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What changes for Anne when a fall is reported

Anne is dual-eligible, enrolled in a D-SNP, and lives alone. At enrollment she has the plan's supplemental benefits, including an SSBCI grocery allowance that required a chronic condition determination. Then a fall is reported at a routine touchpoint, with no hospital stay. Her needs change, and so does the funding source that covers each one first.

A
The situation: One reported fall touches the plan's supplemental benefit, Medicaid, a state waiver, and a community program. Care manager caseloads run in the hundreds, and the next call may reach a different care manager. Without one record, no one sees what was referred, which funding source covers each need, or how long a referral has been open.
Anne
The Member
Without Anchor

The fall is noted, and the follow-up depends on who picks it up. Doctor and pharmacy trips, help at home, and grab bars each sit with a different program, and none of them shows where the others stand.

Each need waits on a separate process.
With Anchor

Anchor surfaces the needs-based benefits that match the new need and which funding source covers each one first. The care manager refers: Medicaid transportation for doctor and pharmacy trips, a waiver referral for help at home, and a community program for grab bars and a ramp. Her grocery allowance continues.

Services matched to her needs, each on record.
Maria
The Caregiver (Anne's daughter)
Without Anchor

Calls member services, a vendor, and the Medicaid case manager to learn what was ordered for her mother. Each call reaches someone different, and each has part of the answer.

Each call gives part of the answer.
With Anchor

Whichever care manager takes her call sees the same record: each referral made for her mother, its status, and how long it has been open, with each vendor's record accepted and graded.

One record, whoever answers.
Lisa
The Care Manager (150 members)
Without Anchor

Referrals go out by phone, fax, and email. No single place shows which funding source covers the need, whether a referral was received, or the latest cap balance.

Manual steps for every referral.
With Anchor

Sends referrals and confirms services from one screen, within the existing care management workflow. The latest available cap balance shows at referral, and each vendor's record comes back accepted and graded.

One screen replaces fragmented referral processes.
"Anne is one of nearly 12.5 million people enrolled in both Medicare and Medicaid. Anchor orchestrates the non-medical benefits matched to her needs, and every service is substantiated at the member level."
CMS Medicare-Medicaid Coordination Office, Fiscal Year 2025 Report to Congress.
Anne is one member. The record Anchor builds for her is what a plan needs across its dual-eligible population.

Each need, the funding source that covers it first, each referral, and each vendor's record, tied to the member with the criteria and PBP on record. Across a plan's dual-eligible members, that record is how the plan substantiates its non-medical benefit spend at the member level.

Anchor builds that record as the work happens.

The Benefit Stack

What covers each need, and when

As Anne's needs change, the care manager sees the needs-based benefits available to her on one screen. Whichever care manager takes the next call sees the same record, with the criteria and PBP that applied at each determination.

Anne's need
At enrollment
A fall is reported at a routine touchpoint
After the waiver is authorized
Groceries
At enrollmentSSBCI grocery allowance, chronic condition criteria met
A fall is reportedSSBCI grocery allowance
After the waiver is authorizedSSBCI grocery allowance
Doctor and pharmacy trips
At enrollmentNo need documented
A fall is reportedMedicaid non-emergency transportation
After the waiver is authorizedMedicaid non-emergency transportation
Help at home
At enrollmentNo need documented
A fall is reportedWaiver referral submitted, days open on the record
After the waiver is authorizedIn-home homemaker service and emergency home response, Medicaid HCBS waiver
Grab bars and a ramp
At enrollmentNo need documented
A fall is reportedCommunity program, referral documented
After the waiver is authorizedCommunity program, referral documented

What the care manager sees

At enrollment
  • Anne's SSBCI qualification on record, with the benefit criteria and the PBP that applied.
  • The plan's other supplemental benefits, which she has without a determination.

What the care manager sees

A fall is reported
  • The needs-based benefits that match the new need, and which funding source covers each one first.
  • The waiver referral and its days open, against the state's decision window.
  • Every referral to a contracted vendor or a community program, documented as it is made.

What the care manager sees

After the waiver is authorized
  • The waiver services now available, added to what Anne already had, not replacing it.
  • Each referral, its status, and how long it has been open.
  • Each vendor's record, accepted and graded.
On one screen: the needs-based benefits matched to Anne, every referral made for her, and where each one stands. Anchor recommends; the care manager decides. Anchor does not author criteria, determine eligibility, enforce caps, or display plan authorizations. Sequencing never withholds a benefit the member qualifies for.

Illustrative example. Covered services, waiver programs, and referral processes vary by state and plan. This example follows Illinois, where a waiver request is a referral to a state-contracted Care Coordination Unit that decides within 30 days, and where the waiver does not cover home modification, so grab bars and a ramp route to a community program.

Your plan

See how Anchor would work for your plan

Our team walks you through how Anchor would fit your state, member mix, and care management workflow, from a member’s need to a documented service.

Request a walkthrough →

Because Anne Deserves More
Than a Spreadsheet

Anchor orchestrates non-medical benefits for dual-eligible members within existing care management workflows. Every service is substantiated at the member level.

Request a Demo
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Contact

Anchor Care, Inc. · 5227 N 7th Street, Phoenix, AZ 85014

Trust & Security

Trust Center

Last updated: April 2026

Anchor is built for health plans operating in a regulated, high-stakes environment. Our security and compliance posture reflects that responsibility.

HIPAA compliance

Anchor operates as a Business Associate under HIPAA when processing protected health information on behalf of covered entities. We execute Business Associate Agreements (BAAs) with all health plan partners prior to any data exchange. Our systems are designed to support the administrative, physical, and technical safeguards required under the HIPAA Security Rule.

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All data transmitted to and from Anchor's systems is encrypted in transit using TLS 1.2 or higher. Data at rest is encrypted using AES-256. Access to production systems is restricted by role-based access controls and multi-factor authentication.

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Anchor's infrastructure is hosted on HIPAA-eligible cloud services. We maintain audit logs of system access and regularly review access permissions. Penetration testing and vulnerability assessments are conducted on a scheduled basis.

Subprocessors

We maintain a list of subprocessors used in the delivery of our services and update it as our vendor relationships change. Health plan partners may request the current subprocessor list by contacting us directly.

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Anchor maintains a documented incident response plan. In the event of a security incident affecting health plan data, we will notify affected partners in accordance with HIPAA Breach Notification Rule requirements and any applicable contractual obligations.

Certifications & Standards

SOC 2 Type I targeted Q2 2026. SOC 2 Type II targeted Q4 2026. HITRUST r2 certification is on our 2027 roadmap. Anchor operates under HIPAA-compliant data handling practices with encryption in transit and at rest, role-based access controls, and annual third-party security review.

Contact

For security inquiries or to request a BAA, reach us at security@anchorcare.ai or submit a security or compliance inquiry through our contact form. · Anchor Care, Inc. · 5227 N 7th Street, Phoenix, AZ 85014