Elderly

AZ | CA | CT | FL | FLMH | HI | HIBH | IL | IN | IABH | MA | MI | MN | MT
NE | NEBH | NM | NC | OK | PA | SC | UTMH | WA

"6. ENROLLMENT AND DISENROLLMENT...
Eligibility for the various AHCCCS coverage groups is determined by one of the following agencies: …
AHCCCSA
AHCCCSA determines eligibility for the SSI/MAO groups, including the FES program related to the SSI-Cash program (aged, disabled, blind), The Arizona Long Term Care System (ALTCS), the Qualified Medicare Beneficiary program and other Medicare cost sharing programs, and the Title XXI program." Arizona Contract, page 18.

"ARTICLE II - DEFINITIONS...
CC. Eligible Beneficiary means any Medi-Cal beneficiary who is residing in Contractor's Service Area with one of the following aid codes… Public Assistance Aged - aid codes 10, 16, 18; Medically Needy Aged - aid code 14…" California Contract, page 6.

"Appendix L: Bulletins, Memos, and Policy Transmittals...
Mandatory Enrollment in Hartford and New Haven Counties...
Elderly…adults on Medicaid or General Assistance…cannot enroll in managed care…" Connecticut Contract, Appendix L, page 1.

"8. Ineligible Recipients. The following categories describe recipients whom the plan shall not enroll under this contract: ...
c. Medicaid eligible recipients who are also members of a Medicare-funded health maintenance organization (HMO) or competitive medical plan..." Florida Contract, page 9.

"FRAIL/ELDERLY PROGRAM
The purpose of the frail/elderly portion of a Medicaid HMO is to manage services for the frail and elderly who are at risk of institutional placement..." Florida Contract, page 189.

FLMH

“2.13 Persons Eligible for Enrollment: ...
B. Ineligible Recipients. The following categories describe recipients not eligible for enrollment under the plan:
1. Recipients in the SSI With Medicare (A and/or B) category of eligibility.” Florida Mental Health RFP, pages 34-35.

“DHS will submit an amendment to this QUEST program to the Health Care Financing Administration (HCFA), to phase in certain eligibility groups of the Aged, Blind and Disabled (ABD) population into the current Hawaii QUEST program. All ABD recipients, with the exception of the following... 3) participants in the PACE program... will be enrolled into a QUEST plan. The Medicaid/Medicare dual eligibles will have the option of enrolling into the Hawaii QUEST program...” Hawaii RFP, unnumbered page.

“20.120 Hawaii QUEST (QUEST)...
ABD recipients who will remain in Medicaid’s fee-for-service program and will NOT be enrolled into QUEST include persons who: ... 3) are PACE participants. The dual eligibles (i.e., recipients with both Medicaid and Medicare Coverage) will have the option of enrolling in the QUEST program. All other ABD eligibles will be enrolled in QUEST plan.” Hawaii RFP, page 5.

“40.230 Categorical Requirements...
If the QUEST waiver is approved by HCFA to phase-in the ABD population, some of the ABD recipients will be incorporated into the QUEST program, effective July 1, 1997. ABD participants...participating in the PACE program...will be excluded from the QUEST program and remain in fee-for-service...The dual-eligible (Medicaid and Medicare eligible) will have the option of enrolling in the QUEST program.” Hawaii RFP, pages 43-44.

“40.740 Option to Disenroll Upon Medicare Eligibility Determination...
At the time of conversion of the ABD population into QUEST, dual-eligible recipients will have the option of enrolling in a health plan. If QUEST is not selected, then the person will remain in the fee-for-service program.” Hawaii RFP, pages 53-54.

HIBH

"20.750 Optional Enrollment
* Medicare Members (Dual eligibles)
Persons who are aged, blind or disabled (ABD) and eligible for Medicaid and Medicare may be enrolled in the BHMC plan on a voluntary basis. All ABD dual eligibles (Medicare and Medicaid) determined to be seriously mentally ill or severely emotionally disturbed, as defined in this section, shall be eligible to receive the specialized behavioral health services described in this RFP…" Hawaii Behavioral Health RFP, page 11.

"Eligible Enrollee means a Client or KidCare Participant except one who:
• is receiving Medical Assistance under Aid to the Aged, Blind and Disabled..." Illinois HMO Contract, pages 2-3.

"3.1.2 Medicaid Eligibility
The Indiana Medicaid program arranges for and administers medical assistance to more than 450,000 individuals. This includes the categorically needy population (those individuals eligible for, or receiving, federal financial assistance or those deemed categorically needy) and those eligible for services under federally-authorized waiver programs. Indiana law does not authorize a medically needy program.

The following categorical groups, which are subject to income and asset limitations, are covered by the Indiana Medicaid program:
* Persons who are age 65 years or older." Indiana RFP, page 3-2.

IABH

"ATTACHMENT ON IOWA PLAN ENROLLMENT CRITERIA...
The following beneficiaries are excluded from enrollment:
* Beneficiaries age 65 or older…" Iowa Behavioral Health Contract, page 77.

