Georgia Medicaid Targeted Case Management (TCM) Guide (2026)

When a vulnerable Georgian leaves the hospital or juggles a child's many specialists, the person who connects the pieces is often a Medicaid case manager. In Georgia, that service has a formal name. Georgia Medicaid Targeted Case Management (TCM) is an optional Medicaid benefit, authorized under Section 1915(g) of the Social Security Act, that pays for case management for specific groups of people: adults with serious mental illness (SMI), children with serious emotional disturbance (SED), people with intellectual or developmental disabilities (I/DD), people with HIV/AIDS, children with special health care needs (CSHCN), some high-risk pregnant women, and people transitioning out of institutions. It costs the participant nothing. This guide explains who qualifies, who delivers TCM in Georgia, what to expect, and exactly how to get connected.

What Georgia Medicaid Targeted Case Management Is

Targeted Case Management is an optional Medicaid state-plan service authorized by Section 1915(g) of the Social Security Act (42 U.S.C. 1396n(g)). A state can elect to cover case management through a state plan amendment, without a waiver, and can target it to specific classes of people (for example, people with HIV/AIDS, chronic mental illness, or developmental disabilities) or to people who live in specific areas. TCM is one of the few Medicaid services allowed to operate outside the usual statewideness and comparability requirements, which is exactly why Georgia can build separate programs around separate populations.1

Federal regulation defines case management as four components of help in gaining access to services: a comprehensive assessment (and periodic reassessment) of the person's needs; development and revision of a specific care plan; referral and related activities to link the person to services; and monitoring and follow-up, including at least one monitoring contact a year. The same federal rules bound what TCM is not. It is not a direct service, so the case manager cannot bill TCM for delivering the underlying medical, social, or educational service the person was referred to. It must be voluntary. The person keeps free choice of any qualified provider. And it cannot duplicate payments made under another program authority.2

In plain terms, the case manager assigned to you at a Community Service Board, a Ryan White agency, or the Department of Public Health is doing a defined Medicaid job: assessing needs, writing and updating a plan, connecting you to the right services, and checking that the plan is working.

Who Georgia Medicaid TCM Covers: The Target Populations

Georgia operates TCM for several distinct populations defined in its Medicaid State Plan. Each population has its own qualification criteria, its own provider type, and its own operating pattern, but all of them rest on the same Section 1915(g) authority and the same four-component definition.1

Adults With Serious Mental Illness (SMI)

The SMI population includes adults age 18 and over with a qualifying mental health diagnosis (schizophrenia, schizoaffective disorder, bipolar disorder, major depression with psychotic features, severe depression or anxiety with functional impairment, severe PTSD, and certain others) plus qualifying functional impairment established through assessment.

The primary providers are Georgia's Community Service Boards (CSBs), the regional behavioral health entities serving communities across the state. CSB SMI case managers are typically master's-level clinicians (LCSW, LPC, LMFT, psychologist) or other qualified mental health professionals. Service intensity ranges from monthly contact for stable individuals to weekly or more frequent contact during a crisis or transition.

Activities include comprehensive psychosocial assessment and reassessment, service-plan development, coordination with the prescribing psychiatrist and therapy providers, medication adherence support (without direct administration), crisis coordination including with mobile crisis teams, housing and employment-support coordination, coordination with primary care and with co-occurring substance use treatment, help with SSI/SSDI and food and utility assistance, and discharge planning after a hospitalization.

SMI TCM is distinct from Assertive Community Treatment (ACT), a more intensive team-based service for people with the most severe and persistent mental illness. ACT teams provide the case-management functions plus direct psychiatric, nursing, and substance use services within the team, and ACT and TCM are generally not billed at the same time for the same person.

Children With Serious Emotional Disturbance (SED)

The SED population includes children and adolescents under age 21 with a qualifying mental health diagnosis and qualifying functional impairment (for example, disruptive mood dysregulation disorder, major depression, bipolar disorder, PTSD, severe anxiety or conduct disorder, or autism spectrum disorder with severe behavioral health needs).

