Care Management Eligibility

The Care Management team reviews all referrals to determine the appropriate level of case management for each referred member.

Ready to refer a member? View the Care Management Referral Form.

Low Risk and Medium Risk

Eligibility for Low Risk and Medium Risk Care Management is reserved for members who have low needs, and require minimal support to achieve their health goal(s). If a member is not eligible for High Risk or Complex Care Management with L.A. Care, the referral will be redirected to one of our Preferred Provider Groups (PPGs).

High Risk

Eligibility for High Risk Care Management is reserved for members with multiple unmanaged chronic conditions with high acute utilization or instability indicators. High Risk is also appropriate for other unique situations not outlined on the referral form.

Complex

Eligibility for the Complex Care Management is reserved for the most at-risk members who display both medical severity and associated high-cost utilization.

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