Managed Care Organizations (MCOs) are authorized to operate a health care delivery plan that authorizes, arranges, provides, and pays for the delivery of health care services to enrolled clients. The care of clients enrolled in the health plan is managed by the MCO through its network of Primary Care Providers (PCPs), specialists, hospitals, and other providers of care who contract directly with the MCO. Managed Care offers an opportunity to assure access to a PCP, emphasizes preventive care, and encourages the appropriate utilization of services in the most cost-effective settings.
Certain Medicaid clients are required to participate in the Nebraska Medicaid Managed Care Program. For a listing of clients required to enroll in Physical Health Managed Care, see 482 NAC Chapter 2 Client Participation. Clients who are required to enroll in Physical Health Managed Care cannot opt out of Managed Care.
The Physical Health MCOs are required to provide the Medicaid services included in the Basic Benefits package 482 NAC Chapter 4, 4.004.01-.02. Pharmacy, dental, long-term care nursing facility, Home and Community-Based Waiver, personal assistance, and mental health/substance use disorder services are not provided by the MCO Physical Health plan but are still available to Managed Care clients.
Clients who are required to enroll in Physical Health Managed Care will receive the Client Guidebook. Once the Client Guidebook has been received, enrollment into an MCO health plan can be made by calling the Medicaid Enrollment Center at 1-888-255-2605 or 402-477-4600 (in the Lincoln area), TTY 402-477-4601, between 8:00 a.m. and 6:00 p.m., Central Time, Monday through Friday.
Nursing Facility Level of Care Evaluation Memo
Level of Care Evaluation Requirements Questions and Answers
(NHC) Notification of Services Nursing Facility/Transplant
Hospice Questions and Answers
Service Area 1
Service Area 1 includes the following counties: Cass, Dodge, Douglas, Gage, Lancaster, Otoe, Sarpy, Saunders, Seward, and Washington.
If you live in this service area you can choose Aetna Better Health of Nebraska or UnitedHealthcare Community Plan for your Physical Health Managed Care Plan.
Service Area 1 Guidebooks and Provider Manual
Service Area 2
Service Area 2 includes the following counties: Adams, Antelope, Arthur, Banner, Blaine, Boone, Box Butte, Boyd, Brown, Buffalo, Burt, Butler, Cedar, Chase, Cherry, Cheyenne, Clay, Colfax, Cuming, Custer, Dakota ,Dawes, Dawson, Deuel, Dixon, Dundy, Fillmore, Franklin, Frontier, Furnas, Garden, Garfield, Gosper, Grant, Greeley, Hall, Hamilton, Harlan, Hayes, Hitchcock, Holt, Hooker, Howard, Jefferson, Johnson, Kearney, Keith, Keya Paha, Kimball, Knox, Lincoln, Logan, Loup, Madison, McPherson, Merrick, Morrill, Nance, Nemaha, Nuckolls, Pawnee, Perkins, Phelps, Pierce, Platte, Polk, Red Willow, Richardson, Rock, Saline, Scottsbluff, Sheridan, Sherman, Sioux, Stanton, Thayer, Thomas, Thurston, Valley, Wayne, Webster, Wheeler, and York.
If you live in this service area you can choose Aetna Better Health of Nebraska or Arbor Health Plan for your Physical Health Managed Care Plan.
Service Area 2 Guidebooks and Provider Manual
Contracts - Service Area 1
Contracts - Service Area 2
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