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State Medicaid Managed Care Enrollment Programs

Code: NL-5000.5000-770

State programs (or private vendors under contract with the state) that enroll Medicaid recipients in a Medicaid managed care program that coordinates the provision, quality and cost of care for its enrolled members. Recipients may have a designated amount of time to choose a managed care option following eligibility determination; and once enrolled, select a primary care practitioner from the plan's network of professionals and hospitals who will be responsible for coordinating their health care and referring them to specialists or other health care providers as necessary. In some situations, where acute and primary care are not integrated into the selected option, people may work with a multidisciplinary team of professionals to support service plan development and implementation. Enrollment in a managed care plan may be voluntary or mandatory for some or all Medicaid recipients in a state. Participation requirements and associated criteria vary from state to state and in some cases, from area to area within the same state. States often make exceptions to their mandatory enrollment requirements for certain individuals and groups, e.g., people with disabilities or identified health conditions, who may be served outside the state's managed care delivery system. These individuals may enroll in a managed care program but are not required to do so. States may also identify a range of Medicaid eligibility groups who are excluded from participating in their managed care programs. Also included are other programs that help people prepare and file State Medicaid Managed Care enrollment applications.

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