SED TCM is delivered by CSBs and other DBHDD-contracted providers, and is integrated where appropriate with the wraparound model, an evidence-based approach to coordinating care across family, school, mental health, and community systems. Activities include child and family assessment, service planning with family input, coordination with the school district (including IEP and Section 504 plans), coordination with therapy and psychiatric medication providers, coordination with juvenile justice or the Division of Family and Children Services (DFCS) where relevant, family support and respite coordination, crisis response including through the Georgia Crisis and Access Line (GCAL), and transition support across developmental milestones.

Individuals With Intellectual or Developmental Disabilities (I/DD)

The I/DD population includes people of any age whose qualifying disability (intellectual disability, autism spectrum disorder, cerebral palsy, epilepsy with significant impairment, and others) originated before age 22 and results in substantial functional limitations.

For people enrolled in the New Options Waiver (NOW) or the Comprehensive Supports Waiver (COMP), the support coordinator's case management is funded as a Section 1915(c) waiver service rather than as 1915(g) TCM. The functional work is largely the same and the support coordinator may be the same person; only the billing authority differs. For people not yet in a waiver, standalone I/DD TCM may apply. This distinction matters because of Georgia's planning list: as of September 2025, roughly 7,900 Georgians were waiting for a NOW or COMP waiver slot, about 38% of them under age 22, and about 43% of those over 22 had waited at least six years. Many people on that list rely on standalone case management while they wait.3

DBHDD-contracted support coordination agencies deliver both waiver support coordination and standalone I/DD TCM. Activities include assessment of intellectual and adaptive functioning, development of an Individual Service Plan (ISP) or comparable care plan, coordination with direct support professionals, day programs, supported employment, and residential supports, behavioral and therapy coordination, family and respite support, and transition planning.

Individuals With HIV/AIDS

The HIV/AIDS population includes people diagnosed with HIV or AIDS who need case management to support treatment, antiretroviral medication adherence, and access to ancillary services. This role is critical because medication adherence drives viral suppression and prevents transmission, and because HIV often arrives alongside significant social and behavioral health needs.

HIV/AIDS case management in Georgia is closely integrated with the federal Ryan White HIV/AIDS Program. The Department of Public Health administers Ryan White Part B. Many HIV case managers are funded through a combination of Medicaid TCM (for people with Medicaid) and Ryan White Part B grant dollars (for people without Medicaid, or for activities Medicaid does not cover). Because Ryan White is the payer of last resort by federal law, Medicaid bills first for Medicaid-eligible individuals and Ryan White covers the gaps, so case managers track time carefully to attribute it to the right funder.

Activities include comprehensive assessment, antiretroviral adherence support, coordination with the HIV care provider and pharmacy, coordination with the AIDS Drug Assistance Program (ADAP) for medication access, coordination with primary care, behavioral health and substance use coordination, housing help including coordination with Housing Opportunities for Persons With AIDS (HOPWA), food assistance, dental coordination, peer support, disclosure support, and end-of-life planning where relevant.

Children With Special Health Care Needs (CSHCN)

The CSHCN population includes children under age 21 with qualifying chronic medical conditions, complex care needs, or significant functional limitations. The Georgia Department of Public Health operates the Children with Special Health Care Needs program, funded through a mix of the federal Maternal and Child Health Bureau Title V block grant and Medicaid TCM for Medicaid-eligible children. Qualifying conditions include congenital and complex chronic conditions, severe developmental disabilities, conditions requiring multi-specialty coordination, and conditions requiring durable medical equipment.

CSHCN case managers are typically registered nurses, licensed clinical social workers, or other qualified pediatric clinicians. Activities include comprehensive assessment, coordination across the child's specialists and the medical-home pediatrician, coordination with durable medical equipment vendors, coordination with the school district (IEP, Section 504, school nursing) and with Babies Can't Wait early intervention for children under three, family support, insurance coordination for families with both Medicaid and private coverage, and transition planning to adult care.

