CAGN23091114EN - Medicaid Plans (2024) - Product Knowledge 1. Manage care plans pay health care providers directly, so enrollees do not pay out-of the pocket for covered services recieved from the plans network of doctors, 2. 3. "on exchange" Enrollees who applied for medicaid through the new york state of health are known as On- Exchange Members. The term comes from the marketplace, or exchange, that enables New York State residents to apply for health care benefits. 4. "Off Exchange" Enrollees who did not apply through the new york state of health and recieved their medical benefits via the HRA or LDSS are known as Off Exchange Members 5. Medicaid Categories= Public assistance, Medical Assistance, Suplemental Assistance, Temporary Assistance for Needy Families (TANF) 6. Mandatory Enrollment= Enrollees who are eligible for Medicaid are required to select a Managed Care Organization (MCO). New York State requires enrollees to select an MCO within 60 days of their confirmed eligibiltiy. 7.Grace Period= 90 Days New members can try us for 90 days. During their first 90 days, members can choose to disenroll in Senior Health Partners and join another health plan any time. If the member does not disenroll in the first 90 days, they must stay in senior health partners for the following nine months, unless they demonstrate a good cause reason. 8. What can an individual do during this Grace Period= 9. 9 months 10.What can an individual do during the lock-in Period?= After the grace period ends, enrollees must stay with their selected plan for the following 9 months. This is called the lock in period. During the lock in period, enrollees can only make changes if they can demonstrate a good cause, or a legitimate reason tha prevents them from staying with their current plan. 11. What type of enrolless are excluded from choosing a Manage care Organization (MCO) 12. What type of enrolles are exempt from choosing a MAnage Care Organization (MCO)= Some enrollees are exempted from the MAndatory Enrollment to a MAnaged Care Organization, its grace period, or the lock-in period, Examples of exempt individuals include. . People in a long term alcohol or residential drug program . People who are in regular