MTCM
What is Medicaid Targeted Care Management
Medicaid Targeted Case Management (MTCM) services are those functions and activities of care coordination which assist eligible members with access to needed medical, social, psychosocial, educational, financial, and other services for health-related social needs required to support the member’s maximum, independent functioning in the community
The primary focus of MTCM is to help clients navigate various healthcare and social services systems, ensuring they receive comprehensive support to achieve their goals and enhance their overall well-being. This service is particularly beneficial for individuals who require multiple health services and have difficulty accessing or sustaining services independently.
Goals of MTCM
MTCM aims to prevent vulnerable clients from falling through the cracks in the human services system and not receiving adequate care. By providing stability, improving quality of life, and reducing recidivism, MTCM helps individuals with disabilities or chronic illnesses thrive in their communities
- Ensure that the changing needs of Medicaid-eligible individuals are addressed on an ongoing basis.
- Empowering the member to maintain and sustain their most optimal level of functioning independently upon completion of MTCM services
- Provide appropriate choices among the widest array of options for meeting those needs.
- Remove barriers to treatment by addressing social, educational, and employment needs.
- Help clients find a support system and connect with services within their community.
- Assist parents in becoming their children’s most prominent advocates.
- Develop plans to help tackle situations, manage stress, and reach goals.
How Can Tailored Care Management Help?
Members receive individualized support and family/caregivers are assisted to address areas that may affect health and well-being, such as finding appropriate resources for housing, employment, food insecurity, and more.
Your Case Manager is your sole contact to coordinate and manage all of
your healthcare needs.
How can MTCM help?
ü Seeing a doctor |
ü Getting disability (SSI, RSDI) |
ü Getting food |
ü Applying for food stamps |
ü Making appointments |
ü Getting a ride to see a doctor |
ü Physically caring for myself |
ü Doing what the doctor tells me to do |
ü Getting clothing |
ü Finding a place to live |
ü Paying bills |
ü Getting help with power bill |
ü Finding a job |
ü Stopping people from taking advantage of me |
ü With certain issues because I cannot hear or see |
ü Quitting a drug habit |
ü Making decisions |
ü Help with school work |
ü Learning to read |
ü Sadness, loss, and grief |
ü Making healthy food choices |
Who is Eligible?
Medicaid Targeted Case Management (MTCM) services are designed to assist specific groups of individuals who require comprehensive support to navigate complex healthcare and social service systems.
MTCM includes only services to individuals who are residing in a community setting OR transitioning to a community setting following an institutional stay.
To be eligible for MTCM, an individual must be enrolled in Medicaid, and meet all of the following criteria:
- Meet eligibility criteria for one of the target populations
- Demonstrate motivation for receiving support in accessing services and be capable of benefiting from this support;
- Be able to participate in the planning process, or if applicable, a responsible party must participate on behalf of the member; and
- A well-defined clinical rationale is documented in the initial referral that explains why the member requires assistance in accessing supportive services due to their specific needs.
- Each member must sign the Agreement to Participate in MTCM Services form. If the member is between ages 0–16, the Parent/Guardian/Caregiver must sign the Agreement to Participate in MTCM Services form.
Target Populations
These services focus on populations that face significant challenges in accessing and coordinating the care they need. The following groups are typically eligible for targeted case management
- Individuals with intellectual and related disabilities
- At-risk children
- Adults with serious and persistent mental illness
- At-risk pregnant women and infants
- Individuals with a psychoactive substance disorder
- Individuals at risk for genetic disorders
- Individuals with head and spinal cord Injuries and related disabilities
- Individuals with sensory impairments
Adults with functional impairments
Key Components of MTCM
MTCM is a comprehensive approach to support individuals with complex needs. The core components of MTCM are essential to its effectiveness, encompassing assessment, planning, facilitation, and advocacy. These elements work together to ensure that clients receive the necessary support and services to improve their overall well-being.
Assessment
The initial step in MTCM is assessment, which involves a thorough evaluation of the client’s needs, strengths, and preferences. Case Managers gather detailed information to understand the individual’s current situation, including their health status, social circumstances, and any barriers they may face. This evaluation sets the stage for a tailored approach to service delivery, ensuring that every aspect of the client’s life is taken into consideration.
During the assessment phase, Case Managers use various tools and techniques to collect relevant information. They may conduct interviews with the client and their support system, review medical records, and consult with other healthcare professionals. The assessment process helps identify the specific areas where MTCM services can have the most significant impact on improving the client’s quality of life.
Planning
Once the assessment is complete, the process moves to planning. This crucial step involves developing an individualized service plan that outlines specific goals and strategies to achieve them. The plan is crafted collaboratively with the client, ensuring their input and preferences are at the forefront. This person-centered approach helps to empower the client and increase their engagement in the process.
The service plan is designed to be flexible and dynamic, ready to adapt to the evolving needs of the client over time. It typically includes short-term and long-term goals, as well as specific actions and interventions to address the identified needs. The plan also outlines the roles and responsibilities of the case manager, the client, and other involved parties in achieving these goals.
