Revision 15-4; Effective October 1, 2015

 

 

M—1010 General Policy

Revision 10-2; Effective April 1, 2010,

 

The applicant is continuously eligible for 12 months beginning the first day of the application month if all eligibility criteria are met. Applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 21st birthday.

The medical effective date cannot precede the month of the applicant’s 18th birthday.

 

M—1011 Three Months Prior Coverage

Revision 10-2; Effective April 1, 2010

 

Follow policy in A-830, Medicaid Coverage for the Months Prior to the Month of Application, to provide Medicaid coverage if the individual meets eligibility criteria.

 

M—1012 Types of Coverage

Revision 15-4; Effective October 1, 2015

 

The type of coverage determines how recipients access Medicaid services. There are two types of coverage. They are fee-for-service and managed care.

Fee-for-Service — Also known as traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.

Managed Care — A service delivery program that provides medical care in a managed care setting. The state pays a monthly premium to the health maintenance organization (HMO) for each recipient enrolled in the plan. The plan processes all provider claims.

Medicaid for Transitioning Foster Care Youth recipients have the option to enroll in either type of coverage. See A-821.2, Managed Care.

Related Policy
Types of Coverage, A-821