Managed Care Day One Sample Clauses
Managed Care Day One. Individuals will enroll in managed care beginning the first day of the month in which Medicaid eligibility is determined. There will be no fee-for-service time period for most services. For members identified on the 834C as being determined Medicaid eligible, during their first month of managed care enrollment the MCP shall pay for all medically necessary covered services provided during the first month.
Managed Care Day One. Effective January 1, 2018, MMC members are enrolled in a MCP the first of the month coinciding with the date of Medicaid eligibility approval. Prior to this program adjustment, MMC members were enrolled in a MCP following the date of approval (either the beginning of the next month or the month after next, depending on approval date). Managed Care Day One is estimated to result in one additional month of MCP enrollment for many new MMC members. Morbidity adjustments were developed based on our review of historical claims experience associated with this additional month of enrollment. Medicaid Buy-in for Workers with Disabilities (MBIWD). Effective July 1, 2018, the non-Dual MBIWD population was enrolled in mandatory managed care under ABD rate cells. MBIWD members also included in the DD waiver population are eligible for voluntary enrollment in managed care. The morbidity of the MBIWD population is anticipated to have an immaterial impact to ABD rate cells. Spenddown Population. Effective July 1, 2018, certain populations previously held out of managed care were enrolled in the MMC program. This includes non-Dual members that were formerly Medicaid Spenddown prior to ODM’s 1634 eligibility conversion. We estimated the morbidity impact associated with this population based on enrollment information provided by ODM.