Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Optional State Plan Services: Targeted Case Management


Until 1986, the only practical avenue available for a state to secure Medicaid funding for freestanding case management services (i.e., case management services not delivered as part of some other service or conducted in conjunction with the state’s operation of its Medicaid program) was through an HCBS waiver program. Coverage of case management services in HCBS waiver programs was nearly universal at that time.

In 1986, Congress created an option for states to cover what were termed “targeted case management” services under their State Plan.34 The expressed statutory purpose of targeted case management is to assist Medicaid recipients in “gaining access to needed medical, social, educational, and other services.” This optional benefit is exempt from the comparability requirement to make services available to all recipients. A state is permitted to amend its State Plan to cover case management services for one or more specified groups of Medicaid recipients(hence the term targeted). It may also offer these services on a less-than-statewide basis (through a State Plan amendment instead of securing a waiver).35

Given the expressed statutory purpose of the benefit--to assist individuals to obtain services from a wide variety of public and private programs--the scope of services a state may furnish through the targeted case management option is relatively broad. In addition to assessment and service/support planning, referrals, and monitoring the delivery of services and supports to ensure they are meeting a beneficiary’s needs, covered activities include assistance in obtaining food stamps, emergency housing, or legal services. (See Chapter 4 for more information about this benefit.)

View full report


"primer10.pdf" (pdf, 2.08Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®