AZ

"6.  ENROLLMENT AND DISENROLLMENT...
Health Plan Choice
Acute member, except for those eligible under the MN/MI program have a choice of available health plans.  A listing of the available health plans and their telephone numbers will be given to each applicant during the application process for AHCCCS benefits. Also included are instructions to applicants to call the health plans directly with specific questions concerning the health plan.  If there is only one health plan for the applicant's Geographic service area, no choice is offered...

Title XXI members must select a health plan prior to being determined eligible and therefore, will not be auto-assigned…"  Arizona Contract, page 19.

"11.  ANNUAL ENROLLMENT CHOICE
AHCCCSA conducts an Annual Enrollment Choice (AEC) for members on their annual anniversary date.  AHCCCSA may hold an open enrollment on a limited basis as deemed necessary.  During AEC, members may change contractors subject to the availability of other contractors within their Geographic Service Area…"  Arizona Contract, page 23.

CO

"II. ELIGIBILITY AND ENROLLMENT…
B.  Enrollment
1.  Voluntary Enrollment and Assignment
Client Enrollment shall be on a voluntary or assignment basis.  Neither the Department nor the Department's Enrollment Facilitator shall do anything to influence the Client's exercise of a free choice of a Contractor's plan...
  b.  Conversion PCP Program Clients...

  Pursuant to 10 CCR 2050-10, § 8.207.26(B), The Client will have no less than sixty-five (65) days of from mailing of the Primary Care Physician’s letter to decide whether to join the Contractor’s Plan or choose a new Medicaid PCP or MCO, except as described at 10 CCR 2050-10, § 8.207.26 (D)."  Colorado Contract, pages 13-14.

DE

"2.1.3.2 MCO Enrollment Materials
During the enrollment phase for January 1, 1999, The HBM will mail enrollment materials no later than five (5) business days after the mailing of advance notice materials. During the ongoing enrollment phase no advanced notice by the HBM will occur. The HBM will mail enrollment materials no later than three (3) business days after receipt of the eligibility roster from the DSS…

Individuals will be asked to complete a managed care enrollment application, indicating the MCO of his or her choice and will be made aware of the auto-assigned MCO choice should they not choose. Members may either return a pre-addressed and stamped document marked with their choice of MCO or call a toll-free telephone number manned by HBM employees. All members of a family will be encouraged (but not required) to select the same MCO."  Delaware RFP, pages II.4- II.5.

"4.3  Describe the methods of establishing eligibility and continuing enrollment (Section 2102(b)(2))
Eligibility and redeterminations of eligibility will be conducted by staff under the administration of the Title XIX/Medicaid program consistent with those activities for Medicaid applicants/recipients.

Individuals will be enrolled with MCOs using the same Health Benefits Manager and the same process of enrollment as is used by Delaware's Diamond State Health Plan.  Individuals will be given a time frame to choose an MCO, and then, in the absence of any indication of choice, will be automatically assigned to an MCO based on location and availability of providers."  Delaware RFP, Appendix A ( SCHIP), page A.11.

DC

"2.  Voluntary Enrollment and Default Providers
  a.  Individuals participating in the Medicaid Managed Care Program will select MCOs at their discretion.  Enrollment by a person eligible under section '1' of this section with Provider shall be voluntary except for those persons who are automatically enrolled with Provider under paragraph 'b' of this section.

  b.  Persons who do not voluntarily select a Managed Care Organization as required under the conditions of the Medicaid Managed Care Program shall be automatically enrolled with a participating Managed Care Organization."  District of Columbia Contract, page 16.

FL

"17. Enrollment.
a. Prior to the choice counseling contractor assuming face-to-face choice counseling and enrollment responsible for the enrollment of recipients into the plan.
  (1)  Medicaid recipients must complete a new pre-enrollment application for each new enrollment period...a.  Prior to the choice counseling contractor assuming face-to-face choice counseling and enrollment responsibilities, the agency shall be responsible for the enrollment of recipients into the plan...
  (3)  The agency, upon receipt of the pre-enrollment transmission and upon receipt of Title XXI MediKids voluntary enrollment information form the agency's MediKids; enrollment contractor, shall be responsible for: ...
  (b)  Forwarding to the plan a list of all new members on a monthly basis, which shall include any voluntary MediKids enrollees to be enrolled by the plan…

b.  After the agency's choice counseling contractor's implementation of face-to-face choice counseling and enrollment activities, the plan shall comply with the following requirements:
   (1)  The agency, after receipt of the enrollment transmission from the choice counseling contractor and determining the applicant's eligibility for enrollment in the plan, shall forward to the plan a list of all new members and their respective plan primary care provides on a monthly basis..." Florida Contact, pages 35-36.

