Time-line for plan selection

CO | DE | HI | KS | MD | MI | MN | MO | NE | NM | NY | NC | OH | PA | RI | VA | WA

“II. ELIGIBILITY AND ENROLLMENT…
B. Enrollment
1. Voluntary Enrollment and Assignment
Client Enrollment shall be on a voluntary or assignment basis...
a. If a Client has not selected one of the Department’s managed health care programs within at least sixty five (65) days of determination or redetermination of eligibility for Medicaid, the Client may be assigned to the Contractor, as specified in 10 CCR 2050-10, § 8.209.29.

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.

“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.

2.1.3.3 HBM Follow Up Process
If a member’s choice information has not been received by the HBM within twenty (20) calendar days after the mailing of the enrollment materials, the HBM will contact the member to remind them about the pending enrollment choice. If a member/family does not select a MCO within thirty (30) calendar days from the postmark date of the initial HBM enrollment mailing, the default assignment choice will become effective. When information regarding MCO selection is received (by mail, through telephone contact or face-to-face contact), the HBM will enter the member’s information into the automated system which interfaces with the State’s Medicaid Management Information System (MMIS). Enrollment rosters will be sent directly from the MMIS to the MCO. MCOs must have electronic systems that will interface with and accept enrollment information from the HBM.” Delaware RFP, pages II.4-II.5.

“40.420 QUEST Enrollment...
If a recipient does not select a plan within 10 days, DHS shall assign the recipient’s enrollment in a health plan...” Hawaii RFP, page 46.

“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. If the beneficiary fails to choose either a PCP or HMO, the fiscal agent will auto-assign the beneficiary to a PCP or HMO...” Kansas Contract, page 44.

“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.” Maryland COMAR 10.09.63.02.

“II-G ENROLLMENT IN THE CHCP...
2. Initial Enrollment...
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.

“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.
Recipients who do not choose a health plan within the allotted time will be assigned to a health plan by the Local Agency or the STATE…” Minnesota Contract, page 20.

“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.

“9.3.3 Forty-Five Day Enrollment Process: The PCP/plan and all enrollment activities shall be completed and entered on the Managed Care File by the EBS within forty-five (45) calendar days following a determination of eligibility, i.e., the client’s case is entered on the Department’s eligibility system as an ‘active’ case...

9.4.1 Reenrollment Rules Within Two Months of Disenrollment: ...
The client is free to choose a different PCP/plan; however, the reenrollment process shall be ‘automatic’ and shall be activated prospectively unless the client contacts the EBS. The client’s choice shall take precedence over the systematic process, if the choice is made prior to system cutoff.” Nebraska Contract, page 34.

“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.

“2.B.2.c Member Selection:
A new MCO mandatory enrollee has the opportunity to select an MCO within fourteen (14) calendar days. A current MCO member has the opportunity to change MCO during the first 30 days of a six month enrollment period. Members will be notified by HSD of the ability to change MCOs at least 60 days before the end of an enrollment period…” New Mexico Contract, pages 24.

“7. Article 2, Section 2.B.2., is amended as follows:
2.B.2.c A new MCO mandatory member has the opportunity to select an MCO within fourteen (14) calendar days.” New Mexico Contract, Amendment #1, page 2.

“1. DEFINITONS...
‘Auto-assignment’ means a process by which an Eligible Person, who is mandated to enroll in managed care, but who has not chosen to enroll within sixty (60) days of receipt of the mandatory notice, is assigned to a MCO …” New York Contract, page 1-1

“6. ENROLLMENT...
6.4 Auto Assignment
Upon implementation of the 1115 Waiver, or other applicable waivers of federal requirements, an Eligible Person whose enrollment in a MCO is mandatory and who fails to select a MCO within sixty (60) days of receipt of notice of mandatory enrollment may be assigned by the LDSS to the Contractor’s plan pursuant to NYS Social Services Law § 364-j and in accordance with Appendix H…” New York Contract, page 6-1.

"4.1 Plan Selection...
The Plan shall provide for a continuous open enrollment throughout the term of this Contract...
Eligible Recipients who do not voluntarily select a Plan within ten (10) business days of the date of interview with the HBM, (thirty (30) days for MAD and MAB Recipients), will be assigned to a Plan…" North Carolina Contract, page 5.

“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 5.

“C. HealthChoices Program...
9. Voluntary Selection of an HMO
Following the pre-enrollment period, HealthChoices eligibles 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.…” Pennsylvania RFP, pages 6-9.

“2.04.06 Open Enrollment
The State shall conduct an open enrolment for all Rite Care participants, except individuals covered for the Extended Family Planning benefit… from August 15 through September 15 annually. Enrollment selections will be effective on October 1. Health Plans which have contractual enrollment limits shall be able to retain existing members who select them, and shall be able to participate in open enrollment until contractual limits are met.” Rhode Island RFP, page 11.

“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.

“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…” Virginia Contract, page 24.

“2.5 Enrollment Period: Subject to the provisions of section 2.8(a), enrollment is continuously open. Members shall have the right to change enrollment prospectively, from one managed care plan to another without cause, each month (42 CFR 434.27).” Washington Contract, page 6.2.

“The terms and conditions of the department’s Request for Qualifications and Quotation (RFQQ) for CHIP, including the amendment and questions and RFQQ answers, are incorporated by reference, except as specifically noted below:
d. Section 2.5, Enrollment period. Enrollment is continuously open, as described in Section 2.5, for CHIP clients residing in counties with one managed care plan or none. CHIP clients resident in counties where two plans are available are subject to the enrollment provisions of the CHIP procurement, as modified by item 2 of this amendment.” Washington CHIP RFQQ, Amendment 1.