Utah Admin. Code R414-140-4 - Restrictions on Changes in Enrollment
(1) The Department must give Medicaid clients
a choice of at least two health plans. Each new applicant for Medicaid in the
urban counties is offered an orientation about Medicaid and the Choice of
Health Care Delivery Program . A health program representative employed by the
Department conducts the orientation and also enrolls Medicaid clients in a
health plan. During the orientation the clients are presented with health plan
options.
(2) The Department
restricts the disenrollment rights of enrollees who are required to enroll with
a health plan in accordance with the regulations at
42 CFR
438.56. Disenrollment rights are restricted
for a period of up to 12 months with the following exceptions:
(a) during the first three months of the
enrollee 's initial enrollment with a health plan, the enrollee may select a
different health plan without cause;
(i) if
the enrollee moves out of the health plan's service area;
(ii) if the enrollee requests to select a
different health plan for good cause and the Department approves the request;
or
(iii) if the enrollee chooses a
different health plan during the Department's annual disenrollment
period.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) The Department must give Medicaid clients a choice of at least two health plans. Each new applicant for Medicaid in the urban counties is offered an orientation about Medicaid and the Choice of Health Care Delivery Program. A health program representative employed by the Department conducts the orientation and also enrolls Medicaid clients in a health plan. During the orientation the clients are presented with health plan options.
(2) The Department restricts the disenrollment rights of enrollees who are required to enroll with a health plan in accordance with the regulations at 42 CFR 438.56. Disenrollment rights are restricted for a period of up to 12 months with the following exceptions:
(a) during the first three months of the enrollee's initial enrollment with a health plan, the enrollee may select a different health plan without cause;
(i) if the enrollee moves out of the health plan's service area;
(ii) if the enrollee requests to select a different health plan for good cause and the Department approves the request; or
(iii) if the enrollee chooses a different health plan during the Department's annual disenrollment period.