A voluntary, capitated managed care plan is available in 10 counties. CHIP enrollees are in the managed care system. All children covered under Title XXI, in both Medicaid and Cub Care, receive the full Medicaid benefits package. Any child who is currently insured or is eligible for the State Employees Health Program will not be enrolled. If an applicant has lost coverage within the past three months, a review will be completed to determine whether coverage has been deliberately dropped.
Health plans are responsible for utilization management.
Comprehensive external reviews are conducted. Immunizations, prenatal care, and pediatric asthma is being studied in-depth as a part of the review process. MCOs must have in place mechanisms to monitor and evaluate availability and accessibility to care and information. National Association of State Medicaid Directors. All rights reserved.