Section He-W 506.05 - Enrollment in Managed Care(a) All medicaid recipients shall be enrolled in managed care unless the recipient is excluded from managed care as described in (b) below.(b) The following individuals shall not be allowed to enroll in managed care:(1) Recipients receiving certain financial benefits from the U.S. Department of Veterans Affairs;(2) Recipients receiving in and out medically needy assistance in accordance with 42 CFR 435.301 and He-W 878.01;(3) Recipients who are eligible under the qualified medicare beneficiary (QMB), specified low-income medicare beneficiary (SLMB), or qualified disabled working individual (QDWI) benefits only, and are not eligible for full medicaid coverage;(4) Recipients who are eligible under the family planning expansion category (FPEC) in accordance with 1902(a)(10)(A)(ii) of the Social Security Act, 42 U.S.C. 1396a(a)(10)(A)(ii) and He-W 509;(5) Individuals during a presumptive eligibility period; and(6) Individuals in a retroactive eligibility period.(c) Any recipient not enrolled in managed care shall receive medicaid services on a fee-for-service basis.(d) All medicaid recipients, age 21 and older, shall be enrolled in the managed care dental benefit, pursuant to section 1915(b) of the Social Security Act.N.H. Admin. Code § He-W 506.05
#10410, eff 9-13-13; ss by #10631, eff 7-1-14
Amended by Volume XXXV Number 45, Filed November 12, 2015, Proposed by #10965, Effective 11/1/2015, Expires11/1/2025.Amended by Volume XLII Number 45, Filed November 10, 2022, Proposed by #13474, Effective 10/25/2022, Expires 10/25/2032.Amended by Number 28, Filed July 13, 2023, Proposed by #13670, Effective 6/22/2023, Expires 6/22/2033.