What is Case Management?

When a woman is diagnosed with breast and/or cervical cancer, and/or certain pre-cancerous conditions, she may be eligible for full West Virginia Medicaid (benefit) coverage while receiving treatment. Once eligibility is determined, the woman is enrolled in the West Virginia Medicaid Treatment Act (MTA) and provided a monthly Medicaid card. As a part of MTA, enrolled women receive case management services through a network of four regional Case Managers. The Case Managers are responsible for assessing the woman's needs in order to identify possible barriers that may interfere with her receipt of treatment and then developing a plan of care to assist and empower the woman in resolving identified barriers, such as transportation needs. The Case Manager is responsible for monitoring the woman and her physician’s plan of care throughout her treatment. Once the physician’s determined treatment is completed, the woman is no longer eligible for the MTA.

What are Case Management goals?

 

	Assure that timely and appropriate diagnostic and treatment services are received
	Assure that women who have participated in the WVBCCSP have been informed of access to an appropriate re-screening process
	Assure that women who have participated in the WVBCCSP return to their previous level of functioning
	Increase women’s knowledge of local and national available resources

What are appropriate referrals for Case Management services?

 

	Breast cancer patients
	Pre-cancerous breast conditions, including atypical ductal hyperplasia
	Cervical cancer/pre-cancerous conditions (confirmed by biopsy), including CIN I; CIN II; CIN III; CIS; LSIL; HSIL; AGC
	Patients who are lost to follow-up or have refused services

For more information on the Medicaid Treatment Act, click here.