Authors: Kelsey Brykman, Center for Health Care Strategies

In 2022, an estimated five to 13 percent of children were identified as having complex behavioral health needs — yet many lack access to needed services. Intensive care coordination provides a high level of support to children, youth, and their families, helping them navigate health and social services to address these needs. Wraparound is an evidence-based approach to intensive care coordination that is individualized, coordinates services across systems, is youth- and family-driven, and incorporates peer support. Implementing Wraparound is important for building a comprehensive array of services to better meet the needs of children and youth with more intensive challenges.

How Does the Wraparound Approach Work?   

Wraparound uses a strengths-based, team approach to care planning and coordination for children, youth, and their families, including those involved in multiple child and family-serving systems. It is a structured approach — not a discrete health care service — that includes four phases: (1) family and team member engagement and orientation; (2) initial care plan development; (3) care plan implementation and refinement; and (4) transition from Wraparound.

Services are provided in a family’s home or a community-based setting, and are facilitated by a care coordinator. Care coordinators partner with families to build a team of formal and informal supports, which can include community-based providers, pediatricians, teachers, counselors, representatives from agencies working with the family, family and/or youth peer supports, relatives, and other members of the family’s support network. Team composition is flexible and tailored to each family’s preferences and needs. Wraparound emphasizes including families’ natural supports — such as friends, extended family, and community members — because these networks offer sustainable assistance when families transition out of Wraparound. The Wraparound team partners with families to develop and implement individualized care plans that build on family strengths to address needs. Wraparound is family-driven, meaning the family’s experience and preferences guide care planning and implementation.

The National Wraparound Initiative defines 10 principles of Wraparound that further define the care delivery model. Successful implementation depends on close adherence to these core principles. For this reason, Wraparound champions and researchers emphasize the need for fidelity to the model — known as “High Fidelity Wraparound”. The Wraparound Evaluation and Research Team at the University of Washington developed standardized tools for assessing Wraparound fidelity and supporting high-quality implementation.

What Role Does Medicaid Play in Supporting a Wraparound Approach?

In May 2013, a joint federal bulletin from the Substance Abuse and Mental Health Services Administration and the Center for Medicaid and CHIP Services highlighted intensive care coordination using Wraparound as an evidence-based approach to support children and families with more intense needs. Wraparound has been widely adopted by states, though implementation structures, administrative supports, and payment approaches vary widely. Most commonly, behavioral health departments lead Wraparound implementation, with funding frequently braided or blended from multiple sources, including Medicaid. States vary in their approaches for funding Wraparound — including how comprehensive rates are (e.g., whether providers are reimbursed for team meetings), how services are paid (e.g., billing in 15-minute increments, monthly rates, or episode-based payments), payment levels, and funding streams. To support Wraparound, states can use various Medicaid authorities, including state plan options (e.g., Targeted Case Management, Rehabilitative Option) and Medicaid waivers.   

Medicaid agencies have opportunities to strengthen implementation of High Fidelity Wraparound by simplifying and making funding more flexible, enhancing infrastructure and training for providers serving children and families, collaborating with other state agencies to align care coordination approaches, and refining standards for intensive care coordination using Wraparound. For example, in July 2025, the California Department of Health Care Services released a concept paper outlining plans to advance intensive care coordination in alignment with national Wraparound standards. Proposed policies included a new payment model to cover core services aligned with the Wraparound approach and new standards for implementation, such as team functions and staffing requirements.

What is the Evidence on Wraparound?

Overall, Wraparound is associated with positive outcomes for children, youth, and families, including greater stability in their homes and communities, reduced need for residential care, improved clinical and functional outcomes, and reduced costs. Wraparound has demonstrated positive impacts across racial and ethnic groups.

What Does Wraparound Look Like in Practice?

The following resources offer insights into how Wraparound programs are designed and implemented.

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