All Medicaid Programs |
Obsolete Policy |
If a recipient has a primary provider or Health Plan, the recipient must seek medical services through, or receive a referral from, the medical provider or those services will not be covered.
If a recipient is on the Restriction Program, the recipient may only receive services from the provider or providers assigned by the Restriction Program, or those services will not be covered.
Otherwise, a recipient may seek medical care anywhere within the State; however, the individual is encouraged to seek the nearest available medical care. Reimbursement for transportation will be denied if the recipient does not receive services from the nearest available medical provider.
Sometimes a recipient enrolled with a Health Plan may need emergency or urgent care in a location in-state that is not serviced by the Health Plan. The recipient must follow the Health Plans rules about contacting the Health Plan when an emergency or urgent care need occurs outside of its service area, or the Health Plan may not cover the services.
Some medical services must be prior authorized. The provider must contact HCF, or the appropriate Health Plan to receive prior authorization.
Non-Emergency medical transportation is only available to Traditional Medicaid recipients to get to and from medical services. Refer to Sec. 651. Emergency medical transportation (ambulance, air ambulance) is available to any recipient who has a life-threatening medical emergency requiring emergency transportation.