Care Management

Care management, which is not recognized as a reimbursable service under Medicaid, refers to programs that seek to help patients achieve an optimal level of wellness, improve coordination of care, and engage beneficiaries and their support systems in a collaborative process designed to manage medical, social, and mental health conditions more effectively.8 Care management programs encompass a broad range of services, that can include distribution of provider and patient educational materials or in-person and telephonic communication between beneficiaries and nurse care managers or social service specialists. As with some disease management programs, states may target their care management programs to Medicaid beneficiaries with specific diseases or to those considered high-risk or high-cost.9 Alternatively, they may take a “population-based” approach, implementing care management broadly, but using different strategies for different subgroups based on their needs. States can implement care management programs by contracting with external organizations, administering care management directly using state staff, or adopting a hybrid of the two models. Care management can be implemented in either a fee-for-service or a risk-based managed care context. Some states link Medicaid care management with a primary care case management program or a medical home initiative.