Frequently Asked Questions

Through our community-based care coordination program, the CHOICE Connect, individuals work with community organizations to get care coordination services to meet their unique needs. Care coordination connect clients to resources and services that provide for a whole-person continuum of care, including physical health, behavioral health, and social supports, such as access to food or housing. The Hub is community-centered, equity-driven, and acknowledges and works to address the barriers to critical services that different individuals may face.

You can connect with the the CHOICE Connect Community Care Hub by calling the referral line or submitting a request online. Based on your location and needs, our Hub Coordinator will assign you to a Hub agency in your area. A care coordination will then help you set goals, access resources and services you want to improve your well-being.

No. Services are offered at no cost to the community.

CHOICE Community-Based Workers will work with you directly to build a stronger, healthier life. That can mean helping with immediate needs and also helping you achieve life goals. Some services we help clients with include:

• Medical referrals
• Food security
• Housing
• Social services
• Mental health
• Medical care
• Healthcare coverage
• Pregnancy support
• Postpartum support
• Employment
• Adult education
• Medication assessments
• Substance use
• Oral Health
• Family planning

• Community members seeking services for themselves
• Friends or family members calling to refer someone they know
• Hospital or medical care staff calling to refer a patient
• Care coordinators from community organizations calling to refer a potential client

We look forward to connecting with you! Our care coordination team listens to your situation and connects you with local resources that match your needs and goals. If we miss your call, we will call you back as soon as we can. We are here during regular business hours, from 8-5, M-F except holidays.

“Community-based Care Coordination” or “CBCC” refers to the process of connecting individuals withcomplex health needs to the most appropriate physical health care, behavioral health care, and socialsupports in the most appropriate setting to improve and manage their health

“Community-Based Worker” or “CBW” means the standard title of the individuals and workforce who are engaged with the Social Care Support Service that is provided by the Community Care Hub. A CBW could be employed directly through a community partner or a community-based organizationwho are contracted with the Community Care Hub.

The Community Care Hubs provide community-based care coordination, known as Social Care Support service, and support the delivery of other approved health-related social needs (HRSN) services.

Health Related Social Needs (HRSNs) refer to the social and economic needs people experience that affect their ability to maintain their health and well-being. As part of the Medicaid Transformation Project 2.0, our State can invest healthcare dollars in meeting these needs. By addressing HRSNs, we can advance health equity and reduce health disparities, which are core to CHOICE’s mission. It can also reduce health care utilization and costs. You can learn more about them here.

The Native Hub is a statewide network of Indian health care providers, tribal social service divisions, and Native-led, Native-serving organizations focused on whole-person care coordination.

Our network includes bilingual Community-Based Workers who speak English and Spanish, along with a variety of language access tools and resources to help us support clients who speak many different languages. We’re committed to helping people connect with care and resources in the language they feel most comfortable using.