1. (a) All medicaid recipients shall be enrolled in managed care unless the recipient is excluded from managed care as described in (b) below.

2. (b) The following individuals shall not be allowed to enroll in managed care:

   1. (1) Recipients receiving certain financial benefits from the U.S. Department of Veterans Affairs;
   2. (2) Recipients receiving in and out medically needy assistance in accordance with 42 CFR 435.301 and He-W 878.01;
   3. (3) Recipients who are eligible under the qualified medicare beneficiary (QMB), specified low-income medicare beneficiary (SLMB), or qualified disabled working individual (QDWI) benefits only, and are not eligible for full medicaid coverage;
   4. (4) Recipients who are eligible under the family planning expansion category (FPEC) in accordance with 1902(a)(10)(A)(ii) of the Social Security Act, 42 U.S.C. 1396a(a)(10)(A)(ii) and He-W 509;
   5. (5) Individuals during a presumptive eligibility period; and
   6. (6) Individuals in a retroactive eligibility period.
3. (c) Any recipient not enrolled in managed care shall receive medicaid services on a fee-for-service basis.

Source. #10410, eff 9-13-13; ss by #10631, eff 7-1-14; ss by #10965, eff 11-1-15; ss by #13474, eff 10-24-22