Michigan Medicare Medicaid Changes for Dual Eligibles | Michigan ...

Effective October 1, 2011, Medicaid beneficiaries with both Medicare eligibility and Medicaid eligibility (dual?eligibles) will transition from an excluded population to a voluntary population for purposes of Medicaid Health?Plan (MHP) enrollment. Certain categories of dual eligibles will remain an excluded segment of this population?and will not be transitioned to voluntary enrollment. The following dual eligibles will remain an excluded?population:
? Dual eligibles with program code C, L, N, or Q;
? Dual eligibles excluded for reasons other than dual eligible status such as Medical Exception or?Incarceration;
? Dual eligibles without full Medicaid coverage such as Qualified Medicare Beneficiaries, Special Low?Income Medicare Beneficiaries and Additional Low Income Medicare Beneficiaries; or
? Dual eligibles enrolled in a Medicare managed care plan (MMCP) that is not approved to serve Medicaid?enrollees in the enrollee?s county of residence.

MHPs are responsible for co-insurance and deductibles for all Medicare-covered services. In general, providers?and MHPs must follow the guidelines for Medicare as described in the Medicaid Provider Manual, Coordination of?Benefits Chapter, Section 2.6 Medicare.

MHPs may require beneficiaries to obtain services from in-network providers and may require enrollees to obtain?prior authorization (PA) for services. Per current contractual restrictions, the MHPs are prohibited from requiring?PA under the following circumstances:
? When a beneficiary is receiving emergency services.
? When a beneficiary receives care from a Federally Qualified Health Center (FQHC) in their county of?residence and the MHP does not have a contract with that particular FQHC.
? When a beneficiary receives immunizations and communicable disease services provided by a Local?Health Department.

MHPs must cover Medicaid-covered prescriptions that are excluded from Part D pharmacy coverage unless the?drug class is specifically carved-out of the MHP benefit.

Christopher J. Berry practices Michigan estate, business, probate and elder law attorney. He has been a lecturer, speaker and writer on estate planning topics. Learn More ? This entry was posted in Medicaid, Medicare. Bookmark the permalink.

Source: http://michiganelderlawcenter.com/proposed-medicaid-medicare-eligibility-dual-eligibles-changes/

nickjr ronald reagan barry white barry white pasta salad recipe coloring pages coloring pages