Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services

Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care

States must have in effect a transition of care policy to ensure continued access to services during a transition from Fee for Service Medicaid (FFS) to a Managed Care plan or transition from one Managed care plan to another "when an enrollee, in the absence of continued services, would suffer serious detriment to their health or be at risk of hospitalization or institutionalization."  This is required by federal regulations as amended in 2016.  42 C.F.R. § 438.62, and is incorporated in the CMS Special Terms & Conditions  of the waiver that authorizes the managed care program in NYS (Web) - (PDF) (Oct. 2021) (Article V(4)(g) at pp. 32-33). 

Transition Policy Must be Publicly Available  


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG



Article ID: 58
Last updated: 19 Oct, 2023
Revision: 1
Medicaid -> Medicaid Managed Care -> Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services
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