Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Case Management for Children and Pregnant Women (CPW) is a benefit of Texas Medicaid that provides health-related case management to children 20 years of age or younger who have a health condition or health risk, and pregnant women of any age with a high-risk condition. CPW case managers are advocates who work with their clients to find solutions to health-related issues and help them overcome barriers to service.
CPW case managers connect their clients with necessary health-related resources, including medical, social, or educational services. Services a CPW case manager might perform include helping an individual and their family with:
- Finding a counselor.
- Working on school or education issues.
- Making community referrals.
Medicaid providers eligible to enroll as CPW case managers include:
- Registered nurses (RNs)
- Licensed social workers (LSWs)
- Federally Qualified Health Centers (FQHCs)
Additional provider criteria and benefit information can be found in the current version of the Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Handbook, Section 3 “Case Management for Children and Pregnant Women”.
Eligible providers in Medicaid rural service areas, including El Paso, Lubbock, Medicaid Rural Service Area West, Nueces, and Jefferson, are highly encouraged to enroll as CPW case managers.
To learn more about becoming a CPW case manager, refer to the Case Management for Children and Pregnant Women (CPW) Services quick reference guide (QRG) on the TMHP website.
For more information, call the TMHP Contact Center at 800-925-9126.