Medicaid Case Management Services in Texas: A Course for Case Managers

Medicaid and Case Management

photo of medicaid puzzle piece being put in place

The expansion of Medicaid managed care in Texas has changed the way many Medicaid recipients receive case management services. Medicaid programs offer various methods of case management or service coordination. What has not changed is the vital role of a case manager or service coordinator to assist with client needs.

Your role as a case manager is crucial. Providing case management services for clients and families helps ensure they find and obtain services they have difficulty finding on their own. In the many ways you provide assistance and support, you help alleviate barriers to health-care services and enable your clients to move through the continuum of health care.

Case managers help to address interrelated medical, social, developmental, behavioral, educational, and financial needs to achieve the best health outcomes for a child, youth, or pregnant woman.

A good case manager has a toolbox filled with a wealth of information about services and how to access them, including:

  • Medical services
  • Specialty referrals
  • Mental health services
  • Education and school services
  • Psychosocial services
  • Durable medical equipment (DME) and supplies
  • Financial assistance
  • Medical transportation

The Power of Versatility

You wear many hats as case managers. You are coordinators, facilitators, mentors, and advocates. Your work includes teaching clients and families how to navigate health-care, social service, and educational systems to find and get the services they need.

News You Can Use

This course provides an overview of how case managers provide services to clients enrolled in traditional fee-for-service (FFS) Medicaid or Medicaid managed care organizations (MCOs). The course focuses on the Case Management for Children and Pregnant Women program and serves as an orientation for the required case manager training.

Who Benefits Most from Care Coordination

Health-care providers may observe or diagnose multiple or complex health conditions in a patient. Care coordination can benefit individuals experiencing:

  • Developmental delays
  • Complex needs that require specialty referrals and medical equipment or supplies
  • Mental health or behavioral issues
  • Issues at home that make it difficult to follow a medical regimen, such as lack of financial or transportation resources
  • Difficulties in school