HI

“35.000 Provision of Services-QUEST-NET...
35.300  Assignment To Health Plans...
New recipients shall select their respective plans or be assigned by MQD.” Hawaii RFP, pages 40-41.

“40.420  QUEST Enrollment...
If the recipient selects a plan, or if there is only one plan servicing the island on which the recipient resides, enrollment shall be initiated immediately...” Hawaii RFP, page 46.

“40.430  QUEST-Net Enrollment...
Recipients entering QUEST-Net from the ABD FFS program shall select their plans or shall be assigned to the plans by DHS.” Hawaii RFP, page 47.

IL

"Article IV
Enrollment, Coverage and Termination of Coverage
(a)  Voluntary Enrollment
Enrollment under this Contract shall be on a voluntary basis.

(b)  Enrollment Process...
(3)  When the Department receives an Eligible Enrollee's selection directly, the Department will electronically communicate a request for site assignment to the Contractor on the day after the Department enters the selection in its records. The Contractor shall subsequently contact the Eligible Enrollee, assist the Eligible Enrollee in selecting a site, Primary Care Provider or Women's Health Care Provider and provide basic education on accessing care from the Contractor. Once selected, the Contractor shall electronically communicate the site to the Department. 

At a future point in time during the term of this Contract, the Department shall require that the Contractor electronically communicate the Primary Care Provider or Women's Health Care Provider selection to the Department. The Department will provide the Contractor with no less than one hundred twenty (120) days advance notification prior to imposing this requirement. When the site, and in the future the Provider, selection is received from the Contractor, the Department will enroll the Eligible Enrollee with the Contractor."  Illinois HMO Contract, pages 11-12.

IA

"8.1.1  General Enrollment
The HMO shall accept as Enrollees all persons who appear on the HMO Enrollment Information...
If an eligible Medicaid recipient fails to choose a Managed Care Entity, the Department shall default enroll those recipient in an HMO if one is available in a county of recipient residence…"  Iowa Contract, page 48."

KS

"A.  ENROLLMENT PROCESS
Enrollment of Medicaid beneficiaries in managed care will include the following components: ...
•  The beneficiary has twenty (20) days to choose an HMO or PCP…"  Kansas Contract, page 44.

"SRS Responsibilities...
Beneficiary choice of a managed care plan shall be voluntary and neither SRS or its agents shall do anything to influence the beneficiary's exercise of free choice. Beneficiaries shall be provided assurances that a decision not to enroll in the HMO's plan shall not affect their eligibility for Medicaid benefits. In the event a beneficiary is mandated to choose a managed care provider and does not act to do so within twenty (20) days from the date of notification, SRS will assign the beneficiary to a managed care provider. Auto-assignment may be made to an HMO or PCCM."  Kansas Contract, page 50.

KY

"The Member Services staff shall be responsible for the following services and tasks: ...
  •  Facilitating the selection of or explaining the process to select or change Primary Care Providers through telephone or face-to-face contact where appropriate.  The Partnership shall assist Members to make the most appropriate Primary Care Provider selection based on previous or current Primary Care Provider relationship, providers of other family members, medical history, language needs, provider location and other factors that are important to the member.  Notifying members immediately if their primary care Provider leaves the program and assisting Members in selecting a new Primary Care Provider."  Kentucky RFA, page 53.

MD

"10.09.63.02...
F.  Recipient Selection of an MCO.
(1)  Except as provided in §F2 of this regulation, a recipient shall have 21 days from the day the Department mails its eligibility notification in which to select an MCO.
(2)  A recipient who is a child in foster care or kinship care shall have 60 days from the date the Department mails its eligibility notification in which to select an MCO.
(3)  A recipient may select an MCO that does not serve the recipient's local access area.
(4)  Upon the request of the recipient or the recipient's representative, the Department shall arrange for a face-to-face meeting with a representative of the Department or its enrollment agent in order to assist a recipient in selecting an MCO.

G.  Except as specified in COMAR 10.09.24.04F(3), a recipient who desires to be enrolled in a particular MCO shall personally authorize, either orally or in writing, enrollment into that MCO."  Maryland COMAR 10.09.63.02.

"10.09.69.01...
I.  An individual eligible for REM may elect to enroll in an MCO by notifying the Department in writing of the election."  Maryland COMAR 10.09.69.01.

