TCM services are reimbursable through Medicaid for children as a non-covered benefit under EPSDT when medical necessity is met.
In most cases children under the age of 22 who experience complex needs or experience serious emotional disturbance including chronic mental illness qualify for TCM services. This is inclusive of individuals with substance use disorders and co-occurring mental illness.
These individuals also may experience chronic unmet health-related needs that lead to the use of the Emergency Department, out-of-home placement, or inpatient treatment to manage illness. Targeted Case Managers Coordinate and review services and activities to ensure that the plan continues to meet the wants and needs of the individual. They provide Coordination of care, make referrals for supports and coordinate with external resources. Targeted Case Managers are also responsible for Linking to Services and Resources which addresses the individual's needs and helps them achieve the goals documented in their person-centered plan.
