A managed care organization (MCO) is a group that provides healthcare benefits and services to qualified people on Medicaid. In Maryland, this is done through the HealthChoice Program, Maryland’s statewide managed care program. MCOs work with a network of doctors to ensure that the people on Medicaid have appropriate access to the healthcare they need.
What is a managed care program?
A managed care program is a delivery system that the manages cost, quality and use of healthcare benefits and services. For people on Medicaid, this means that their health benefits and other services are provided through an MCO.
Who is allowed to participate in an MCO?
Most people on Medicaid qualify for coverage in an MCO under the HealthChoice Program. Medicaid recipients have the option to select their own MCO. People who may not qualify for Medicaid coverage through an MCO include:
- Individuals over 65 years old,
- Who are right now (or will be) in a hospital for long-term care or mental issues that will exceed more than 90 days and
- Who are in limited coverage categories (example: women who get family planning services through the Family Planning Program).
What services are provided under an MCO?
Medicaid recipients are eligible for primary care services and specialty health care services under their coverage with an MCO. In addition, MCO’s may offer services such as:
- Language translation to understand and learn prevention and good health habits,
- Health education,
- Case management,
- Disease management,
- Special arrangements and home visits for certain special needs and hard-to-reach populations, and
- Assistance with setting up programs, such as transportation and The Special Supplemental Nutrition Program for Women, Infants and Children (WIC Program).
How do I get started?
For more information about coverage and how to join Jai Medical Systems, contact us today.