand the medications you are taking.
• Know the importance of the foods you eat.
• Know why it is so important for you to test your blood sugar as often as your provider asks you to.
• Understand why exercise and weight control are so important.

Continuous glucose monitoring for members with diabetes

AmeriHealth Caritas Ohio partners with Pulsewrx to provide members living with diabetes with mobile smartphones. Apps and tools on the phone will support continuous glucose monitoring (CGM) so members with diabetes can have easier control of their blood sugar levels. View the wireless program informational flyer (PDF). To enroll, go to mybenefitphone.com. For questions, call Member Services 24 hours a day, seven days a week at 1-833-764-7700 (TTY 1-833-889-6446).

Join the diabetes program today

To join the diabetes program, please call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Or, you can log in to the member portal and go to Enroll in a Special Program.

Your PCP (primary care provider), specialist, or other healthcare provider may also talk to you about becoming a part of the program. They can call us to have you join.

If we see from your health history that you might benefit from the program, we may send you information in the mail about enrolling in the program.

If you are a part of but no longer want to be in the Diabetes Program, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Leaving the program will not change your benefits. It will also not change the way AmeriHealth Caritas Ohio or the Ohio Department of Medicaid (ODM) treats you.

1. “Diabetes,” familydoctor.org, September 20, 2020,  https://familydoctor.org/condition/diabetes/. 

Pregnancy Program — Bright Start^®

Bright Start is a special program for our pregnant members.

When you join Bright Start, a case manager will call you and work with you to help you receive and use program services. If your pregnancy is high-risk, a team of nurses and care connectors will check in with you often to help you stay connected to care during your pregnancy. 

What can the Bright Start program do for me?

• Get help signing up for childbirth and other health information classes.
• Get help choosing a provider who is right for you.
• Get help receiving care in a timely manner.
• Get information on prenatal vitamins and eating right during your pregnancy.
• Get information on staying away from drugs, alcohol, and smoking.
• Work with your provider and dentist to help you have healthy teeth and gums.
• Get information and resources to help you have a safe pregnancy and a healthy baby.

Join Bright Start today

To join Bright Start, please call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Or, you can log in to the member portal and go to Enroll in a Special Program.

Your PCP (primary care provider), specialist, or other healthcare provider may also talk to you about becoming a part of the program. He or she can call us to have you join.

If we see from your health history that you might benefit from the program, we may send you information in the mail about enrolling in the program.

If you are a part of but no longer want to be in the Bright Start program, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week. Leaving the program will not change your benefits. It will also not change the way AmeriHealth Caritas Ohio or the Ohio Department of Medicaid (ODM) treats you.

Other Special Programs

Dental Program

AmeriHealth Caritas Ohio offers one additional cleaning and exam for adults ages 21 and older (some restrictions and limitations may apply). This is in addition to the standard Medicaid benefit.

Food as Medicine

Qualifying members recently discharged from a hospital or enrolled in our diabetes program, and pregnant and post-delivery members and their families can receive home-delivered meals at no cost.

Living Beyond Pain

This chronic pain management program can help you improve your pain management skills through education and collaboration with health care providers. Through this program, AmeriHealth Caritas Ohio offers you pain management alternatives to opiates, which can lead to dependence and addiction. This includes 15 additional chiropractic and 30 acupuncture visits per year for members who do not qualify for the state benefit.

Vision Program

AmeriHealth Caritas Ohio offers one additional eye exam every 12 months for adults ages 21 through 59 diagnosed with diabetes. This is in addition to the standard Medicaid benefit.