Medicaid - HMO - 12 Month Enrollment Period

Medicaid Options is a state-sponsored program that helps Medicaid recipients enroll in Medicaid managed care programs: Medicaid Health Maintenance Organizations (HMOs), the Medicaid Provider Access System (MediPass), Provider Service Networks (PSNs), and the Children’s Medical Services (CMS) Network for children with special health care needs.

Managed Care Mandatory Assignment

Florida law mandates that Medicaid recipients (low-income family and child recipients and SSI recipients without Medicare) eligible for managed care must enroll in a Medicaid managed care program.

Eligible recipients are given 30 days from the date that Medicaid eligibility begins to select a managed care option. If recipients do not select a managed care option, AHCA assigns them to MediPass, an HMO, or a

Nursing facility residents who are Medicaid eligible under the Institutional Care Program (ICP) and who receive nursing facility services for more than 30 days are not enrolled in a managed care program.

12-Month Enrollment Period
Recipients who become eligible for Medicaid and enroll with a managed care plan will begin a 12-month enrollment period in which they have 90 days to try the plan. After the initial 90 days, they will remain with their plan for the next nine months, as long as they do not lose Medicaid eligibility. Only plan
changes for “good cause” will be allowed during these nine months. Each year thereafter, recipients will receive notification of their open enrollment period when they can change plans for the following year.

SSI recipients under age 19, foster care children, children in subsidized adoption arrangements, children enrolled with Children’s Medical Services, American Indians, and dually-eligible Medicare and Medicaid recipients are allowed to change managed care plans at any time.

Recipients may change primary care providers within their current plans. To change their primary care provider, recipients should contact the program in which they are enrolled (the HMO’s member services office, PSN’s enrollee services office, or their Medicaid area office, respectively).

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