"10.09.65.02...
J.  An MCO shall permit the enrollment of a waiver-eligible Program recipient who is enrolled by the Department or who selects the MCO, unless the MCO's enrollment meets or exceeds any enrollment limits mutually agreed to by the Department and the MCO…"  Maryland COMAR 10.09.65.02.

MABH

"SECTION 4:  DIVISION  RESPONSIBILITIES...
4.4.  Enrollment and Disenrollment for Recipients
A.  Enrollment and Eligibility Verification
The Division shall:
1.  maintain sole responsibility for the enrollment of Recipients into the MH/SAP;
2.  notify the Contractor of all enrollments; and
3.  enable the Contractor to verify each Recipients eligibility status in the MH/SAP through access to the Recipient Eligibility Verification System (REVS) or through nightly transfer of REVS file updates, or both."  Massachusetts MH/SAP Contract, Appendix A, page 35.

MI

"II-G ENROLLMENT IN THE CHCP...
2. Initial Enrollment
After a person applies to FIA for Medicaid, he or she will be assessed for eligibility in a Medicaid managed care program. If they are determined eligible for the CHCP, they will be given marketing material on the Contractors available to them, and the opportunity to speak with an Enrollee counselor to obtain more in-depth information and to get answers to any questions or concerns they may have.  Beneficiaries must decide on the Contractor they wish to enroll in within 30 days from the date of approval of Medicaid eligibility…"  Michigan Contract, page 17.

MN

"Section 3.1.2. Enrollment...
B.  Order of Enrollment. The HEALTH PLAN shall enroll Recipients in the order in which they apply or are assigned…"  Minnesota Contract, page 20.

"Section 3.2.3.
D.  Recipient Education.
1)  The STATE or the Local Agency will inform Recipients who reside in the Service Area of the options available in health care coverage.  The STATE or Local Agency shall describe through presentations and/or written materials the various health plans available to Recipients in a particular geographic area and complete representatives on the enrollment form or release of information form.  For Recipients who are assigned to a HEALTH PLAN, a signature will not be obtained.  Tribal governments may assist the STATE or Local Agency in presenting or developing materials describing the various health plan options for their members…"  Minnesota Contract, page 23.

MO

"2.4.4  Voluntary Selection of Health Plan:  Missouri MC+ eligibles will be given fifteen (15) calendar days from the time of their eligibility for managed care to select a health plan.  All members of a family will be encouraged to select the same health plan.  If a family does not select a health plan within the fifteen (15) day window, the family will automatically be assigned to a health plan."  Missouri RFP, page 35.

NE

"2.2 Scope: ...
A client who is already participating in the NHC and who is enrolled with a plan shall remain with that plan if the Department continues a contractual relationship with that plan and that is the client's choice…"  Nebraska Contract, page 3.

"9.3.2 Enrollment for the Basic Benefits Package: The client shall complete the following activities: ...
(c) Choose a Primary Care Physician (PCP)/plan. Note: Except as described in 9.6 of this contract, family members may select different PCP/plans, but shall be encouraged to choose the same plan."  Nebraska Contract, pages 33-34.

"9.6.2 Enrollment of a Pregnant Woman and Her Unborn Child for the Basic Benefits Package: During the enrollment process, an eligible pregnant woman shall be required to choose the same plan, but not necessarily the same PCP, for herself and her eligible unborn/newborn child...

9.8.1 Completion of the Enrollment Process: The client or the client’s legal representative shall complete the enrollment process. For purposes of completing the enrollment process, the following rules apply: ...
(b) The client or his/her legal representative (i.e., guardian, conservator, or power of attorney (POA) if the POA has this level of authority) shall make the choice of a PCP/plan; and
(c) Child Welfare staff may act on a Department ward’s behalf. The child’s foster parents must be involved in the selection of the PCP/plan. Child Welfare staff shall consider whether it is appropriate for the biological parents to be involved in the  enrollment activity/choice of PCP/plan."  Nebraska Contract, pages 36-37.

"11.3 Enrollment Activities: The EBS shall complete the following enrollment activities for mandatory clients (and also for potential mandatory clients, if requested), in coordination with the plan and the Department: ...
(d) Assist the client or his/her legal representative in choosing a PCP/plan, based on a process, approved by the Department, that protects the client’s right to choose and that is equitable and without bias to any particular plan...The client is free to choose a PCP/plan from all available options; however, the EBS shall screen for the following and similar information…"  Nebraska Contract, pages 61-62.

