Traditional Medicaid vs. Medicaid Managed Care: What’s the Difference?
If you have Medicaid in Texas, you may have heard people talk about Traditional Medicaid and Medicaid through a managed care company.
They may sound like two completely different types of insurance, but they are both Texas Medicaid.
The main difference is who manages your Medicaid benefits.
What Is Traditional Medicaid?
With Traditional Medicaid, your Medicaid benefits are handled directly through the Texas Medicaid program.
You may also hear this called fee-for-service Medicaid or Title XIX Medicaid.
Instead of having a private health insurance company manage your benefits, your Medicaid services are handled through the state Medicaid system.
For example, someone with Traditional Medicaid may simply have their Texas Medicaid information without having a Medicaid health plan such as Molina or UnitedHealthcare.
What Is Medicaid Managed Care?
Many people in Texas receive their Medicaid benefits through a managed care company.
You still have Medicaid. The difference is that Texas has assigned or allowed you to select a health plan to help manage your Medicaid benefits.
Depending on the Medicaid program and where you live, you may see names such as:
Community Health Choice
Molina Healthcare
UnitedHealthcare Community Plan
Wellpoint
Texas Children's Health Plan
Think of the managed care company as the health plan that helps administer your Medicaid coverage.
So, What's the Difference?
Here's a simple way to think about it:
Traditional Medicaid:
Texas Medicaid manages your benefits directly.
Managed Care Medicaid:
You still have Texas Medicaid, but a health insurance company manages your benefits for Medicaid.
That's it!
Both individuals can be Medicaid recipients. They may simply receive their benefits in different ways.
Why Does This Matter for Home Care?
This difference becomes important when you're trying to receive services such as personal assistance or help at home.
The company or program managing your Medicaid can determine:
Who you contact about services
Which home care agencies you can choose
How services are authorized
Who approves your hours
Which providers are in your network
For example, a home care agency may be able to accept someone with Traditional Medicaid but may need a separate contract with a managed care company before accepting one of that company's Medicaid members.
That's why one home care agency may tell you, “Yes, we accept Medicaid,” but still need to know exactly what type of Medicaid you have.
How Do I Know Which One I Have?
One of the easiest things you can do is look at your insurance cards.
If you have a Medicaid health plan card with the name of a company such as Molina, Community Health Choice, UnitedHealthcare, Wellpoint, or Texas Children's Health Plan, you may be receiving Medicaid through managed care.
If you're unsure, that's okay. You can contact your Medicaid plan or Texas Medicaid and ask:
“Do I have Traditional Medicaid, or is my Medicaid managed by a health plan?”
Knowing the answer can make it much easier when you're looking for doctors, home care agencies, personal attendants, or other Medicaid services.
Need Help Understanding Your Medicaid Home Care Options?
At EverHope Primary Home Care, we know Medicaid terminology can be confusing.
If you or a loved one has Medicaid and needs assistance at home, we can help you identify what type of Medicaid coverage you have and determine whether EverHope may be able to provide your authorized personal care services.
EverHope Primary Home Care
📞 832-458-1159
Eligibility and authorization for Medicaid services are determined by Texas Medicaid or the member's Medicaid managed care plan. EverHope Primary Home Care does not determine Medicaid eligibility.
