How do Medicaid Eligibles Receive Services?
Once someone has filed an application and been determined eligible for Medicaid, they will likely receive their medical services through the States Medicaid Managed Care Program, HealthChoice. If someone qualifies for HealthChoice, they will choose a Primary Care Provider (PCP) and be enrolled with a Managed Care Organization (MCO) of their choice. If the person does not qualify for HealthChoice (e.g., because they are also Medicare eligible, eligible for Medicaid through spenddown, or eligible in a long-term care facility), they will still receive Medicaid services, but through fee-for-service (FFS). This means that each medical provider who provides services to the Medicaid recipient bills the Medicaid program for payment. Prior to HealthChoice and other managed care programs, all provider claims for Medicaid services were handled this way. Under HealthChoice managed care, the MCOs contract with DHMH to provide Medicaid covered services through their provider networks in return for m