NV

"6.  Section II.  Enrollment, Paragraph B.  Date of Enrollment on page 47 of the Contract is changed to include as follows:
   'Individuals may apply for Nevada Check up at any time.  Once eligibility is determined, families who reside in Clark County or Washoe County (Reno/Sparks only) will be required to complete an enrollment form to select a managed care Contractor.  Families will be given a choice of any managed care Contractor that provides services in the geographic area.  DHCFP will enroll the child at the beginning of the next administrative month following receipt of the completed enrollment form and quarterly premium.  Special rules apply to newborn children.  See Paragraph H.'"  Nevada Amendment #1, page 7.

NJ

"ARTICLE 7
ENROLLMENT
7.1  Enrollment shall be voluntary...
7.2  The health benefits coordinator (HBC), an agent of DMAHS, will enroll Medicaid applicants.  The HBC will explain the HMO programs, answer any questions, and assist eligible individuals or, where applicable, an authorized person in selecting a plan…"  New Jersey Contract, page 40.

NM

"2.B.2.a  Minimum Selection Period:
The client shall have a minimum of fourteen (14) calendar days to select an MCO from the provided information.  If a selection is not made during this selection period.  HSD shall assign the client to an MCO."  New Mexico Contract, page 24.

NY

"6.  ENROLLMENT...
6.3  Enrollment Decisions
An Eligible Person's decision to enroll in the Contractor's plan shall be voluntary except as otherwise provided in Section 6.4 of the Agreement…"  New York Contract, page 6-1.

NC

"4.1  Plan Selection
Recipients will select and be assigned to a Plan only through an independent Health Benefit Manager (HBM) who will perform this function under separate contract to the Division...

Eligible family members in the same case must select the same Plan.  Family members shall be permitted to choose different providers within the same Plan.  Eligible members residing in the same household are encouraged to select the same Plan, but are not required to do so…"  North Carolina, page 5.

ND

"5.1  Enrollment
Enrollment in the Contractor's plan shall be voluntary.  The Contractor shall accept as enrolled all persons who appear as enrollees on the Contractor enrollment notification file, provided that the number of enrollees does not exceed the ceiling as referenced in Section 2.10 of Attachment C of this agreement...

The Contractor shall conduct a continuous open enrollment period during which the Contractor shall accept all eligible recipients in the order in which they apply without regard to health status of the recipient or any other factor(s) up to the limits described in Section 2.10."  North Dakota Contract, Attachment C, page 34.

OH

"B.  Background...
Program Characteristics...
ODHS supports and encourages all eligible individuals to actively select an MCP; however, when individuals in mandatory enrollment counties do not make a choice within thirty days of notification, assignments to plans are made…"  Ohio RFP, page 4.

OK

"2.4  Member Enrollment and Disenrollment
2.4.1  Eligibility Determination and Enrollment...
Recipients will enroll in a Health Plan in one of two ways: by voluntarily choosing a Plan...

2.4.2  Open Enrollment...
Both existing enrollees and new eligibles will be informed of their option to choose a Health Plan…"  Oklahoma RFP, pages 15-16.

OR

"A.  Enrollment
Enrollment is the process by which DHR signs on with a particular contractor those individuals who have been determined to be eligible for services under the Oregon Health Plan Medicaid Demonstration Project and/or the Childrens' Health Program. DHR shall sign on such individuals with the contractor selected by the individual unless, pursuant to OAR 410-141-0060, DHR assigns the person to a contractor because the individual failed to select a contractor. Contractor shall have an open enrollment period at all times, during which Contractor shall accept, without restriction, all eligible individuals in the order in which they apply and are signed on by DHR, unless OMAP and Contractor have jointly closed enrollment with Contractor because Contractor's maximum enrollment limit has been reached or for any other reason mutually agreed to by OMAP and Contractor...

(2)  Contractor shall have not less than 30 continuous days of open enrollment in each service area every Agreement Year regardless of Contractor's maximum enrollment limit specified in Section 1, Status of Contractor, and Contractor's actual enrollment, unless otherwise approved by OMAP. The open enrollment periods for consecutive Agreement years may not be more than 14 months apart."  Oregon Contract, pages 28-29.

ORMH

"IV.  Enrollment and Disenrollment
A.  Enrollment
1 ...DHS shall sign on such individuals with the contractor selected by the individual… Contractor shall have an open Enrollment period at all times, during which contractor shall accept, without restriction, all eligible individuals in the order in which they apply and are signed on with Contractor by DHS…"  Oregon Mental Health Contract, page 4.

