CMH basics and being your own best case manager
Your case manager is not your enemy, and they are not your only path forward either. Once you know who actually does what, you stop waiting on people who were never the ones who could say yes.
At your next appointment, ask each person present their title and who they report to. Write it down. You are building the org chart nobody ever hands a family, and you’ll use it every time something stalls.
Case manager
Assesses eligibility, writes the plan of service, and authorizes hours. Your first call for anything plan-related.
Supports coordinator
Handles day-to-day coordination under self-determination arrangements, often the person who actually returns your calls.
Direct service providers
The actual staff delivering care, rotating constantly due to the statewide DSP workforce shortage.
The PIHP
Controls the money and the appeals process. Your case manager cannot overrule a PIHP funding decision alone.
A written meeting agenda
Meetings without an agenda drift. A one-page list of what you need decided keeps everyone on the same page.
The follow-up email
Summarizing every meeting in writing within 24 hours is the single habit that builds your paper trail automatically.
Who does what
Eligibility, plan of service, hour authorizations
Day-to-day coordination under self-determination
Funding decisions, rate setting, formal appeals
Actual daily care, subject to constant turnover
Whitney stopped calling her case manager and hoping. After every meeting, she sent a two-paragraph email summarizing what was said and what was promised, with a date attached to each promise. Six months later, when a promised respite authorization never arrived, she forwarded the original email with one line: “Following up on this, dated March 12th.” It arrived within the week.
When you need to be your own best case manager, here is how
Practice ladder
- 1Ask every new contact their exact title and role.
- 2Bring a written agenda to every scheduled meeting.
- 3Send a follow-up email within 24 hours, every time.
- 4Keep a dated escalation log of unresolved promises.
- 5Escalate to a supervisor after two weeks of silence.
- 6Contact your PIHP directly when CMH cannot resolve it.
Have ready
- A contact list with names, titles, and who reports to whom
- A one-page meeting agenda template
- A follow-up email template you can reuse each time
- A dated escalation log of open items
- Your PIHP regional office’s direct contact information
You are not replacing your case manager. You are making sure nothing depends on anyone’s memory but your own.
Whitney’s case manager was not a villain. She was managing a caseload that had doubled in two years, answering phones for families in genuine crisis, and doing her honest best with less time than any of them deserved. Whitney figured that out fast, and instead of waiting for a system that was structurally unable to keep up, she built her own tracking system around it. Six months later, that system is the reason a promised respite authorization actually arrived instead of quietly disappearing.
Four roles, one confusing org chart
Michigan’s Community Mental Health system involves at least four distinct roles that most families never see mapped out anywhere. Your case manager handles eligibility determinations, writes your plan of service, and authorizes the specific hours and supports in that plan. A supports coordinator, if your family uses a self-determination arrangement, handles day-to-day coordination of the budget and providers you’ve hired directly. Your direct service providers are the actual people delivering care day to day, a group that turns over constantly given Michigan’s ongoing direct support workforce shortage. And above all of them sits your PIHP, the regional entity that controls the actual money, sets provider rates, and hears formal appeals when CMH says no.
Confusing these roles costs you real time. Asking a case manager to override a PIHP funding decision is asking the wrong person. Asking a rotating direct service provider to explain a plan of service authorization is asking someone who was never given that information in the first place.
The meeting agenda that keeps you in control
Walk into every scheduled meeting with a written, one-page agenda: what you need decided, in order of priority, with space to note what was actually agreed. This does two things. It keeps a rushed thirty-minute appointment focused on your actual priorities instead of drifting, and it gives you a document to reference later when someone’s memory of the meeting differs from yours.
The follow-up email that does the heavy lifting
Within 24 hours of any meeting or phone call, send a short email summarizing what was discussed and what was promised, with names and dates attached to each commitment. This is not about being adversarial. It is about making sure that six months later, when a promise has quietly slipped through the cracks of somebody’s overloaded caseload, you have a dated record to forward instead of a memory nobody can verify.
Building your own escalation log
Keep a simple running log: date of request, who you asked, what was promised, and whether it happened. When two weeks pass with no movement, that log is what tells you it’s time to escalate to a supervisor, and it’s what makes your escalation email specific instead of vague. “This has been outstanding since March 12th, per the attached email” moves faster than “we’ve been waiting a while.”
When to go straight to the PIHP
If your case manager and their supervisor genuinely cannot resolve something, because the answer requires a funding decision, a rate exception, or a formal appeal, stop waiting for CMH to escalate it internally and contact your PIHP’s regional office directly. This is not going over anyone’s head. It is going to the office that was always the one with the actual authority to say yes.
This week. Build your contact list with titles. Start your escalation log with whatever is currently outstanding.
Next meeting. Bring the one-page agenda. Send the follow-up email within a day, every time, without exception.
You cannot control how large your case manager’s caseload is. You can control whether anything you’re owed depends entirely on someone else’s memory.
Jim Palasty is the founder of OASIS for Autism and a single father of an adult autistic daughter in Michigan.