Case Management for Children and Pregnant Women is a Texas Medicaid benefit for eligible patients who have medical-related needs that might affect their health care. The patients must be eligible for Medicaid and be either:
- A child age birth through 20 years with a health condition or at risk for a medical condition, illness, injury or disability that limits the child’s ability to function or engage in activities or social roles compared to healthy same-age peers, or
- A pregnant woman of any age with a medical or psychosocial condition that increases the risk for pregnancy or postpartum complications.
Many of these patients have complex needs that range from specialty referrals and medical equipment/supplies to educational, psychosocial, financial and transportation services. Case managers, who are licensed social workers or registered nurses, help patients and their families connect with these services.
You can access resources that provide information on case management services from this page.
Health-care providers play an important role in referring their patients with such needs for case management services. Effective September 1, 2022, patients enrolled in Medicaid managed care receive case management services through their managed care organization (MCO). Refer patients enrolled in Medicaid managed care to contact their MCO using the phone number on the back of their insurance MCO card. To make a referral for a patient enrolled in fee-for-service Medicaid, call 1-877-THSTEPS or obtain a Referral Form.
Online Provider Training
Medicaid Case Management Services in Texas: A Course for Case Managers
Learn how case managers support Medicaid services for children and families in Texas. This course provides guidance about how case managers work with various state programs, including traditional fee-for-service Medicaid and managed care organizations.
* Required course for Case Management for Children and Pregnant Women case managers.
Case Management Services in Texas
Integrate case management services to support patients and families dealing with special health-care needs or chronic conditions. Includes information about eligibility for Case Management for Children and Pregnant Women.
* Required course for MCO service coordinators. A certificate will be provided upon course completion.
In-Person Provider Training
The pre and post-test listed below should only be completed by case management providers that have been approved by DSHS and are enrolled in or have attended the in-person case management training.
Resources for Providers
The printed materials below are available for download in PDF format and can be ordered here.
Case Management Brochure
Case Management Poster
Flyer for Case Management Provider Recruitment
Resources for Personal Care Services
Personal Care Services (PCS) is a Medicaid benefit that helps clients with everyday tasks. These tasks are called activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
For more information, or for questions about the PCS benefit, call the Texas Medicaid & Healthcare Partnership (TMHP) PCS Client Line toll free at 1-888-276-0702, Monday through Friday, 7 a.m. to 7 p.m.
Personal Care Services (PCS) Brochure