Does [state] use managed care plans for home care, and how do I contract with them?
Many states pay for some home care through managed care plans, but plans differ by state and by program. Check your state Medicaid site for the plan list, and ask each plan how to join its network. Check each client’s eligibility to see who to bill. Waiver programs may be handled outside managed care.
Managed care means the state pays a plan, and the plan pays providers. Whether your clients are in managed care depends on the state and on the program.
How to find out:
- Find your state’s list of plans on the state Medicaid site.
- Find out which programs are in managed care and which are fee-for-service. Waivers often differ.
- Check each client’s coverage in the state portal before the first visit. It usually shows if the person is in a plan.
- Ask each plan about contracting. Most have a provider enrollment page. Expect paperwork, credentialing, and sometimes a wait.
- Learn each plan’s prior authorization, EVV, and claim rules.
Example: Georgia Families uses three care management organizations: Amerigroup, CareSource and Peach State Health Plan. For GAPP, prior authorization comes from the CMO or from Alliant, depending on the child. For CCSP and SOURCE, the state says approved Medicaid agencies bill the department directly.
If you are unsure who pays, call the state provider services line before you deliver care.
Sources
- Care Management Organizations (CMO) · Georgia DCH
- GAPP presentation (June 2023) · Georgia Medicaid (GAMMIS)
- Elderly and Disabled Waiver Program (long version) · Georgia DCH
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
Want to see where this is costing your agency money? Four minutes, your agency’s name on the answer.