Revision 20-4; Effective October 1, 2020
The person is continuously eligible for 12 months beginning the first day of the application month if all eligibility criteria are met. Applicants are eligible to receive benefits beginning the month of their 18th birthday through the end of the month of their 21st birthday.
The medical effective date cannot precede the month of the applicant’s 18th birthday.
Medical Coverage for Individuals Confined in a Public Institution, B-500
M—1011 Three Months Prior Coverage
Revision 10-2; Effective April 1, 2010
Follow policy in A-830, Medicaid Coverage for the Months Prior to the Month of Application, to provide Medicaid coverage if the individual meets eligibility criteria.
M—1012 Types of Coverage
Revision 15-4; Effective October 1, 2015
The type of coverage determines how recipients access Medicaid services. There are two types of coverage. They are fee-for-service and managed care.
Fee-for-Service — Also known as traditional Medicaid, allows access to any Medicaid provider and self-referral to specialists. The provider submits claims directly to the claims administrator for reimbursement of Medicaid-covered services.
Managed Care — A service delivery program that provides medical care in a managed care setting. The state pays a monthly premium to the health maintenance organization (HMO) for each recipient enrolled in the plan. The plan processes all provider claims.
Medicaid for Transitioning Foster Care Youth recipients have the option to enroll in either type of coverage. See A-821.2, Managed Care.
Types of Coverage, A-821