Medicaid Managed Care Program

All individuals who are Medicaid eligible are required to enroll in a Medicaid Managed Care Plan unless they have been identified as either exempt or excluded.

What is Medicaid Managed Care?

Medicaid Managed Care provides Medicaid-eligible individuals access to health care through Medicaid Managed Care Plans. These plans provide the majority of Medicaid services such as primary, specialty, ancillary and inpatient services. Medicaid services such as pharmacy and dental will continue to be provided through the traditional Medicaid system.

Who must join?

All Medicaid-eligible individuals, unless they are determined to be exempt or excluded.

Who is exempt or excluded from Managed Care?

Exempt [not required to enroll, but may enroll voluntarily]:

• Native Americans.
• Providers not geographically accessible.

Excluded [not eligible to enroll, even voluntarily]:

• Individuals who are dually eligible [Medicare/Medicaid].
• Foster children in the placement of a voluntary agency.
• Individuals covered under other insurance (Third Party Health Insurance).
• Permanent residents of residential health care facilities.

Above examples represent the most common exempted/excluded categories of individuals.

What does Medicaid Managed Care cost?

There is no cost to enroll.

What services are covered?

• Physician services.
• Inpatient and outpatient health care.
• Lab tests and x-rays.
• Vision, speech and hearing services.
• Short-term rehabilitation.
• Durable medical equipment.
• Emergency room and emergency ambulance services.
• Mental health/alcohol and substance abuse treatment [as medically necessary].
• Family planning.
• Radiation therapy, chemotherapy, hemodialysis.