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Enhanced Care Program


How to join:

You can join the free Texas Medicaid Enhanced Care program if:

  1. You have a disability or you are on Temporary Assistance to Needy Families (TANF).
  2. Your Medicaid payments are made by the Primary Care Case Management (PCCM) program, or if you have regular Medicaid where each doctor you go to gets paid individually.
  3. Your doctor says you have at least one of these illnesses:
    • Asthma
    • Diabetes
    • Congestive heart failure
    • Chronic obstructive pulmonary disease
    • Coronary artery disease

If you can join this program, you will get a letter in the mail telling you that you are in the program. You do not have to do anything to join the program.

Cost
The program is free. You will get:

  • A doctor who will take care of most of your needs.
  • A nurse care manager to help you, your doctor or any one else who helps you take care of your health.
  • A Texas Medicaid phone number that you can call any time of the day or night, to talk to a nurse about your health.
  • A nurse who can help you learn more about your sickness and how to take better care of your health.  The nurse can answer questions about your medicines, treatments and how to understand your doctor’s orders or test results.
  • The newest information about your sicknesses.
  • Easy-to-read information about your health.

Texas Medicaid Enhance Care Program

Client Frequently Asked Questions


1. How do I qualify to participate in this program?
You qualify for the Texas Medicaid Enhanced Care program if you are a Medicaid fee-for-service or Primary Care Case Management (PCCM) client, you meet certain eligibility requirements determined by your doctor and have one or more of the following conditions:

  • Diabetes
  • Asthma
  • Congestive heart failure (CHF)
  • Chronic obstructive pulmonary disease (COPD)
  • Coronary artery disease (CAD)
2. How can I participate or get enrolled in this program?
If you meet the qualifications, you are automatically enrolled.
3. How do I know if I am enrolled in the program?
You will receive a letter in the mail about your enrollment in the program.  Call 1-800-777-1178 if you have questions about your enrollment.
4. Do I have to pay anything to participate in this program?
The Texas Medicaid Enhanced Care Program is free for those who qualify.
5. What type of services does the program offer?
The Texas Medicaid Enhanced Care Program offers you:

  • A doctor to be your primary care provider (PCP), if you don’t already have one.
  • A nurse care manager to work with you, your doctor and other health care providers.
  • Access to the Texas Medicaid Nurse Advice Line 24 hours a day, seven days a week, so you can talk to a nurse about your health, any of your medicines or whether to seek additional medical care.
  • Education and counseling from a specially trained registered nurse.
  • The most up-to-date news and information about diabetes, asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD).
  • Easy-to-read material on your health condition.
6. If I don’t want to participate in this program, who do I call to decline services?
You can call 1-800-777-1178 and inform the nurse you are not interested in participating in the program.
7. How do I contact a nurse?
You can talk to a nurse 24 hours a day, seven days a week, by calling the free Nurse Advice Line at 1-800-777-1178.
8. Can my caretaker call the Nurse Advice Line for information or am I the only one allowed to call the nurse?
The nurses generally work directly with you, but they will make every effort to help a caretaker when it is appropriate. Here are some examples of when a nurse may talk to a caretaker: the client has given the nurse permission to work with a family member caretaker, the client is a minor or the client is disabled.
9. What kind of information can the nurse provide?
The nurse can help you learn more about your condition and how to better manage your health.  The nurse can answer your questions about medication and treatments, managing symptoms and understanding a doctor’s orders or test results.
10. Can the program help me find a doctor that accepts Medicaid?
The program will work with you to find providers — health center, clinic, doctor or specially trained nurse — that accept Medicaid.
11. Who can I call if I have more questions about this program?
You can call 1-800-777-1178 with any questions you have about the Texas Medicaid Enhanced Care program.
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