Dems: Upcoming MCO change deadline

June 13, 2016

This is just a quick reminder that Thursday, June 16 is the last day that a Medicaid managed care member can change their MCO without cause.


Members may call Member Services at IME to change their MCO if they desire to do so at 1-800-338-8366.


After June 16, members must have “cause” to disenroll from their current MCO and switch to another.


The following are “cause” for disenrollment:


  1. The enrollee moves out of the MCO’s, PIHP’s, PAHP’s, or PCCM’s service area.


  1. The plan does not, because of moral or religious objections, cover the service the enrollee seeks.


  1. The enrollee needs related services (for example a cesarean section and a tubal ligation) to be performed at the same time; not all related services are available within the network; and the enrollee’s primary care provider or another provider determines that receiving the services separately would subject the enrollee to unnecessary risk.


  1. Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the enrollee’s health care needs.


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