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Case Management

SMI Specialty Plan Case Management Support from SMI Trained Staff

SMI Care Managers are trained to understand the unique challenges that you face. They offer the highest quality of care. SMI Specialty Plan members also get support through Sunshine Health’s case managers. At least once per quarter, we check on members to see if you need help with services like:

  • Behavioral (mental health and substance use), medical or pharmacy 
  • Social services like housing, food, etc.

Access to a School Specialist

As a SMI Specialty Plan member, you and their family have access to our School Specialist. This person knows how to work with the schools to help our members get the services they need to improve school success.

Access to Housing Specialist

Our SMI Specialty Plan members have access to our Housing Specialist, who will assist them in working with local agencies to find safe, stable housing.

Access to Integrated Care through Behavioral Health Homes/Patient Centered Medical Homes

SMI members are more likely to have multiple health issues like hypertension, diabetes, cardiovascular disease, etc., than the general population. They are also less likely to have access to a PCP. To ensure easy access to a PCP for our SMI members, we help facilitate access to one who is part of a Behavioral Health Home or Patient Centered Medical Home.

Private Duty Nursing (PDN) Real-Time Reporting Process

We want to ensure that your child is receiving the services required to keep them safe in your home. Please contact Sunshine Health right away when a Private Duty Nursing shift is missed. Here are a couple ways to reach us:

  1. Contact your child’s Care Manager
    If you don’t know who your child’s care manager is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  2. Contact your child’s Care Manager’s supervisor
    If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
  3. Call the 24-hour Sunshine Health Nurse Advice Line
    1-866-796-0530 (TTY 1-800-955-8770)
    • Press 1 for Member
    • Press 2 for LTC or 3 for MMA
    • Press 5 for Nurse Advice Line
  4. Email Sunshine Health
    • Include your child’s name, Medicaid ID number and home health provider, the date and time of the shift missed, and your contact information.

When we are notified of a missed shift, your child’s Care Manager will:

  • Contact your child’s home health agency to identify the issue with coverage.
  • Work with the home health agency to ensure services will occur as authorized.
  • Help with finding another home health agency who can provide care to your child.  

Please contact your child’s Care Manager if you have any questions or concerns.

Frequently Asked Questions

The case management team includes behavioral health trained professionals as well a medical and behavioral nurses, social workers and care coordinators.

All members have access to care management—regardless of their health conditions. It can help you stay healthy if you have a chronic condition such as cancer, high blood pressure or diabetes.

All members are assigned a case manager. We encourage members to contact us to find out who the case manager is. Please call Member Services at 1-866-796-0530 (TTY 1-800-955-8770).