Managed Care Program

The Managed Care Program is designed to improve access to medical care for Medicaid/CHIP recipients as well as improve the quality of care they receive by giving them a medical home.

The majority of recipients who qualify for Medicaid/CHIP are required to participate in the Managed Care Program. Recipients either choose or are assigned a Primary Care Provider (PCP). This allows the recipient and their physician to develop a relationship in which the best medical care can be provided.

As a managed care recipient, you are required to receive non-emergent managed care services from your Primary Care Provider (PCP). You are also required to have a referral (permission) from your PCP for non-emergent specialty and hospital services. You can receive certain services called Managed Care Exempt Services from other providers without a referral from your PCP.

• See Medical Assistance Program Recipient Handbook to view services

Recipients eligible for the following programs must participate in Managed Care:

• Supplemental Security Income (SSI) recipients: blind, disabled people age 19 and older.
  
• Families eligible for the Low Income Families (LIF) Program.
  
• Low income children eligible for Medicaid.
  
• Children eligible for CHIP.
  
• Women eligible for low income pregnancy coverage.

Recipient Information:

• Managed Care Reminders: Covered Services
• Managed Care Reminders: Your Responsibilities
• Recipient Reminders on Emergency Room Care and Other Information
  
• Primary Care Provider Selection/Change Forms
  
• Primary Care Provider (PCP) List
  

Through the Managed Care Program, eligible recipients receive a continuity of care from one chosen primary care provider (PCP) or clinic. When specialty care is required, recipients are referred by their PCP to ensure a consistent plan of care is continued throughout treatment.