High-Risk Pregnant Women

Georgia covers TCM for some categories of high-risk pregnant women under State Plan provisions. The population includes women with conditions such as gestational diabetes, hypertensive disorders of pregnancy, multiple gestation, a history of preterm delivery, substance use during pregnancy, severe mental illness during pregnancy, and severe chronic medical conditions.

For most pregnant Medicaid members, who are enrolled in a Care Management Organization (CMO), high-risk pregnancy case management is usually delivered through CMO care management or Intensive Care Management and funded through the CMO's capitation rather than billed separately as TCM. Standalone TCM applies more often in fee-for-service Medicaid. Either way, the work can continue well past delivery: Georgia extended postpartum Medicaid coverage to a full 12 months after the end of pregnancy effective November 1, 2022, so case management can follow a participant across the entire 12-month postpartum period.4 That extension uses the permanent state option that Congress created under Section 1902(e)(16) of the Social Security Act and made permanent through the Consolidated Appropriations Act, 2023.5

Activities include prenatal care coordination, coordination with maternal-fetal medicine specialists, behavioral health and substance use coordination, nutrition coordination including WIC, non-emergency medical transportation (NEMT) coordination for prenatal appointments, postpartum care coordination, and linkage to home visiting and postpartum family planning.

Individuals Transitioning From Institutions

Federal law allows TCM during the days immediately before an institutional discharge so that transition planning can begin early. Under the implementing rule, a person leaving a long-term institutional stay of 180 consecutive days or longer may be treated as transitioning to the community during the last 60 consecutive days before discharge; for a short-term stay of less than 180 days, the window is the last 14 days before discharge. (People aged 22 to 64 in an Institution for Mental Diseases, and inmates of public institutions, are excluded.)6

Georgia's Olmstead Settlement Agreement with the U.S. Department of Justice required the state to expand intensive community-based case management for people leaving state psychiatric hospitals and large I/DD institutions, as part of its compliance with the Americans with Disabilities Act and the Olmstead v. L.C. decision, which requires states to serve people with disabilities in the most integrated setting appropriate. Georgia's Money Follows the Person demonstration, run by the Department of Community Health with DBHDD and the Division of Aging Services, similarly transitions people out of institutions into the community using the state's Medicaid waivers.7 The settlement-related Intensive Case Management teams operate with structural similarities to ACT but are funded and tracked separately, with performance metrics reported to a court-appointed reviewer.

How Families Qualify and Get Connected

In every case, the individual or family can self-refer. A provider referral is not required, and TCM is voluntary, so you can start, decline, or stop at any time without affecting your other Medicaid services.2 The pathway depends on the population:

• SMI or SED: Contact your regional Community Service Board. Each CSB covers a defined catchment area. Call DBHDD Intake at 1-888-273-1414 for help finding the right CSB. A qualified mental health professional then completes an assessment establishing diagnosis and functional impairment.
• I/DD (or NOW/COMP support coordination): Call DBHDD Intake at 1-888-273-1414. Waiver applications are submitted online through the Georgia Collaborative ASO's Individual IDD Connects portal, and your DBHDD Regional Field Office can help if you need it.8
• HIV/AIDS: Contact your regional Ryan White Part B provider, or call DPH for a referral. Availability varies by region.
• CSHCN: Call the DPH Children with Special Health Care Needs program at 1-855-707-8277 for an intake assessment.
• High-risk pregnancy: Ask your obstetrician for a referral. If you are enrolled in a CMO, call its care-management line: Amerigroup Community Care 1-800-600-4441, CareSource 1-855-202-0729, or Peach State Health Plan 1-800-704-1484. As of 2026, those three are Georgia Families' only care management organizations.9
• Institutional transition: The discharge planner should begin referrals during the allowed pre-discharge window. You can also contact community providers directly.

What to Expect From Targeted Case Management

Once eligibility is established and you agree to receive TCM, the case manager conducts an initial comprehensive assessment, usually over one or two visits, covering medical, behavioral health, social, family, housing, and financial needs. The case manager then writes a care plan documenting goals, services, providers, contact frequency, and crisis plan, and reviews it with you and, with your consent, your family.

