Medicaid Care Management Software for Government and Community Programs
Helios® by Elligint Health is Medicaid care management software built for managed Medicaid, public agencies, and community care organizations. Care teams coordinate medical, behavioral, and social care for complex members and do more with the same size team, even as budgets tighten and Medicaid rules change. One Helios customer coordinates care for more than 1 million Medicaid members on the platform.
What Is Medicaid Care Management Software?
Medicaid care management software is the technology Medicaid managed care organizations (MCOs) and public programs use to coordinate care for members with complex medical, behavioral, and social needs, authorize services, and meet state and federal reporting requirements. Managed care now runs most of Medicaid: 78% of enrollees were in comprehensive risk-based managed care plans in 2024, according to KFF.
Helios is Medicaid care management software built for members whose needs cross medical, behavioral, and social care. Helios CM and Helios UM run on one cloud-based, FHIR-native platform, with SDOH assessments and community referrals built into care team workflows and configured to each state’s contract.
The Pressures Medicaid Programs Face — and How Helios Responds
Medicaid programs serve some of the most complex members in healthcare, under rules set by both CMS and each state. Most are being asked to do it with tighter budgets and the same or fewer care managers.
Tighter Budgets
Medicaid funding is under pressure, and every dollar spent maintaining software is a dollar not spent on members. Helios is cloud-based software maintained and updated on a regular release cycle, so programs stop paying to keep homegrown systems, servers, and custom code running.
Whole-Person Care Across Medical, Behavioral, and Social Needs
Medicaid members often need help with housing, food, and transportation as much as clinical care. Helios embeds SDOH assessments in care workflows and connects care teams to local resources through integrations with findhelp and Unite Us.
State-Specific Rules That Keep Changing
Every state writes its own contract, reporting, and quality requirements, and they shift with each procurement cycle. Helios is 90% configurable with no-code tools, so assessments, workflows, and authorization rules follow your state contract without custom development.
More Members, Same or Fewer Care Managers
Care management teams are asked to cover growing caseloads without adding staff, and duplicate data entry eats the time they need for members. Helios automates assessments, task assignments, and care plan workflows, so care managers spend their time with members instead of on forms.
Medicaid Care Management Software Across Public Programs
Helios includes out-of-the-box Medicaid templates and configures to the populations, contracts, and partners each program serves.
Medicaid Managed Care Organizations
Run care management and utilization management for Medicaid members on one platform, including Medicaid-specific needs such as Managed Long-Term Care (MLTC) authorization and transportation management. For HCBS and long-term services and supports, see our MLTSS programs.
Dual-Eligible Members
Members covered by both Medicare and Medicaid need one coordinated plan of care, not two. Helios gives care teams a single member record and care plan across both programs, cutting duplicate assessments and handoffs. Learn how Helios supports Medicare Advantage plans.
Public Agencies and Public Health Programs
Helios helps state and local agencies coordinate services across providers and community partners, track program performance in real-time dashboards, and keep the documentation oversight required in one system of record.
Community and Home-Based Care
Care doesn’t stop at the clinic door. Helios supports community organizations and home-based care teams with service planning, telehealth through Helios Visit®, secure member texting through Helios Text®, and SDOH referrals through findhelp and Unite Us.
Other Organizations We Serve
Health Plans/Payers
Unify care management, utilization management, and analytics across Medicare Advantage, Medicaid, and commercial lines of business.
Value-Based Care Organizations
Align quality, cost, and performance across ACOs, clinically integrated networks, and value-based contracts.
MLTSS Programs
Coordinate HCBS services, long-term supports, and state waiver requirements in one system of record.
One Platform Built for Medicaid Programs
Helios modules work independently or together. Start with the capability your program needs most, and add the rest as your contracts or populations expand.
Helios CM
Care management software for complex Medicaid populations, with 360° member views, automated care plans and assessments, and built-in texting (Helios Text®) and telehealth (Helios Visit®) to reach members where they are.
Helios UM
Utilization management software that automates prior authorizations, appeals, and grievances, with configurable rules for state-specific Medicaid benefits and service authorizations.
Advanced Analytics
Population health management analytics that segment your Medicaid population by risk, surface open care gaps, and track cost and utilization trends like ER visits and readmissions.
Helios Partner Ecosystem
Pre-integrated partners, including findhelp and Unite Us, connect care teams to community resources for food, housing, and transportation without leaving Helios.
Proven Results for Medicaid Programs
A regional care coordination organization that supports more than 1 million Medicaid members, roughly one in three in its state, replaced its homegrown case management system with Helios CM. Automated assessments, workflows, and task assignments cut the manual work behind each member interaction and improved care team efficiency by 85%. Browse the Resource Hub for more case studies and expert perspectives.
Related resources
Medicaid Care Management Software FAQs
Look for care management built for members with complex medical, behavioral, and social needs; SDOH assessments and community referrals built into care workflows; configuration that follows each state’s contract and reporting rules; FHIR-native interoperability; and third-party validation such as NCQA and HITRUST. Helios by Elligint Health delivers all five on one cloud-based platform.
Yes. Helios gives care teams one member record and one care plan across both programs, so dual-eligible members don’t go through duplicate assessments or end up with conflicting plans of care.
Yes. Through the Helios Partner Ecosystem, Helios integrates with findhelp and Unite Us. Care teams identify social needs through embedded SDOH assessments, then refer members to local food, housing, and transportation resources from within their workflow.
Yes. Helios is 90% configurable with no-code tools, so assessments, workflows, and authorization rules can follow your state contract and program requirements, including Managed Long-Term Care (MLTC) authorization and transportation management.
Helios supports care in community and home settings with service planning, telehealth through Helios Visit®, secure member texting through Helios Text®, and SDOH referrals through findhelp and Unite Us.
Ready for What’s Next in Medicaid?
Whether you’re stretching a tighter budget, expanding SDOH programs, or replacing a system your care teams have outgrown, Helios gives Medicaid programs one platform to coordinate whole-person care and adapt as the rules change.