1. (1)(a) The department shall give Medicaid members a choice of at least two health plans.

   1. (b) Each new applicant for Medicaid in a mandatory enrollment county shall be offered an orientation about Medicaid and the CHCDP.

      1. (i) A health program representative employed by the department shall conduct the orientation and enroll Medicaid members in a health plan.
      2. (ii) During the orientation, each member shall be presented with health plan options.

2. (2) The department restricts the disenrollment rights of members who are required to enroll with a health plan in accordance with 42 CFR 438.56. Disenrollment rights are restricted for a period of up to 12 months, except during the first three months of the member's initial enrollment with a health plan, if:

   1. (a) the member chooses a different health plan during the department's annual open enrollment period;
   2. (b) the member moves out of the health plan's service area; or
   3. (c) the member requests to select a different health plan for good cause and the department approves the request.

KEY: Medicaid, enrollee, PIHP, PCCM

Date of Last Change: November 13, 2025

Notice of Continuation: June 4, 2024

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108