AFDC
AL| CA| GA | MS | NY | NC"Section Eleven: Eligible Recipients
Medicaid eligibles that must participate in Patient 1st are those for whom eligibility has been determined as listed below. Eligibility categories include: (The numbers in parenthesis indicate the numerical indicator for each aid category.)...
AFDC and AFDC related. (3)...Medicaid recipients in the above categories of Medicaid eligibility are excluded from participation in Patient 1st in the following circumstances:
1. Medicaid eligibility is retroactive only.2. Recipient is enrolled in another managed care program in which access to primary care physician is limited (i.e., HMO).
3. Recipient is a lock-in.
4. Recipient resides in a residential facility such as a nursing home or ICF/MR or a group home resident.
Recipients are removed from Patient 1st participation if they are changed to a category of eligibility as listed in 1 through 4 above. Dependent upon when a person becomes Medicaid eligible, they may not yet be enrolled in Patient 1st.
If you have a patient who is enrolled in Patient 1st who should not be enrolled, please contact the Customer Service Unit at ---. An example may be a child who is truly in foster care but who is certified for Medicaid through SSI. This child should not be enrolled but is due to how the system recognizes aid categories." Alabama PMP, pages 18-19.
"Eligible Beneficiary means any Medi-Cal beneficiary who is residing in the Contractor's service area with an appropriate aid code as identified by the Department and who is not certified as eligible for the Genetically Handicapped Persons Program or the California Children's Services Case Management Program, who is not in need of services for chronic renal dialysis or major organ transplants, or who is not institutionalized in a skilled nursing or immediate care facility." California Contract, page 5.
"702. Eligible Aid Categories
1. Membership in GBHC is mandatory for Medicaid recipients who reside in a GBHC participating county and who are eligible for Medicaid in one of the following aid categories: ..." Georgia Agreement, page VII-1."4.11 Eligible Clients
Medicaid clients who must participate in HealthMACS are those for whom the Mississippi Department of Human Services (DHS) determines eligibility and who live in a county in which HealthMACS has been implemented. Eligibility categories include:
1. Aid to Families with Dependent Children (AFDC): Children under 18 who are deprived of a parent and the needy caretaker; may be incapacitated or unemployed." Mississippi Manual, pages 71, 82."5. PERSONS ELIGIBLE FOR ENROLLMENT
5.1(a) Except as specified in Section 5.1(b), and 6.1 below: all persons in the following Medicaid eligible categories, who reside in the Service Area are entitled to voluntary enrollment in a managed care plan and shall be offered the opportunity for enrollment with the (PCP/Contractor): ...NCAid to Families with Dependent Children-Related (Medicaid only)" New York Contract, pages 15-16. "Eligible Recipient - Persons eligible in the following Medicaid categories: Aid to Families with Dependent Children (AFDC)... Recipients who are determined eligible in accordance with Federal and State laws and who reside in a Carolina ACCESS service area." North Carolina Agreement, page 1.