NYS DOH Issues Medicaid Update

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The New York State Department of Health’s June Medicaid Update notes that Medicaid beneficiaries who are enrolled into partial capitation MLTC plans will have a 90-day grace period to change plans before being subject to a nine-month “lock-in” period during which they may not transfer plans without demonstrating evidence of “good cause.” The DOH’s examples of “good cause” include the enrollee moving to a new service area, the failure of the plan to furnish services, or it is determined that the enrollment was non-consensual. This limitation on the ability of patients to change MLTC plans may prevent patients from changing MLTC plans to a plan that contracts with a LHCSA of their choice. The DOH also encouraged providers to monitor the eMedNY site for updates and to consider sending representatives to training sessions across the state.

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