Ongoing contact frequency varies by population and intensity. SMI TCM at a CSB might mean weekly contact for someone newly engaged and monthly contact once stable; CSHCN TCM might mean monthly contact that increases during a care transition; intensive case management after an institutional discharge often involves near-daily contact in the first weeks. Reassessment happens at regular intervals, typically at least annually.2 Crisis response is part of the job: your case manager should respond within the agency's stated window or connect you to crisis services. In Georgia, calls, texts, and chats to 988 are answered around the clock by the Georgia Crisis and Access Line, the state's single entry point for behavioral health crises and mobile crisis dispatch.10

How Georgia Medicaid TCM Compares to Other Authorities

A Georgia Medicaid beneficiary can receive case management under several different authorities. Knowing which one applies tells you which agency to call when something goes wrong, and the non-duplication rule means a single case-management function cannot be billed under two of them at once.2

Georgia operates five active Section 1915(c) HCBS waivers: the Community Care Services Program (CCSP), Service Options Using Resources in Community Environments (SOURCE), the Independent Care Waiver Program (ICWP), the New Options Waiver (NOW), and the Comprehensive Supports Waiver (COMP). Case management inside any of these is paid by the waiver, not as TCM.11 Georgia has not adopted a broad Section 1945 Health Home benefit; comparable functions are handled through HCBS waiver case management, CMO Intensive Care Management, and DBHDD-funded behavioral health case management.

When the same person is eligible under more than one authority, Georgia's State Plan and CMO contracts keep the lines clear by naming a primary case manager, specifying which functions each authority covers, coordinating across case managers through shared planning, and documenting the boundaries in the record. A practical example: an HCBS waiver case manager owns the waiver services, an SMI TCM case manager owns psychiatric care and treatment adherence, and CMO care management coordinates the medical care across the plan's network.

Provider Rules, Billing, and the Compliance Backstory

TCM providers must meet qualifications set in the Georgia State Plan and the DCH and DBHDD provider manuals. Requirements vary by population but generally include a relevant bachelor's or master's degree (social work, psychology, education, nursing, public health), appropriate licensure where applicable (LCSW, LPC, LMFT, RN), and population-specific training. The employing agency must be enrolled as a Medicaid TCM provider with the Department of Community Health.

TCM is billed in short units, with some populations using monthly bundled rates. Documentation has to support the billed time: the date, duration, and nature of each contact; the activities performed (assessment, care planning, referral, monitoring); and outcomes and next steps. Time spent on direct service delivery, agency administration, or supervision cannot be billed as TCM.2

The reason the paperwork is so exacting is a long federal enforcement history. The CMS interim final rule that tightened the case-management definition (published December 4, 2007) was driven by audits, state-plan reviews, and Government Accountability Office findings of improper or excessive TCM billing, including states using contingency-fee consultants to maximize federal dollars. CMS cited concrete examples: one state agency claimed $86.6 million in federal share across fiscal years 2002 and 2003 for unallowable TCM, and in a CMS audit of one county 72% of encounters in a one-year period were billed incorrectly. CMS estimated the rule would cut federal case-management and TCM spending by $1,280 million between fiscal years 2008 and 2012.6 The detailed documentation your case manager keeps is a direct response to that regime, not arbitrary bureaucracy, and it also protects continuity if your case manager changes.

Worked Examples

Aisha, 34, Atlanta, SMI TCM at View Point Health (Gwinnett CSB). Aisha has schizophrenia and a history of psychiatric hospitalizations. After her most recent discharge she was connected to View Point Health for outpatient psychiatric care and TCM. Her case manager, Tonya, a Licensed Clinical Social Worker, completed an assessment over two visits and built a service plan covering medication adherence, housing, peer support, primary care, and family relationships. Tonya helped Aisha apply for SSDI and HUD-subsidized housing and connect with a primary care provider for her hypertension. When Aisha's auditory hallucinations worsened last spring, Tonya worked with the prescriber to adjust her medication and stepped up contact for six weeks. Aisha credits Tonya with helping her avoid another hospitalization.

