Case Management for Children and Pregnant Women

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.

Making Referrals

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 visit Case Management for Children and Pregnant Women.