Excluded Populations. The following categories describe Medicaid recipients who are not eligible to enroll in a Health Plan:
Excluded Populations. The following populations are ineligible for enrollment in Medicaid managed care.
Excluded Populations. A TANF beneficiary or Medicaid recipient in the following programs may not enroll in a frail/elderly component of a Medicaid HMO:
Excluded Populations. The following children and/or young adults are excluded from participation in RIte Smiles: • Children and/or young adults residing in a nursing home or an intermediate care facility for the persons with intellectual/developmental disabilities (ICF/1/DD); • Children and/or young adults with third-party coverage for dental benefits; and, • Children and/or young adults residing outside of Rhode Island. These children and/or young adults will continue to access their benefits through the State's Medicaid fee-for-service system.
Excluded Populations. A member of the household of a clinically-eligible HIV/AIDS recipient who is no longer enrolled in this plan or a recipient who otherwise meets a requirement of an excluded population as specified in Attachment II, Section III, A.3., of this Contract.
Excluded Populations. The following Eligibles will be excluded from enrollment in SoonerSelect Dental: • Dual Eligible Individuals; • Individuals enrolled in the Medicare Savings Program, including Qualified Medicare Beneficiaries (QMB), Specified Low Income Medicare Beneficiaries (SLMB), Qualified Disabled Workers (QDW) and Qualified Individuals (QI); • Persons with a nursing facility or ICF-IID level of care, with the exception of Dental Health Plan Enrollees with a pending level of care determination. • Individuals during a period of Presumptive Eligibility; • Individuals infected with tuberculosis eligible for tuberculosis-related services under 42 C.F.R. § 435.215; • Individuals determined eligible for SoonerCare on the basis of needing treatment for breast or cervical cancer under 42 C.F.R. § 435.213; • Individuals enrolled in a §1915(c) Waiver; • Undocumented persons eligible for Emergency Services only in accordance with 42 C.F.R. § 435.139; • Insure Oklahoma Employee Sponsored Insurance (ESI) dependent children in accordance with the Oklahoma Title XXI State Plan; • Coverage of Pregnancy-Related Services under Title XXI for the benefit of unborn children (‘Soon- to-be-Sooners’), as allowed by 42 C.F.R. § 457.10; and • Individuals determined eligible for Medicaid on the basis of age, blindness, or disability.
Excluded Populations. Individuals eligible for Medicaid who cannot voluntarily enroll with a CCN including: • Individuals receiving hospice services; • Individuals Residing in Nursing Facilities (NF) or Intermediate Care Facilities for the Developmentally Disabled (ICF/DD); • Individuals with Medicare(dual eligibles): • Individuals who have been diagnosed with tuberculosis, or suspected of having tuberculosis, and receiving tuberculosis-related services through the Tuberculosis Infected Individual Program; • Individuals receiving services through any 1915(c) Home and Community-Based Waiver including, but not limited to: o Adult Day Health Care (ADHC) - Direct care in a licensed adult day health care facility for those individuals who would otherwise require nursing facility services; o New Opportunities Waiver (NOW) - Individuals who would otherwise require ICF/DD services; o Elderly and Disabled Adult (EDA) - Services to persons aged 65 and older or disabled adults who would otherwise require nursing facility services; o Children’s Choice (CC) - Supplemental support services to disabled children under age 18 on the NOW waiver registry; o Residential Options Waiver (ROW) - Individuals living in the community who would otherwise require ICF/DD services; o Supports Waiver – Individuals 18 years and older with mental retardation or a developmental disability which manifested prior to age 22; and o Other HCBS waivers as may be approved by CMS. • Individuals under the age of 21 otherwise eligible for Medicaid who are listed on the Office for Citizens with Developmental Disabilities’ Request for Services Registry, also known as Xxxxxxxx Class Members; • Individuals enrolled in the Program of All-Inclusive Care for the Elderly (PACE), a community-based alternative to placement in a nursing facility that includes a complete “managed care” type benefit combining medical, social and long-term care services; • Individuals with a limited eligibility period including: o Spend-down Medically Needy Program - An individual or family who has income in excess of the prescribed income standard can reduce excess income by incurring medical and/or remedial care expenses to establish a temporary period of Medicaid coverage (up to three months); and o Emergency Services Only - Emergency services for aliens who do not meet Medicaid citizenship/ 5-year residency requirements; • Individuals enrolled in the LaCHIP Affordable Plan Program (LaCHIP Phase V) that provides benchmark coverage with a premium to...
Excluded Populations. Medicaid populations that cannot participate in Medicaid managed care include:
Excluded Populations. The following individuals are excluded from the ConnectCare PCCM program and are excluded from this Demonstration.
Excluded Populations. Beneficiaries in Excluded Populations may not enroll in PHPs and will continue to receive Medicaid services through Fee-for-Service and LME/MCOs (as applicable).