"SECTION 1. DEFINITION OF TERMS...
Emergency Aid to the Elderly… (EAEDC) - a cash assistance program administered by the Massachusetts Department of Transitional Assistance. Individuals receiving EAEDC cash assistance are eligible for MassHealth Basic coverage upon Managed Care enrollment in accordance with the requirements of 130 CMR 508.000…" Massachusetts Contract, pages 6-9.

"II-E MEDICAID ELIGIBILITY AND CHCP ENROLLMENT...
1. Medicaid Eligible Groups Who Must Enroll in the CHCP: ...
*Persons receiving Medicaid for the aged

2. Medicaid Eligible Groups Who May Voluntarily Enroll in the CHCP:
*Persons with both Medicare and Medicaid eligibility…" Michigan Contract, page 16.

"Article 2. Definitions...
Section 2.4. Aged means a category of PMAP Enrollees used as a factor to determine the Rate Cell status of an individual Enrollee. The Aged category includes those PMAP Enrollees who are age 65 and older." Minnesota Contract, page 10.

"ELIGIBLE GROUPS
The eligibility subtypes targeted for the HMO program are: ...
aged, blind, and disabled RECIPIENTS
RECIPIENTS of home and community-based waiver services for the developmentally disabled

People in these subtypes are not eligible to enroll in HMOs if they have Medicare in addition to MEDICAID coverage, are in a nursing home or are institutionalized, are medically needy, are RECIPIENTS of home and community based waiver services for the aged or disabled…" Montana Contract, Attachment 4, page 63.

"9.2.1 Mandatory for the NHC Basic Benefits Package: The following Medicaid-eligible clients are required to participate in the NHC, if the client’s eligibility assistance case is managed by the Health and Human Services (HHS) District Office in the designated coverage areas, unless excluded pursuant to Section 9.2.5 of this contract: ...
(b) Clients participating in the Aid to Aged, Blind, and Disabled Program Grant/Medical pursuant to Title 469 NAC…" Nebraska Contract, page 31.

NEBH

"9.2 Mandatory and Excluded Clients
9.2.1 Mandatory for the Nebraska Health Connection (NHC) Mental Health/ Substance Abuse Package: The following Medicaid-eligible clients are required to participate in the NHC, unless excluded pursuant to Section 9.2.5 of this contract: ...
(b) Clients participating in the Aid to Aged, Blind, and Disabled Program - Grant/Medical pursuant to Title 469 NAC…" Nebraska Behavioral Health Contract, page 32.

"2.A.5.a.vi Coordination With Waiver Programs. The CONTRACTOR shall provide all covered benefits to members who are waiver participants. There are four Home and Community-Based Waiver programs: ...the Disabled and Elderly Waiver… An integral part of each waiver is the provision of case management." New Mexico Contract, pages 16-17."

"3.2 Persons Ineligible for Enrollment
The following categories of Recipients are not eligible to enroll in the Plan: …
f. Medicaid for the Aged (MAA)…" North Carolina Contract, page 5.

"2.4.6 Exceptions to Health Plan Enrollment
The following categories of members who otherwise qualify will be excluded from participation in the managed care program: ...
• Individuals who are older than 65 years of age and not eligible for Medicare benefits…" Oklahoma RFP, page 18.

"C. HealthChoices Program
3. Phase-In
Contracts to operate the HealthChoices Program will become effective in accordance with the following schedule.
Mandatory recipient enrollment for the Second Phase of program eligible groups:
July 1, 1997: …Healthy Horizons (Exception: An individual who is determined eligible for Healthy Horizons for cost sharing coverage only (categories PG and PL) will not be enrolled in the HealthChoices Program)...

5. HealthChoices Program Eligible Groups
For Purposes of this RFP, the HealthChoices Program population is defined to consist of six (6) different eligible groups, or aid categories

The six (6) eligible groups are described below...
c. Healthy Horizons: An MA program which provides non-money payment (NMP) MA and/or payment of the Medicare premium, deductibles, or coinsurance to…persons age sixty-five (65) and over.

Exception: An individual who is determined eligible for Healthy Horizons for cost sharing coverage only (categories PG and PL) will not be enrolled in the HealthChoices Program…" Pennsylvania RFP, pages 6-8.

"MARKETING, ENROLLMENT, AND MEMBER EDUCATION POLICY AND PROCEDURES...
* HMO's should clearly state that this program is limited to certain Medicaid eligibles who:
- do not also have Medicare;
- are not age 65 or older…" South Carolina Contract, Appendix J, page 1.

UTMH

"Rate Cells...
Separate rates will be established for each eligible group as follows: ...
4. Aged…" Utah Mental Health Contract, page 23.

"(4) A client who is a Medicare beneficiary is not currently eligible to enroll with an HO managed care plan." Washington Contract, page 3, WAC 3.