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Case Management Services Offered at SNAHC

With a wide variety of programs and services offered at SNAHC, we seek to help patients efficiently find what they are looking for to reach their wellness goals.  Case management services are open to SNAHC patients through Pathways (Whole Person Care Program) or HHP (Health Homes Program).

Currently, there are 8 case managers ready to support patients who are participating in our Pathways and HHP programs.  Case managers check on patient program eligibility, and reach out to patients for enrollment.  SNAHC providers can refer patients to join HHP.  Pathways referrals are currently unavailable, but the case management department continues to support those who are currently enrolled.

Case managers provide the following services:

  • Appointment accompaniment
  • Appointment scheduling
  • Coordination of external specialty care
  • Coordination of Behavioral Health Care
  • Case Conferencing with patient’s Community Health Workers and Housing agencies
  • Health Plan and Medi-Cal Transportation
  • Housing assistance through Sacramento Covered. SNAHC does not provide any direct housing assistance.
  • Coordination with Pathways Service Partners through a shared portal
  • Patient engagement and follow-up
  • Patient-driven goal setting

Patient Testimony

At SNAHC, we value the healing that comes from embracing trusted relationships with members of your health home.  Our case management team furthers this sense of belonging.

In March of 2020, a Native patient arrived at our health center feeling shaky, overwhelmed, and exhibiting low blood pressure.  He expressed that he was homeless and had been using drugs.  Our case management team involved themselves by staying with the patient until they found him shelter for the night through HOPE Cooperative.  He was later referred into the Pathways program, which connected him with social services and health care organizations which could help him further with medical, housing, and transportation needs.

The first few months in the Pathways program were difficult for the patient.  He was intermittently housed through Sacramento Covered, but had trouble settling in as he was often traveling, making it difficult to stay consistent with his housing plan.  While he originally came to SNAHC for support and was communicating with his case manager frequently, he was also not following his care plan, missing appointments, and was not ready to address his substance use issues.

In October, a shift occurred.  The patient came in to SNAHC once more, sick and exhausted, stating that he was ready for a change in his life.  The patient was sent to the hospital for psychiatric evaluation and detox.  He was then re-connected with his Native Behavioral Health counselor at SNAHC and enrolled in a residential treatment program, of which he is currently apart of.

When our case managers spoke with the patient in November of 2020, he said he was doing well and wanted to continue with another residential treatment stay.  The patient has now accomplished 80 days of sobriety!  He stated that he was grateful that SNAHC did not give up on him and he was blessed to have our support. The patient will resume working with Sacramento Covered for housing support when his residential treatment is completed.

The patient’s immense resiliency, combined with SNAHC’s support, meant he was able to carry out his goals of sobriety. The SNAHC case management team will stay by his side and support him as he continues his wellness journey.

SNAHC has become his health home, his community, and his safe place. We are proud to serve diverse community members through our case management services and meet them where they are to advance in their wellness journeys.


Sacramento Native American Health Center is a non-profit 501(c)(3) Federally Qualified Health Center committed to continue and share the legacy of a healthy American Indian / Alaska Native community based on cultural values delivered through a traditional, innovative and accessible patient-centered health home. SNAHC offers primary care, oral health, behavioral health, specialty, and supportive services in midtown Sacramento. We are open to all, and all are welcome. For more information on SNAHC, visit or call 916-341-0575 for an appointment.

Jeanine Gaines



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