Care Management Overview Coordinated care for complex challenges

Care management is a set of activities intended to improve patient care and reduce the need for medical and other human services by enhancing coordination of care, eliminate duplication, and helping patients and caregivers more effectively manage health conditions. Service providers are encouraged to communicate with one another so all of the individual and family’s needs are addressed in a comprehensive manner. This work is done through a Care Manager.

At Catholic Family Center, Care Managers focus on whole health, including; substance abuse, mental and behavioral health, primary care, social support, academic achievement, psycho-social and financial improvement, as well as coordinating activities with providers.

On "Health Homes"

A Health Home is a group of health and community agencies that have agreed to work together to help people with many health issues get what they need to keep them healthier and safer in the community. Each person who joins gets a “care manager.”

This is a way to coordinate care for our Medicaid patients who have complex chronic diseases and mental health challenges. While many Medicaid patients are relatively healthy, there are several groups whose conditions are more severe, requiring support and assistance in the community.

Services Provided by Care Management

Care Management services at CFC offer linkage to most important resources for individuals and families such as access to food, cleaning supplies, assistance in application for benefits and entitlements, etc... In addition, we provide care coordination and management services for individuals who are struggling with medical, mental, behavioral, and social needs. We support members to maintain connection with providers and receive the help they need.

Learn more about each of our service areas:

Recovery-oriented programs designed to build stability on a person's individual path to recovery.

Children and Youth Health Homes Addressing family needs appropriately

Contact Information:

About the Program

A Children’s Health Home is a community-based care management program that provides comprehensive, person-centered, family-driven care planning for Medicaid members with high needs.

At Catholic Family Center, our Children’s Health Home program goal is to ensure all of the child’s/youth’s providers communicate with one another, and all aspects of care and social, behavioral, medical, mental, and academic needs and goals are met and coordinated. Our Health Home Care Manager’s role is to build linkages to community supports and resources, as well as to enhance the coordination and integration of primary and behavioral healthcare to better meet the needs of children and youth with multiple chronic illnesses.

Services Provided

  • Connecting to other health care providers
  • Connecting to mental health, and substance abuse providers
  • Helping to obtain needed medications and medication management
  • Advocacy and support in medical, mental, academic and court settings
  • Housing assistance
  • Medical appointment transportation
  • Link to other social services, such as food, benefits, and locating transportation
  • Connecting with other community supports, and develop life skills
  • Programs to help with economic and financial improvement
  • Employment Services, such as job training, resume building, interview skills, and job application assistance
  • Assistance in maintaining a job
  • Assistance with improving academic achievement
  • Help obtaining a GED, and much more!

Eligibility Criteria

The child or youth must be under the age of 21; and

  • is currently Medicaid-covered or able to qualify for Medicaid; and
  • has a chronic health, medical, and/or mental health condition (e.g., ADHD, Depression, Anxiety Disorder, Asthma, Diabetes, Sickle Cell Anemia, PTSD, Learning Disorders, Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), or obesity), or
  • has HIV/AIDS, or
  • a serious emotional disturbance, or
  • has experienced trauma


To learn more, or to make a referral, download our program brochure.

Early Intervention Creating opportunities for children with disabilities or developmental delays

Our Early Intervention services are provided in coordination with our Children, Youth and Family care management services. Visit the Early Intervention site.

Who is CFC

A quick overview of Catholic Family Center

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Providing the most vulnerable with hope