How to get Medicaid Case Management Services

Navigating the healthcare system can feel overwhelming. You know your adult child needs coordinated care, but figuring out how to get a case manager with Medicaid often seems complex. Below is a clear, two-step path to connect your family with the professional support you need.

1. Secure Medicaid Eligibility

Case management is a service provided to individuals already enrolled in Medicaid. The first and most crucial step is to apply for and be approved for coverage. This can be done in two steps:

• Confirm Eligibility: Medicaid is designed for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. In North Carolina, many individuals with IDD access services through the NC Innovations Waiver (for people who need a higher level of long-term, community-based support) or the 1915(i) program (for those who need certain home- and community-based services but may not meet the same institutional level-of-care criteria). Each state has specific income, resource, and clinical requirements.
  
• Submit Your Application: You can apply for Medicaid at any time; there is no limited enrollment period. The easiest way is to apply through your state’s Medicaid agency, which you can find on the official Medicaid.gov website.

2. Connect with a Case Manager

Once Medicaid eligibility is confirmed, you can actively pursue case management services. A dedicated Medicaid case manager becomes your family’s primary advocate, coordinating the full spectrum of care. Here’s how to connect with a case manager:

• Contact Your Health Plan: If enrolled in a Medicaid managed care plan, your first call should be to them. Ask for a referral to an in-network provider for case management mental health services or IDD support.
• Inquire with Your State Agency: Your state’s Medicaid office or local social services department can also provide a list of qualified agencies and help you initiate the process.

An effective case manager coordinates medical appointments, therapies, and community resources. They are essential for navigating complex needs, including specialized support like behavioral health case management. Their goal is to create a unified care plan that promotes independence and enriches your adult child’s life.

Frequently Asked Questions

What does a case manager actually do?

A case manager is a health and human services professional who helps you and your family navigate the healthcare system. They assess, plan, and coordinate all necessary medical, therapeutic, and social services to ensure your loved one receives holistic, whole-person support.

How do I choose the right case management provider?

Look for an organization with a deep understanding of the IDD community and a comprehensive range of interconnected services. Ask about their approach to personalized care planning and how they collaborate with families. The right partner will feel like a true extension of your support system.

What if my application for services is denied?

If you encounter a denial at any stage, you have the right to appeal the decision. A qualified case management organization can often provide guidance and advocacy to help you navigate the appeals process effectively.

Take the Next Step Toward Coordinated Care

Securing a case manager is a powerful step toward ensuring your adult child has the integrated support they need to thrive. To better understand how this support fits into a long-term plan for independence, we invite you to download our free Guide to Supported Living.