Case Management

Case management refers to services that assist eligible enrollees to secure medical and other services necessary for appropriate health care treatment. Case management is not the direct provision of care and services, but is often a separate and reimbursable class of services. The services are an optional Medicaid benefit and can include educational, social, and otherwise non-covered health services. Targeted case management (TCM) in Medicaid refers to case management services that are provided to specific populations (e.g., individuals diagnosed with HIV/AIDs or living in a particular county). Relevant Federal Legislation or Regulation: Case Management and Targeted Care Management, Social Security Act § 1915(g). Describes Medicaid case management and TCM services, including assessment of a beneficiary to determine service needs, development of a specific care plan, referral and related activities to help an individual obtain needed services, and monitoring and follow-up activities. 42 C.F.R. § 440.169 and 42 C.F.R. § 441.18. CMS regulations regarding Medicaid case management and targeted case management services.