Conflict Free Case Management

When you are struggling to get the supports you or your family member need to live independently, it’s important to have an advocate who’s knowledgeable about the disability service system.  This is what a case manager (otherwise known as a service coordinator) is supposed to do. He or she is supposed to help you to understand the services you qualify for and how to access them, while maximizing your independence.

People who receive services from an area agency most often receive case management from the area agencies although they can choose to receive independent case management. Sometimes, those area agencies also provide direct services which can create a conflict of interest.
In another model in New Hampshire, people who receive CFI (Choices for Independence) services have independent case managers from a variety of case management organizations across the state.

In 2016, the federal Medicaid agency told NH’s Bureau of Developmental Services that there are potential conflicts of interest with the current service delivery system for the DD and ABD waivers because most case managers for people with developmental disabilities are employed by area agencies that also provide services.

A conflict of interest occurs when:

The case manager is caught between the needs/interests of the client and the needs/interests of the area agency. Conflicts for case managers can include:

  • Promoting the over-or under-utilization of services, for example by not recommending costly services a person needs because the services are too expensive.
  • Keeping individuals as their clients rather than promoting independence and educating clients about their freedom to choose an independent case manager because the area agency does not want to lose funding; and
  • Advocating for a service delivery system and plan that is not person-centered, for example by advocating for services that are readily available rather than services the person really needs.

The federal Medicaid agency directed NH’s Bureau of Developmental Services to come up with a plan to address the potential conflicts in the current case management system and BDS is working with a variety of stakeholders to look at the issue now.

DRC-NH believes that strong and independent case management is vital to a system of services that is person-centered and promotes the rights of the individual. This should include:

  • Clearly defining the role and responsibilities of the case manager in the service delivery system.
  • Holding all case management agencies responsible for ensuring their case managers are meeting these expectations.
  • Prohibiting case managers from being assigned additional responsibilities that could create conflicts of interest.
  • Outlining training and education requirements for case managers.
  • Ensuring that individuals with disabilities are regularly educated about the choice of case managers and how to change case managers.
  • Regularly publishing a list of case management agencies and make it available to people with disabilities.
  • Clearly separating case management responsibilities from responsibilities regarding resource allocation and eligibility determination.
  • Clearly separating case management responsibilities from monitoring and oversight of direct service providers. While case managers will be monitoring the quality of services provided to the individuals on their caseload, they should not be solely responsible for monitoring provider agencies.
  • Ensuring reimbursement for case management services is reasonable.
  • Educating people with disabilities about the responsibilities of their case manager and what to do if their case manager is not meeting these expectations
  • Developing a robust system to monitor the quality of case management services including a process to solicit and investigate individual complaints by an independent agency

As New Hampshire examines its current system of service delivery for people with disabilities, it must not be bound by the status quo. It’s important that we are open to changes to ensure we are providing the best quality services to people with disabilities.