Over the past few months, we have attempted to keep you updated on changes to Mississippi Youth Programs Around the Clock (MYPAC) so that you can know what you can expect from those services and so that you can give your input into proposed changes. As part of our updates, we have also shared information about Wraparound, the care-coordination approach that MYPAC uses. Wraparound is an example of conflict-free case management.
Understanding conflict-free case management and what it should look like can be confusing. This 2014 document from the National Senior Citizens Law Center, Conflict Free Case Management: Themes in States Working to Implement New Systems, explains that the concept of conflict-free case management is not new and is required by several federal policies and laws. The document goes on to describe that conflict-free case management helps people who might otherwise be in institutions live in the community because it allows a singular focus on what those people, or, in the case of children, their families, think would most help them. The publication then lists three ways in which case management can be conflicted if case managers work for the same places that provide services (quoted exactly as written except case manager is substituted for the word agent):
- Assessment: The case manager may have an incentive during the assessment to assess for more or fewer services than the individual needs.
- Financial interest: The case manager may be more interested in a care plan that retains the individual as a client than one that assists with independence. The case manager may not suggest outside providers due to concerns over lost revenue.
- Convenience: The case manager or service provider may develop a care plan that is more convenient for the provider than a plan that is person-centered.
The publication also emphasizes the importance of these things:
- Separation of Eligibility Determination and Care Planning from Service Provision. The person who helps figure out if your child qualifies for service, helps you figure out what services you want and the processes for doing those things, should be separate from the people or organization that provides the services (“service provision”).
- Separation of Case Manager from Service Provision. Whoever helps coordinate your services, and helps you make any changes that you want, should be separate from the people providing services. The care coordinator should just be focused on helping you.
- Oversight and Monitoring by the State. State agencies like the Division of Medicaid and the Department of Mental Health should be making sure that these care coordination/case management/wraparound are separate from services.
- A Process for Grievances and Appeals. There should be ways for you to let the system know if it seems like the case manager or the care coordination provided to your family has conflicts.
- Stakeholder Engagement. All stakeholders should be engaged in the process, including beneficiaries, family members, advocates, providers, state leadership, managed-care organization leadership and case-management staff. Everyone should be at the table, including families.
If your child has significant mental health needs and is at risk for out of home placement—for example, they’re in a psychiatric hospital or residential treatment facility—a case manager or wraparound facilitator should be available to you and your family to help you pick the services and supports that you think would most help your family. That person should be able to help you without feeling any pressure to try to get you to use the services from their own agency. They should be someone that you feel comfortable telling if you want to change services or service providers and who can help you do that.
The more input that families give, the more likely we can work together to make sure that families and children receive conflict-free case management. One opportunity to do that is through the Interagency Coordinating Council for Children and Youth. An update on wraparound and MYPAC is an agenda item at the Council’s next meeting on November 16. Meetings are open to the public and include time for public comment. The Mississippi Department of Mental Health will soon have MYPAC standards that are open for comment. Your feedback about how well these standards work with wraparound and what you want for your child would be very helpful. We encourage anyone who wants to give input to consider these opportunities.
We welcome additional input or feedback about what we have shared.