Excluded Populations. The following populations are ineligible for enrollment in Medicaid managed care. a) Individuals who are Dually Eligible for Medicare/Medicaid. b) Individuals who become eligible for Medicaid only after spending down a portion of their income (Spend-down). c) Individuals who are residents of State-operated psychiatric facilities or residents of State-certified or voluntary treatment facilities for children and youth. d) Individuals who are residents of Residential Health Care Facilities ("RHCF") at the time of Enrollment, and Enrollees whose stay in a RHCF is classified as permanent upon entry into the RHCF or is classified as permanent at a time subsequent to entry. e) Individuals enrolled in managed long term care demonstrations authorized under Article 4403-f of the New York State PHL. f) Medicaid-eligible infants living with incarcerated mothers. g) Infants weighing less than 1200 grams at birth and other infants under six (6) months of age who meet the criteria for the SSI or SSI related category (shall not be enrolled or shall be disenrolled retroactive to date of birth). h) Individuals with access to comprehensive private health care coverage including those already enrolled in an MCO. Such health care coverage, purchased either partially or in full, by or on behalf of the individual, must be determined to be cost effective by the local social services district. i) Xxxxxx children in the placement of a voluntary agency. j) Certified blind or disabled children living or expected to be living separate and apart from the parent for thirty (30) days or more. k) Individuals expected to be eligible for Medicaid for less than six (6) months, except for pregnant women (e.g., seasonal agricultural workers).
Appears in 4 contracts
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.), Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Excluded Populations. The following populations are ineligible for enrollment in Medicaid managed care.
a) Individuals who are Dually Eligible for Medicare/Medicaid.
b) Individuals who become eligible for Medicaid only after spending down a portion of their income (Spend-down).
c) Individuals who are residents of State-operated psychiatric facilities or residents of State-certified or voluntary treatment facilities for children and youth.
d) Individuals who are residents of Residential Health Care Facilities ("RHCF") at the time of Enrollment, and Enrollees whose stay in a RHCF is classified as permanent upon entry into the RHCF or is classified as permanent at a time subsequent to entry.
e) Individuals enrolled in managed long term care demonstrations authorized under Article 4403-f of the New York State PHL.
f) Medicaid-eligible infants living with incarcerated mothers.
g) Infants weighing less than 1200 grams at birth and other infants under six (6) months of age who meet the criteria for the SSI or SSI related category (shall not be enrolled or shall be disenrolled retroactive to date of birth).
h) Individuals with access to comprehensive private health care coverage including those already enrolled in an MCO. Such health care coverage, purchased either partially or in full, by or on behalf of the individual, must be determined to be cost effective by the local social services district.
i) Xxxxxx children in the placement of a voluntary agency.
j) Certified blind or disabled children living or expected to be living separate and apart from the parent for thirty (30) days or more.
k) Individuals expected to be eligible for Medicaid for less than six (6) months, except for pregnant women (e.g., seasonal agricultural workers).
1) Xxxxxx children in direct care (unless LDSS opts to enroll them see Section 5.l(b)).
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Excluded Populations. The following populations are ineligible for enrollment in Medicaid managed care.
a) Individuals who are Dually Eligible for Medicare/Medicaid.
b) Individuals who become eligible for Medicaid only after spending down a portion of their income (Spend-down).
c) Individuals who are residents of State-operated psychiatric facilities or residents of State-certified or voluntary treatment facilities for children and youth.
d) Individuals who are residents of Residential Health Care Facilities ("RHCF") at the time of Enrollment, and Enrollees whose stay in a RHCF is classified as permanent upon entry into the RHCF or is classified as permanent at a time subsequent to entry.
e) Individuals enrolled in managed long term care demonstrations authorized under Article 4403-f of the New York State PHL.
f) Medicaid-eligible infants living with incarcerated mothers.
g) Infants weighing less than 1200 grams at birth and other infants under six (6) months of age who meet the criteria for the SSI or SSI related category (shall not be enrolled or shall be disenrolled retroactive to date of birth).
h) Individuals with access to comprehensive private health care coverage including those already enrolled in an MCO. Such health care coverage, purchased either partially or in full, by or on behalf of the individual, must be determined to be cost effective by the local social services district.
i) Xxxxxx children in the placement of a voluntary agency.
j) Certified blind or disabled children living or expected to be living separate and apart from the parent for thirty (303) days or more.
k) Individuals expected to be eligible for Medicaid for less than six (6) months, except for pregnant women (e.g., seasonal agricultural workers).
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
Excluded Populations. The following populations are ineligible for enrollment in Medicaid managed care.
a) Individuals who are Dually Eligible for Medicare/Medicaid.
b) Individuals who become eligible for Medicaid only after spending down a portion of their income (Spend-down).
c) Individuals who are residents of State-operated psychiatric facilities or residents of State-certified or voluntary treatment facilities for children and youth.
d) Individuals who are residents of Residential Health Care Facilities ("RHCF") at the time of Enrollment, and Enrollees whose stay in a RHCF is classified as permanent upon entry into the RHCF or is classified as permanent at a time subsequent to entry.
e) Individuals enrolled in managed long term care demonstrations authorized under Article 4403-f of the New York State PHL.
f) Medicaid-eligible infants living with incarcerated mothers.
g) Infants weighing less than 1200 grams at birth and other infants under six (6) months of age who meet the criteria for the SSI or SSI related category (shall not be enrolled or shall be disenrolled retroactive to date of birth).
h) Individuals with access to comprehensive private health care coverage including those already enrolled in an MCOMCD. Such health care coverage, purchased either partially or in full, by or on behalf of the individual, must be determined to be cost effective by the local social services district.
i) Xxxxxx children in the placement of a voluntary agency.
j) Certified blind or disabled children living or expected to be living separate and apart from the parent for thirty (30) days or more.
k) Individuals expected to be eligible for Medicaid for less than six (6) months, except for pregnant women (e.g., seasonal agricultural workers).
1) Xxxxxx children in direct care (unless LDSS opts to enroll them see Section 5.1(b)).
Appears in 1 contract
Samples: Medicaid Managed Care Model Contract (Wellcare Health Plans, Inc.)
