New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 506 - MEDICAID CARE MANAGEMENT (MCM)
Section He-W 506.05 - Enrollment in Managed Care
Universal Citation: NH Admin Rules He-W 506.05
Current through Register No. 40, October 3, 2024
(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.
#10410, eff 9-13-13; ss by #10631, eff 7-1-14
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