WAG 20-24-04

MCOs are responsible for providing the same medical services that are covered under Medicaid, with a few exceptions. revised textDental services for MCO enrollees are covered directly through DentaQuest. The MCO covers treatment of medical conditions of the eye, but not an examination to determine the need for eyeglasses, nor any services provided by an Optometrist. Pharmacy services provided by a pharmacy are not covered by the MCO. Clients should receive their vision and pharmacy services from any provider that accepts the HFS medical card.

revised textA client enrolled in an MCO should receive all other services through the MCO's network. A client who is out of the service area and needs medical attention that is not an emergency must call the MCO for a referral.

In an emergency the client can go to the nearest hospital to receive services. Each MCO has emergency after-hours phone numbers available for enrollees to call.

If a client has an MCO reflected on their MediPlan or All Kids medical card and needs medical services, but has moved to an area that is not serviced by an MCO, they can be immediately disenrolled from the MCO.