Managed Care

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Unless noted below, all persons receiving Medicaid either through Public Assistance or direct Medicaid must choose a Managed Care provider.

These persons can not be enrolled in a Managed Care Plan: 

  • People in nursing homes, hospice or the Long Term Home Health Care Program, including long term demonstration programs
  • Residents of State psychiatric or residential treatment facilities for children and youth
  • People receiving mental health family care services
  • People who will be eligible for less than six months (such as seasonal farm workers)
  • People who become eligible for Medicaid only after spending some of their income for medical services
  • A person with private health insurance if the private insurance costs less than a Medicaid managed care plan
  • A premature infant eligible for SSI whose mother was not getting Medicaid when the infant was born
  • Homeless persons living in New York City shelters
  • Infants living with their mothers in jails or prisons

These people can decide IF they want to join a managed care plan: 

  • People with HIV infection
  • People in alcohol and drug abuse residential programs
  • Pregnant women already getting prenatal care from a physician who does not belong to any Medicaid managed care plan
  • Residents in facilities for the mentally retarded and people with similar needs
  • Some developmentally disabled people or physically disabled children who receive care at home or in the community through existing waiver programs and those whose needs are similar
  • Native Americans
  • People with chronic medical conditions being treated by a specialist who is not part of a Medicaid managed care plan
  • Children diagnosed with serious emotional disturbance and adults diagnosed with serious mental illness
  • People who have a doctor who speaks their primary language and no plan has a doctor who speaks this language