Medicaid Benefits: Online Database

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Benefits by Service: Targeted Case Management (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 1

No: 49

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes			Services provided for multiple populations - See service-specific FN	Negotiated rate	CN
Alaska
Yes				Fee for service	CN
Arizona
Yes				Capitated rate	CN & MN
Arkansas
Yes				Fee for service, negotiated rate or cost based payment	CN & MN
California
Yes				Cost based payment	CN & MN
Colorado
Yes				Fee for service or negotiated rate	CN
Connecticut
Yes				Negotiated rate	CN & MN
Delaware
No
District of Columbia
Yes			Quantity limits vary by type of service	Fee for service	CN & MN
Florida
Yes			Quantity and frequency limits vary by service	Fee for service or contracted rate	CN & MN
Georgia
Yes			Quantity and frequency limits vary by group served	Fee for service or negotiated rate	CN & MN
Hawaii
Yes				Negotiated rate	CN & MN
Idaho
Yes		Yes	Services limited to Enhanced Plan, quantity and frequency limits vary by group served	Fee for service	CN
Illinois
Yes			Quantity and frequency limits vary by group served	Fee for service	CN & MN
Indiana
Yes			Quantity and frequency limits vary by group served	Fee for service	CN
Iowa
Yes		Specified services		Prospective cost based rate	CN & MN
Kansas
Yes				Reasonable charge	CN & MN
Kentucky
Yes				Cost based payment	A, B, C & D - See state-specific FN
Louisiana
Yes				Fee for service or monthly rate	CN & MN
Maine
Yes			Coverage limitations vary by setting and provider	Negotiated rate	CN & MN
Maryland
Yes				Fee for service	CN & MN
Massachusetts
Yes				Fee for service or negotiated rate	CN & MN
Michigan
Yes				Fee for service or capitated rate	CN & MN
Minnesota
Yes			B - limited to mental health conditions	Fee for service, cost based payment or negotiated rate	A & B - See state-specific FN
Mississippi
Yes				Fee for service or negotiated rate	CN
Missouri
Yes	$1/day			Fee for service	CN & MN
Montana
Yes				Fee for service	A & B - See state-specific FN
Nebraska
Yes				Fee for service	CN & MN
Nevada
Yes				Prospective cost based rate	CN
New Hampshire
Yes				Fee for service or cost based payment	CN & MN
New Jersey
Yes				Fee for service	CN & MN - See state-specific FN
New Mexico
Yes				Fee for service	CN
New York
Yes				Fee for service	CN & MN
North Carolina
Yes				Fee for service	CN & MN
North Dakota
Yes				Fee for service	CN & MN
Ohio
Yes				Fee for service	CN
Oklahoma
Yes			Quantity and frequency limits vary by group served	Fee for service	CN
Oregon
Yes				Fee for service or cost based payment	A - See state-specific FN
Pennsylvania
Yes			Varies by targeted group	Fee for service	CN & MN
Rhode Island
Yes				Fee for service	CN & MN - see state-specific FN
South Carolina
Yes				Cost based payment	CN
South Dakota
Yes				Prospective cost based rate	CN
Tennessee
Yes					A & B - See state-specific FN
Texas
Yes		Yes		Cost based payment	CN & MN
Utah
Yes				Fee for service	A & B - See state-specific FN
Vermont
Yes				Fee for service or cost based payment	A & B - See state-specific FN
Virginia
Yes			Limits vary by population group served	Fee for service	CN & MN
Washington
Yes			Coverage parameters vary by condition and need	Fee for service, capitated rate or cost based payment	CN & MN
West Virginia
Yes		Yes		Prospective cost based rate	A & B
Wisconsin
Yes				Fee for service, per diem or percentage of charge	CN & MN
Wyoming
Yes				Fee for service	CN
American Samoa
No
Guam
No
Northern Mariana Islands
No
Puerto Rico
Yes			Limited to services rendered by health plan staff	Capitated payment	CN & MN
Virgin Islands
No

Definition/Notes: Link to Targeted Case Management Footnote


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