Welcome to Molina® Guided Care for Medicare

Hear from Molina Healthcare medical directors and nurse practitioners about Molina Guided Care and how it can help.


What is Molina Guided Care?

Molina Guided Care is a type of specialized health care that focuses on you and your serious illness or chronic condition. Our Molina Guided Care team takes a personalized approach to your disease or illness. Our focus is to reduce pain, stress, and confusion. We want to get to know you on a personal level. We listen to what you want so you can keep your independence.

In short, we focus on giving you and your family the best quality of life possible.
Molina Guided Care may be available to those who have Medicare Advantage or who have both Medicare and Medicaid, also known as D-SNP (Dual Eligible – Special Needs Plan).

Providing Comfort, Care, and Freedom

When is Molina Guided Care helpful, and how to start treatment? When is Molina Guided Care helpful, and how to start treatment?

Molina Guided Care is for people who have serious diseases or illnesses that need special care and attention on a regular basis. The Molina Guided Care team is here to help you at home through in-person and online appointments. On this team, there can be doctors, nurses, social workers, spiritual advisors, and other types of experts. Together, they work on writing a treatment plan that helps with the physical, emotional, and spiritual problems that come with being sick.

Cancer, liver disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), AIDS, advanced dementia, or a mix of serious conditions like diabetes or a stroke are among the most common diagnoses.

Your primary care physician (PCP) can refer you to a Molina Guided Care provider. Talk to your PCP if you or someone you care about has a serious illness or chronic condition. Your PCP can tell you if your condition qualifies for Molina Guided Care.

Benefits of starting care early Benefits of starting care early

The sooner you see the need for Molina Guided Care and begin treatment, the better this is for you. People that start treatment sooner can see improved symptoms and a longer lifespan. Other advantages are:

  • Improved quality of life: Molina Guided Care can make your life better because it focuses on you and taking care of the symptoms of your specific illness.
  • Reduced hospitalizations: Molina Guided Care can help manage your symptoms to keep you at home instead of the hospital or emergency room. This saves you from the cost and stress of a hospital visit.
  • Fewer unnecessary or unwanted treatments: Molina Guided Care helps you make well-informed decisions about your care. We can tell you about treatments or tests that you don’t need or want. This saves you time, money, and stress because it lets you focus on more important things.
  • Better coordination of care: Molina Guided Care teams are usually made up of different types of health care professionals who work together to make sure you get the best care. So it is easier for you to decide what to do.
  • Support for families: You and your family get the same help and education from the Molina Guided Care team. This helps your family members or caregivers understand how to best support you as you manage your illness together.
  • Emotional and spiritual care: Molina Guided Care can help you and your family feel better emotionally and spiritually, which is especially important when someone is sick.

Overall, Molina Guided Care can improve your quality of life, lower the cost of health care, and help families work together.

Talking about the need for care with a member Talking about the need for care with a member

Molina Guided Care lets you decide what you want to get out of treatment and what to do when it is no longer working. We think about what you want. Here are some tips to help in a conversation about starting Molina Guided Care:

  • Ask what the member understands about their current health condition(s)
  • Plan what you want to say, but be ready to adapt to where the conversation goes
  • Make the patient feel at ease in a quiet setting
  • Be patient and talk about their concerns
  • Keep it positive and remind the patient that Molina Guided Care keeps them as safe and healthy as possible
Making the decision for a member Making the decision for a member

Sometimes a member is not able to make the decision to start Molina Guided Care themselves. In these cases, a family member will need to know the member’s benefits. In other cases, a family member may need the member’s approval to make healthcare choices.

The need to get answers to questions on the member’s behalf may involve Protected Health Information (PHI). This calls for certain signed consent forms. Some examples of these forms are listed below:

  • Verbal Consent (Up to 14 days only): This is given by the member who has the capacity to do so. It can be done in person or over the phone and must be done by the member. This lets the caregiver get information about the member that is relevant to the caregiver’s involvement. It does not allow the caregiver to make any changes.
  • Protected Health Information Form (PHI) The member or their Personal Representative can complete this form. This lets molina share PHI but does not require them to do so.
  • Appointment of Representative Form (CMS-1696) - An appointed representative is a family member, friend, doctor, or another person. They are approved to act on your behalf in filing a grievance, coverage determination or appeal. This form is for Medicare members.
  • Durable Medical Power of Attorney (POA): This document is recommended for all members and can allow someone else to make a healthcare decision on behalf of the member, considering the member’s wishes. This document must be signed by a person who has the capacity to make medical decisions. This document is generally used when the member cannot make decisions for themselves. The form giving Medical POA comes from your state. The signed Medical POA makes a person the Personal Representative to the member as stated by HIPAA rules. Forms for this type of POA are different for each state. You can find the right form by going to the bottom of this page and choosing your state. This will take you to the page on your Molina Healthcare website with the state form link.
    • Note: This is different from an advance directive (AD). An AD makes clear a member’s medical wishes but does not appoint a person to make healthcare choices.

This information does not, and is not intended to, constitute legal advice. Readers of this information should talk to an attorney to get advice with respect to any legal matter.

Helping you so you can help others


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