Problem Solving
Problem-Solving is a vital component of MTCM and a primary role of the assigned Case Manager. It involves representing and standing up for the client’s rights and interests as well as addressing the multifaceted challenges faced by their clients and work towards improving their overall health and well-being.
Case Managers may intervene in situations where clients face discrimination, ensuring they receive fair and equal treatment. Case Managers also provide advocacy, which involves empowering clients to advocate for themselves, strengthening their ability to navigate various systems confidently. Advocacy is particularly important for vulnerable populations, such as those with serious mental illnesses or children with severe emotional disturbances, who may struggle to navigate complex systems on their own.
Through problem solving, Case Managers work to ensure that clients receive the services and support they need to achieve their goals. This may involve communicating with healthcare providers, insurance companies, or social service agencies on behalf of the client
Identification of and Connection to Needed Resources
Identification of and connection to needed resources is a key component of MTCM that focuses on helping clients access and navigate various services and resources. Case Managers act as liaisons between clients and service providers, coordinating care across different systems and ensuring seamless transitions between services.
This component involves activities such as making referrals to appropriate providers, arranging appointments, and coordinating transportation when necessary. Case Managers also work to remove barriers that may prevent clients from accessing needed services, such as language barriers or lack of information. By facilitating connections and streamlining processes, Case Managers help clients receive timely and appropriate care
Benefits of MTCM
MTCM offers numerous advantages for individuals with complex needs, healthcare systems, and society as a whole. This comprehensive approach to case management has a significant impact on improving outcomes for vulnerable populations, particularly within the Medicaid system
Improved Access to Services
One of the primary benefits of Medicaid Targeted Case Management is its ability to enhance access to essential services. Case Managers assist individuals in navigating the often-complicated healthcare and social services landscape, ensuring they receive the comprehensive support necessary to meet their needs. By identifying and removing barriers to treatment, MTCM helps clients access medical, social, educational, and other support services that are crucial for their well-being.
MTCM Case Managers work closely with clients to develop personalized care plans that outline specific goals and strategies. This tailored approach helps to empower clients and increase their engagement in the process of accessing necessary resources and services. By facilitating connections and streamlining processes, Case Managers ensure that clients receive timely and appropriate care, ultimately leading to better health outcomes
Enhanced Care Coordination
MTCM plays a vital role in coordinating care across various life domains, including healthcare, housing, transportation, legal issues, finances, and employment. This comprehensive approach ensures that all aspects of an individual’s needs are addressed efficiently and effectively. Case Managers act as liaisons between individuals we support and service providers, coordinating care across different systems and ensuring seamless transitions between services.
The enhanced care coordination provided by MTCM is particularly beneficial for individuals with multiple chronic conditions or complex health needs. By facilitating communication among healthcare providers, social services, and other support systems, case managers help to prevent fragmentation of care and reduce the risk of gaps in service delivery
Enhanced Care Coordination
MTCM plays a vital role in coordinating care across various life domains, including healthcare, housing, transportation, legal issues, finances, and employment. This comprehensive approach ensures that all aspects of an individual’s needs are addressed efficiently and effectively. Case Managers act as liaisons between individuals we support and service providers, coordinating care across different systems and ensuring seamless transitions between services.
The enhanced care coordination provided by MTCM is particularly beneficial for individuals with multiple chronic conditions or complex health needs. By facilitating communication among healthcare providers, social services, and other support systems, case managers help to prevent fragmentation of care and reduce the risk of gaps in service delivery.
Better Health Outcomes
MTCM has been shown to have a positive impact on health outcomes for individuals with complex needs. Studies have demonstrated that MTCM can lead to reduced mortality rates, decreased hospital readmissions, and improved overall health status. By ensuring that clients receive appropriate and timely care, Case Managers help to prevent complications and exacerbations of chronic conditions.
The individualized approach of MTCM allows for early identification of potential health issues and prompt intervention. This proactive stance helps to prevent minor health concerns from escalating into more serious problems, ultimately contributing to improved health outcomes and enhanced quality of life for clients.
Cost-effectiveness
While MTCM requires an initial investment of resources, it has been shown to be cost-effective in the long run. By improving care coordination and reducing unnecessary healthcare utilization, MTCM can lead to significant cost savings for healthcare systems and payers
Studies have demonstrated that MTCM can result in decreased emergency department visits, reduced hospital readmissions, and lower overall healthcare expenditures. The cost-effectiveness of MTCM is particularly evident in the management of chronic conditions, where improved care coordination can prevent costly complications and reduce the need for expensive interventions
Furthermore, by helping clients access appropriate services and support, MTCM can contribute to improved self-management skills and increased independence. This, in turn, can lead to reduced reliance on costly healthcare services over time, resulting in long-term cost savings for both individuals and healthcare systems.
For inquiries and further assistance, contact our office at 843-456-5045 or Schedule online today to see if you meet criteria for MTCM.