What is an MCO?

A Managed Care Organization is a branch of a major insurance company that is contracted with the state of Texas to manage Medicaid services. Right now, MCO’s only manage physician services, prescription medications, and some specialized equipment, otherwise referred to as acute services. In the future, MCO’s will manage all Medicaid services, including the services we provide, including group home services. MCO’s receive the funds for such services up front, and then determine how to distribute those funds, based on what they believe individuals need. MCO’s authorize acute Medicaid services now, and will ultimately authorize all Medicaid services in the future. MCO’s employ service coordinators to help determine what they believe individuals need.

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