Questions and Answers
The Caring Program and how we help
- What is the Caring Program?
- Is a "chronic condition" the same as a "special health care need?"
- Why do these children and their families need help?
- What is care coordination?
- How can care coordination help me?
- What can the Caring Program do specifically for my child?
- What can the Caring Program do for me and my family?
- What kind of information is available? (Is it all "disease" specific?)
- Can the nurse Care Coordinators provide medical care for my child (wound care, suctioning, PT, OT, etc.)?
- What are the credentials of the Caring Program's Care Coordinators?
- Have other families benefited from the services provided?
CHIP and Caring Program Eligibility and Availability
- Who is eligible for the Caring Program?
- What is CHIP?
- How can I get CHIP for my child?
- Where is the Caring Program offered?
- How much does it cost to participate in the Caring Program?
- How is care coordination different than care/case management?
- If I have CHIP through other PA CHIP contractor or insurer can I enroll my child in the Caring Program?
- Will my CHIP premium go up next year if I use the Caring Program?
- Could I lose my free CHIP benefits if my child participates in the Caring Program?
- Could my personal Highmark premium be negatively affected if my child participates in the CHIP Caring Program?
- Is my child's health condition appropriate for the Caring Program?
- How long can I participate in the Caring Program?
How you can get help
1. What is the Caring Program?
The Caring Program: Care Coordination for Children with Special Health Care Needs is a free program for children enrolled in CHIP through Highmark. Children with chronic conditions and/or special health care needs and their families are provided information, education and referrals that link the children with the specific resources they need.
2. Is a "chronic condition" the same as a "special health care need?"
Yes, the terms chronic condition and special health care need are synonymous. The term is inclusive of all medical and/or mental health conditions that are expected to last at least 12 months.
According to the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services, “Children with special health care needs (CSHCN) are defined as those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.” Based on this definition, the 2001 National Survey of Children with Special Health Care Needs estimated that 9.4 million children in the U.S. (or 12.8 percent) have special health care needs.3. Why do these children and their families need help?
Issues related to children with chronic conditions are often times complex and difficult to comprehend. Adding to this is a system of care which is often fragmented, in which each separate piece operates in its own area of expertise. Many families often don’t know where to turn for help or how to access services. The Caring Program supports families in obtaining and coordinating the services they need.
Care Coordination is a process that links children with chronic conditions and/or special health care needs, along with their families, to services and resources in a coordinated way to maximize the children's health and quality of life.
5. How can care coordination help me?
The Caring Program's Care Coordinators can help families in one of two ways:
Level 1: Care Coordinators, via telephone, e-mail or written correspondence, provide families with information, education and referrals that the families can independently access.
Level 2: Community-based care coordination is designed for families who need the more tailored and personal assistance of a community-based Care Coordinator due to the complexity of the child's condition and/or family circumstances. Care Coordinators meet with the family in their home, and at the family's request, can also attend physician appointments, school meetings and community meetings.
6. What can the Caring Program do specifically for my child?
If your child is enrolled in CHIP through Highmark, the regionally based Care Coordinators can provide a range of services for children with chronic conditions and/or special health care needs. The Care Coordinators can provide telephonic support, information and referrals to your family. The Care Coordinators can also provide more intensive assistance to those in need of more help by accompanying a child (and parent) to medical appointments and/or school or community meetings in an effort to enhance communications among the families and the systems involved in the child’s life.
7. What can the Caring Program do for me and my family?
The Caring Program is a family-centered program. We know that often times not only the child with the chronic condition and/or special health care need is impacted by their condition, but that the entire family is impacted and in need of help. The Care Coordinators assist families in identifying their most pressing unmet needs and help them in obtaining the resources needed to address those concerns.
8. What kind of information is available? (Is it all "disease" specific?)
A variety of information on chronic conditions and/or special health care needs is available by calling the Caring Program’s toll free number at 1-866-823-0892. While specific medical advice is not provided, educational resources regarding conditions, as well as the socially-related impact of those conditions and the associated resources are available.
9. Can the nurse Care Coordinators provide medical care for my child (wound care, suctioning, physical therapy, occupational therapy, etc.)?
No, the function of the Care Coordinators is to educate families and to provide support as well as information and referrals.
10. What are the credentials of the Caring Program's Care Coordinators?
The Caring Program's Care Coordinators are registered nurses and/or medical professionals with extensive pediatric and/or social service experience. The Care Coordinators average nearly 25 years experience in health care fields.
11. Have other families benefited from the services provided?
As of February, 2009, more than 10,000 families have benefited from the services of the Caring Program: Care Coordination for Children with Special Health Care Needs since its implementation in early 2005. You can read about some of the families who have been helped by the Caring Program here.
12. Who is eligible for the Caring Program?
Any child with a chronic condition and/or special health care need who is enrolled in Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark is eligible for the Caring Program.
CHIP is short for Pennsylvania's Children's Health Insurance Program—Pennsylvania's program to provide free or low-cost health insurance to uninsured kids. Go to chipcoverspakids.com for more information.
14. How can I get CHIP for my child?
You can obtain more information regarding CHIP from the Pennsylvania Insurance Department (chipcoverspakids.com), or you can call 1-800-543-7105 for more information on CHIP administered by Highmark.
15. Where is the Caring Program offered?
The Caring Program: Care Coordination for Children with Special Health Care Needs is available in all of the 49 Pennsylvania counties covered by Highmark. Go to PA Counties Served for a complete list of the counties served by the program.
16. How much does it cost to participate in the Caring Program?
Nothing. The Caring Program: Care Coordination for Children with Special Health Care Needs is free of charge for any child enrolled in CHIP administered by Highmark.
17. How is care coordination different than care/case management?
Care coordination assists families in a holistic family-centered manner for as long as the family needs assistance, until the child reaches 19 years of age and as long as the child is enrolled in CHIP through Highmark. Care management is typically a function of a health insurance company that provides families and physicians with authorizations and referrals for needed services within their benefit plans. Care managers can also help families by recommending resources for the individual patient, typically for a relatively short or defined period of time.
18. If I have CHIP through other PA CHIP contractor or insurer can I enroll my child in the Caring Program?
Not at this time. The Caring Program is a model program of the Highmark Caring Foundation and is currently only available to children enrolled in CHIP through Highmark.
19. Will my CHIP benefits be negatively impacted next year if I use the Caring Program?
CHIP benefits and/or eligibility are NOT impacted by participation in the Caring Program, nor will your CHIP premium go up as a result of your participation.
20. Could I lose my free CHIP benefits if my child participates in the Caring Program?
No, your child's participation does not impact their CHIP coverage.
21. Could my personal Highmark premium be negatively affected if my child participates in the CHIP Caring Program?
No. The products are totally separate insurance products and do not affect one another.
22. Is my child's health condition appropriate for the Caring Program?
If your child is enrolled in CHIP administered by Highmark and has a chronic condition (a health-related condition that is expected to last for 12 months or more), your child would likely benefit from the Caring Program. You can call our toll-free number at 1-866-823-0892 for more information.
23. How long can I participate in the Caring Program?
Your child can participate in the Caring Program: Care Coordination for Children with Special Health Care Needs for as long as they are enrolled in CHIP through Highmark or until 19 years of age.
24. How can I get information about the Caring Program?
You can contact us via e-mail. Or you can call us toll-free at 1-866-823-0892.
25. Can I contact a Care Coordinator in my county?
You can see if your Pennsylvania County has a Care Coordinator and who that Care Coordinator is by clicking on PA Counties Served. Contact information for the Care Coordinators is provided there.