PA

"C.  HealthChoices Program...
9.  Voluntary Selection of an HMO
Following the pre-enrollment period, HealthChoices eligibiles will be given up to four (4) weeks from the time they are deemed eligible to receive MA benefits in the HealthChoices area to select an HMO.  Each family member has the option to select an HMO…of their own; however, family members will be strongly encouraged to establish and maintain coverage from the same HMO…"  Pennsylvania RFP, pages 6-9.

PABH

"1.  Pre-Enrollment...
  B)  Behavioral Health
  All persons whose enrollment is mandatory for November 1, 1996, will be notified that they will be assigned to the MCO for their county.
  Those persons whose enrollment is voluntary until July 1, 1997, must be notified that in order to be enrolled in the MCO they must first elect to enroll in a HealthChoices physical health HMO."  Pennsylvania Behavioral Health RFP, page 42.

RI

"2.04.08  Voluntary Selection of Health Plan
Rite Care eligibles shall be given fourteen (14) calendar days from the time of their enrollment counseling session to select a Health Plan.  All members of a family must select the same Health Plan.  If a family does not select a Health Plan within the 14 day window, it shall automatically be assigned to a Health Plan...

If Rite Care eligibles do not attend an enrollment counseling session, they will be given the opportunity to enroll by mail.  They will have a thirty (30) day window from the date of the mailing to select a Health Plan.  If a family does not select a Health Plan within the 30-day window, it shall automatically be assigned to a Health Plan…"  Rhode Island RFP, pages 11-12.

TN

"2-6.    Enrollment
a.  Enrollment Guidelines
  4...Except for any applicable TennCare policies and procedures requiring assignment in a health plan, all applicants shall be required at the time of their application to select a plan from the plans available in the community service area where the applicant resides and the enrollee will be advised to seek medically necessary services during the period the application is pending only from providers in the network of the plan the applicant selected or was assigned…"  Tennessee Contract, pages 34-35.

TX

"7.8  PRIMARY CARE PROVIDERS…
7.8.12  PCP Selection and Changes.  All Medicaid recipients who are eligible for participation in the STAR program have the right to select their PCP and HMO…"  Texas Contract, pages 63, 66.

UT

"Article III - Enrollment, Orientation, Marketing, and Disenrollment
A. Enrollment Process
  1.  Enrollee Choice
  The DEPARTMENT will offer potential Enrollees a choice among all MCOs available in the Enrollment Area... The Medicaid client's intent to enroll is established when the applicant selects The CONTRACTOR, either verbally or by signing a choice of health care delivery form or equivalent.  This initiates the action to send an advance notification to the CONTRACTOR."  Utah Contract, Attachment B, page 3.

VA

"4.  Open Enrollment
The Department shall conduct an annual open enrollment for all Medallion II participants.  The open enrollment period shall be for sixty (60) calendar days.  Enrollment selections will be effective on the first of the next month following the open enrollment period…"  Virginia Contract, page 24.

WA

"2.6  Enrollment Process:  To enroll as a member with the Contractor, the client, his/her representative or his/her responsible parent or guardian must complete and submit a DSHS enrollment form to DSHS, or call the DSHS toll-free enrollment number...
All eligible clients shall be enrolled by DSHS with the Contractor of their choice if the Contractor has not reached the enrollment limit…

2.7  Enrollment Limits and Order of Member Acceptance...
The Contractor will accept the enrollment of members up to the total enrollment limit, and members will be accepted in the order in which they apply.  No eligible client shall be refused membership or re-enrollment, have his/her enrollment terminated, or be discriminated against in any way because of his/her health status, or the existence of a pre-existing physical or mental condition, including pregnancy and/or hospitalization.

All eligible clients shall be enrolled by DSHS with the Contractor of their choice if the Contractor has not reached the enrollment limit.  The Contractor shall accept clients/members who are assigned by DSHS in accordance with WAC 388-538-060, except as specifically provided in Section 2.9."  Washington Contract, pages 6-7.

WI

"VII. ENROLLMENT AND DISENROLLMENT
A. ENROLLMENT… Enrollment in the HMO shall be voluntary by the recipient except where limited by Departmental implementation of a section 1915(b) waiver. The current 1915(b) waiver requires mandatory enrollment into an HMO for those service areas in which there are two or more HMOs with sufficient slots for the HMO eligible population, or where there is one HMO and a Primary Provider Program whose combined slots are sufficient for the HMO eligible population."  Wisconsin Contract, page 54.