Instructions to Access Requirements: In the behavioral health (BH) benefit package, there are services and/or levels of care that are subject to prior authorization. Medicaid pays last, after Medicare and any other health insurance you have. Behavioral Health Prior Authorization Requirements. People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you’re a dual eligible and you get Medicare-covered services. If you want to provide feedback on Medicaid managed care, but are not a Medicaid beneficiary, please email. Medicaid may pay for other drugs and services that Medicare doesn't cover.Ĭontact your State Medical Assistance (Medicaid) office.Premiums, if you have to pay a premium for that coverage. Depending on the level of Medicaid you qualify for, your state might pay for: The selected PHPs will provide managed care services to most Medicaid and NC Health Choice beneficiaries.If you have Medicare and qualify for full Medicaid coverage: What’s a premium, deductible, coinsurance, or copayment? To get more details, call your State Medical Assistance (Medicaid) office and ask about medical help for people with limited resources. PHP PAR CA COHEN MEDICAL CORPORATION PHP PAR Y Y EXCEPT MEDICALLY NEEDY SHARE. You do this by paying non-covered medical expenses and cost sharing (like premiums and deductibles) until your income is lowered to a level that qualifies you for Medicaid. 19 of 25 TABLE 8-1 MEDICAID MANAGED CARE ENROLLMENT REPORT PROGRAM SUMMARY. Some states let you “spend down” the amount of your income that’s above the state’s Medicaid limit. You might be able to get Medicaid if you meet your state’s resource limit, but your income is too high to qualify. The Division of Health Care Financing and Policy (DHCFP) Behavioral Health Unit (BHU) has updated the Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP) policy language in Medicaid Services Manual (MSM) Chapter 400 Mental Health and Alcohol/Substance Abuse Services. Generally, you must meet your state’s rules for your income and resources, and other rules (like being a resident of the state).
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