Nebraska Medicaid Program
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Managed Care is the way some clients receive their Medicaid benefits. It is a health care delivery system where Managed Care Organizations (MCO) are contracted to operate a health plan that authorizes, arranges, provides, and pays for the delivery of services in a basic benefits package to enrolled Medicaid 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, coordination of medical care, 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.
Currently, Physical Health managed care is offered in the following counties:
Clients can choose between the Coventry Nebraska or UnitedHealthcare Community Plan (formerly Share Advantage) health plans. Both health plans are provided by Managed Care Organizations (MCOs). MCOs are authorized to operate a health care delivery plan that authorize, arrange, provide, and pay 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 Physicians (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.
Clients who are required to enroll in physical health managed care will receive the Client Guidebook (Guía del Cliente”). 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 471-7715 (in the Lincoln area).
The MCOs are required to provide the Medicaid Services included in the Basic Benefits package. Pharmacy, dental, long-term care nursing facility, Home and Community-Based Waiver, personal assistance, and mental health/substance abuse services are not provided by the MCO health plan but are still available to managed care clients.
Nebraska Medicaid also provides managed care for behavioral health services by contracting with Magellan Behavioral Health, an Administrative Service Organization (ASO). Magellan coordinates, manages and provides access to mental health and substance abuse services to Medicaid eligible clients. You can contact Magellan at: 800-424-0333.
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