Marcus, 12, Augusta, SED TCM at Serenity Behavioral Health Systems. Marcus has bipolar disorder and severe anxiety and has been hospitalized twice in two years. His SED case manager, Andrea, a Licensed Professional Counselor, runs a wraparound team that includes Marcus's mother Karen, his school counselor, his prescriber, his therapist, and a parent peer specialist who supports Karen. The team meets monthly to review his IEP, medication response, school attendance, and home behavior plan. Andrea arranges respite for Karen, helped Marcus get into a summer therapeutic camp, and is managing his transition to high school. The wraparound approach has kept Marcus out of the hospital for over a year.

Eleanor, 67, Macon, HIV/AIDS TCM at a Ryan White program. Eleanor was diagnosed with HIV three years ago and is dual eligible for Medicare and Medicaid. Her case manager, Renee, is funded through a mix of Medicaid TCM and Ryan White Part B and tracks her time to keep the funders separate. Renee coordinates Eleanor's HIV care with the infectious disease specialist, her primary and diabetes care, her depression treatment, and her dental care through a Ryan White-funded program, and helped her enroll in HOPWA-funded supportive housing. Eleanor's HIV is well controlled and her overall health has improved.

Jamil, 6, Columbus, CSHCN TCM through DPH. Jamil was born with a complex congenital heart defect, has a feeding tube, and has developmental delays. His mother, Karina, was overwhelmed coordinating cardiology in Atlanta, pulmonology and gastroenterology in Columbus, a durable medical equipment vendor, his special-education preschool, and his pediatrician. After a hospital social worker told her about the CSHCN program, Karina enrolled Jamil. His case manager, Vanessa, a pediatric registered nurse, coordinates his appointments, makes sure records move between providers, attends his IEP meetings, and manages his dual coverage. Karina says Vanessa gives her back hours each week.

Lorraine, 58, Savannah, I/DD TCM. Lorraine has Down syndrome and mild intellectual disability and lives with her daughter Tasha. She is on the NOW/COMP planning list, so she receives standalone I/DD TCM through a DBHDD-contracted support coordination agency while she waits. Her case manager, James, helped her enroll in a day program three days a week and coordinates her primary, dental, and behavioral health care. He is also helping Tasha plan for Lorraine's longer-term future and advocates for her waiver enrollment.

Diana, 28, rural Bulloch County, high-risk pregnancy care management. Diana's first pregnancy ended in preterm delivery at 32 weeks, and she now has gestational diabetes and lupus. Her obstetrician referred her to Amerigroup care management when she enrolled in pregnancy Medicaid, and the plan's Intensive Care Management team flagged her as high-risk. Her nurse, Patricia, coordinates her care between the obstetrician and the maternal-fetal medicine specialist 60 miles away in Savannah, arranges NEMT for the longer trips, supports her insulin and lupus medication adherence, and runs weekly third-trimester check-ins. Patricia will continue this work through Diana's 12-month postpartum coverage.4

Common Questions and Problems

Can my CMO care manager and my CSB case manager work together? Yes. CMO care management coordinates your physical health and plan-network services; CSB SMI TCM coordinates your psychiatric care. The two should communicate with you and, with your consent, with each other. Ask both to coordinate by phone or video.

My case manager says she cannot drive me to appointments. Why? TCM cannot include direct service delivery. Non-emergency medical transportation is a separate Medicaid service. Your case manager can arrange transportation through an NEMT provider but cannot personally drive you.2

My family member is in a nursing facility. Can he get TCM? Generally not during the institutional stay, because the facility's payment is meant to cover comparable functions. The exception is the pre-discharge transition window, when TCM is allowed to support a successful return to the community.6

What if I am unhappy with my case manager? Ask for a different case manager at the same agency, or transfer to another qualified agency in your area. The provider's quality-assurance staff or the DBHDD or DPH program staff can help.

Can my family caregiver be paid as my case manager? No. Federal Medicaid rules do not allow family caregivers to be paid as case managers for their own family members. The case manager role is distinct from paid personal-support roles.

Key Contacts

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The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.