Disenrollment Procedure

Enrollment in Medicaid managed care is generally mandatory, with consumers allowed to disenroll only under specified conditions.  In general, states are responsible for processing disenrollments from Managed Care Organizations (MCO).  Contracts with MCOs specify the form disenrollment requests must take, the procedure of processing requests, effective dates, and notice requirements.

Contents – To access the full text, please click each sub-topic.

  • State will process all disenrollments from MCO: Florida a
  • State will make final determinations about granting disenrollment requests: Florida b, Hawaii c, New York d, Tennessee e
  • State will process all disenrollment requests submitted in writing by a member or representative: Hawaii f
  • State must approve any MCO request for disenrollment for cause: Texas g

  • CMS must review and approve disenrollment where member engaged in disruptive behavior: Minnesota h

  • MCO may not request disenrollment of member, but MCO must inform state promptly when MCO knows or has reason to believe member may satisfy any of the conditions for termination: Tennessee i
  • MCO must submit disenrollment requests in writing to state, with all supporting documentation meeting state requirements: New Mexico j
  • If disenrollment request is granted, MCO remains responsible for member’s care until member is enrolled with new MCO: New Mexico k
  • MCO must provide written confirmation to member of an oral request to disenroll and maintain a copy in member’s record: New York l
  • MCO must attempt to obtain member’s signature on voluntary disenrollment form, but may not delay disenrollment while it attempts to secure the member’s signature: New York m

 

  • Member request to disenroll may be made orally or in writing to state, entity designated by state, or MCO: New York n

  • Effective date of all approved disenrollments will be no later than the first day of the second month in which request was filed: Hawaii o, New Mexico p, New York q
  • Effective date of disenrollments other than at the request of member are determined by state and indicated in termination record: Tennessee r
  • If state fails to make determination in specified time frame, disenrollment will be considered approved: Hawaii s, New Mexico t

  • State will notify MCO by final transfer: Florida u
  • State will notify member by surface mail: Florida v
  • When MCO requests an involuntary disenrollment, it must notify consumer in writing including the reason for the request, and an explanation that MCO is requesting the consumer be disenrolled in the next contract month, or sooner if necessary: Florida w
  • Within 5 calendar days of receiving state’s enrollment files, MCO must send notice of disenrollment to all members who were disenrolled due to moving outside the region: Florida x
  • MCO must give prior verbal and written notice to member, with a copy to state, of its intent to request disenrollment: New York y
  • Notice must include mailing address and phone number of state agency: New York ``
  • State must notify member of decision to disenroll: Texas aa
  1. Fla. Contract, Atch. II, p. 37.  (back)
  2. Fla. Contract, Atch. II, p. 37.  (back)
  3. Haw. RFP, p. 183.  (back)
  4. N.Y. Medicaid Advantage Plus Contract, App. 8, p. 14.  (back)
  5. Tenn. Contract, p. 38.  (back)
  6. Haw. RFP, p. 57.  (back)
  7. Tex. Contract, p. 24.  (back)
  8. Minn. Contract, p. 42.  (back)
  9. Tenn. Contract, p. 39.  (back)
  10. N.M. Contract, p. 24.  (back)
  11. N.M. Contract, p. 24.  (back)
  12. N.Y. Medicaid Advantage Plus Contract, Sect. 8, p. 2; N.Y. Partnership Contract, p. 18.  (back)
  13. N.Y. Medicaid Advantage Plus Contract, Sect. 8, p. 2; N.Y. Partnership Contract, p. 18.  (back)
  14. N.Y. Medicaid Advantage Plus Contract, App. 8, p. 10.  (back)
  15. Haw. RFP, p. 58.  (back)
  16. N.M. Contract, p. 25.  (back)
  17. N.Y. Medicaid Advantage Plus Contract, Sect. 8, p. 2.  (back)
  18. Tenn. Contract, p. 39.  (back)
  19. Haw. RFP, p. 58.  (back)
  20. N.M. Contract, p. 25.  (back)
  21. Fla. Contract, Atch. II, p. 37.  (back)
  22. Fla. Contract, Atch. II, p. 37.  (back)
  23. Fla. Contract, Atch. II, p. 46-47.  (back)
  24. Fla. Contract, Atch. II, p. 47.  (back)
  25. N.Y. Medicaid Advantage Plus Contract, App. 8, p. 14.  (back)
  26. N.Y. Medicaid Advantage Plus Contract, App. 8, p. 14.  (back)
  27. Tex. Contract, p. 24.  (back)

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