Current through Register Vol. 50, No. 9, September 20, 2024
A. The
following Medicaid recipients shall be mandatory participants for integrated
specialized behavioral health and physical health services:
1. children who are blind or have a
disability and related populations, under age 18;
2. aged and related populations, age 65 and
older who are not blind, do not have a disability, and are not members of the
§1931 adult population;
3. children
who receive foster care or adoption assistance (title IV-E), or who are in
foster care or who are otherwise in an out-of-home placement;
4. children with special health care needs as
defined in §1932(a);
5. Native
Americans;
6. full dual eligibles
(for behavioral health services only and non-emergency medical transportation
(NEMT);
7. children residing in an
intermediate care facility for persons with intellectual disabilities (for
behavioral health services only and NEMT);
8. all enrollees of waiver programs
administered by the LDH Office for Citizens with Developmental Disabilities
(OCDD) or the LDH Office of Aging and Adult Services (OAAS) (mandatory for
behavioral health services only and NEMT);
9. all Medicaid children functionally
eligible for the CSoC;
10. adults
residing in a nursing facility (for behavioral health services only and
NEMT);
11. supplemental security
income/transfer of resources/long-term care related adults and children (for
behavioral health services only and NEMT); and
12. transfer of resources/long-term care
adults and children (for behavioral health services only and NEMT).
B. Mandatory participants shall be
automatically enrolled and disenrolled from the MCOs.
C. Notwithstanding the provisions of
Subsection A of this Section, the following Medicaid recipients are excluded
from enrollment in the MCOs and the CSoC contractor:
1. for adults and children:
a. refugee cash assistance;
b. refugee medical assistance;
c. spend-down medically needy;
d. specified low-income beneficiaries
(SLMB)-only;
e. aliens emergency
services;
f. qualified individuals
(QI) 1;
g. long-term care (LTC)
co-insurance;
h. qualified disabled
and working individuals (QDWI); and
i. qualified medicare beneficiaries
(QMB)-only; and
2.
adult-only populations excluded from the 1915(b) waiver:
a. residents of an ICF/ID;
b. Program of All Inclusive Care for the
Elderly (PACE); and
c. Take Charge
Plus.
3.- 10.
Repealed.
D. Any Medicaid
eligible person is suspended from participation during a period of
incarceration.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.
