Medicaid/MMA Benefits

Community Care Plan will help you with these services.
We will work closely with your doctor or provider to make sure you get the services you need.

Medicaid (MMA) Quick Links

MEMBERS | HOW TO APPLY

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Expanded Benefits Plan Benefits: A - I Plan Benefits: L - R
Plan Benefits: S - Z Birth, Baby, Beyond
Telehealth Benefits

Expanded Benefits

Expanded benefits are extra goods or services we provide to you, free of charge. Call Member Services to ask about getting expanded benefits.

Equine Therapy

Equine therapy includes interactions between the member and horses to help improve behaviors and emotions.

COVERAGE/LIMITATIONS: Up to 10 therapy treatment sessions per year for 21+ years old. One evaluation/ re-evaluation per year.

PRIOR AUTHORIZATION: Plan OK Needed

Occupational Therapy

Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself, and using items around the house.

COVERAGE/LIMITATIONS: Up to 7 therapy treatments unit per week for 21+ years old. One evaluation/ re-evaluation per year.

PRIOR AUTHORIZATION: Plan OK Needed

Physical Therapy

Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition.

COVERAGE/LIMITATIONS: Up to 7 therapy treatments unit per week for 21+ years old. One evaluation/ re-evaluation per year.

PRIOR AUTHORIZATION: Plan OK Needed

Hearing Services

Hearing tests, treatments, and supplies that help diagnose or treat problems with your hearing. This includes hearing aids and repairs.

COVERAGE/LIMITATIONS: Please contact member services for more information 1-866-899-4828. Service is for 21+ years old.

PRIOR AUTHORIZATION: No Plan OK Needed

Vision Services

Visual Aids are items such as glasses and contact lenses.

COVERAGE/LIMITATIONS: Contact lenses - 6-month supply for 21+ years old. Frames – 1 per year for 21+ years old. Also includes one eye exam per year.

PRIOR AUTHORIZATION: Please contact 20/20 Vision at 1-877-296-0799

Prenatal Services

Services that ensure that you and your baby are healthy during and after your pregnancy.

COVERAGE/LIMITATIONS: Please contact member services for more information at 1-866-899-4828. Plan OK needed for hospital grade breast pump rental.

PRIOR AUTHORIZATION: Please contact member services for more information at 1-866-899-4828

Respiratory Therapy

Services to help you breathe better while being treated for a respiratory condition, illness or disease.

COVERAGE/LIMITATIONS: One (1) per day for 21+ years old. One evaluation/re-evaluation per year and one treatment per day; does not require plan OK.

PRIOR AUTHORIZATION: Plan OK Needed

Speech Therapy

Services that include tests and treatments to help you talk or swallow better.

COVERAGE/LIMITATIONS: Up to 7 therapy treatments units per week. One evaluation/re-evaluation per year, one evaluation of oral & pharyngeal swallowing function per year, one AAC initial evaluation per year, one AAC re-evaluation per year, and up to 4 30-minute sessions for AAC fitting, adjustment, & training visits per year; does not require plan OK.

PRIOR AUTHORIZATION: Plan OK Needed

Primary Care Services

Routine or sick visits to your Primary Care Physician (PCP) for adults 21+ years old.

COVERAGE/LIMITATIONS: Unlimited Visits

PRIOR AUTHORIZATION: No Plan OK Needed

Newborn Circumcision

Available upon request during the initial hospitalization visit and in physician offices within 12 weeks after birth. A limit of (1) per lifetime.

COVERAGE/LIMITATIONS: Available within the first (12) weeks of birth. One (1) per lifetime.

PRIOR AUTHORIZATION: No Plan OK Needed

CVS Discount Program

All enrollees will receive a CVS discount card providing 20% off purchases including Over the Counter medications.

COVERAGE/LIMITATIONS: 20% discount off certain OTC items.

PRIOR AUTHORIZATION: No Plan OK Needed

Doula Services

A non-medical person who stays with and assists you before, during, or after childbirth.

COVERAGE/LIMITATIONS: Unlimited per pregnancy

PRIOR AUTHORIZATION: No Plan OK Needed

Medically Related Home Care Services/Homemaker

Homemaker service for medical needs.

COVERAGE/LIMITATIONS: Two (2) carpet cleanings/year for enrollees with asthma.

PRIOR AUTHORIZATION: Plan OK Needed

Home Delivered Meals – Post Facility Discharge (Hospital or Nursing Facility)

Meal delivery after your inpatient hospital stay.

COVERAGE/LIMITATIONS: Ten (10) meals annually.

PRIOR AUTHORIZATION: No Plan OK Needed

Home Delivered Meals – Disaster Preparedness/Relief

Meal delivery before or after a natural disaster.

COVERAGE/LIMITATIONS: One (1) annually.

PRIOR AUTHORIZATION: No Plan OK Needed

Home Visit by a Clinical Social Worker

Services of a clinical social worker in home health or hospice setting.

COVERAGE/LIMITATIONS: 48 visits per year for 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Meals and Lodging – Non-emergency Transportation Daytrips

For non-emergency care when you have to travel a long distance.

COVERAGE/LIMITATIONS: $150 per stay.

PRIOR AUTHORIZATION: No Plan OK Needed

Nutritional Counseling

Provides you with information on the right type of foods to eat and based on your health needs.

COVERAGE/LIMITATIONS: Unlimited.

PRIOR AUTHORIZATION: Plan OK Needed

Swimming Lessons

Drowning Prevention Lessons.

COVERAGE/LIMITATIONS: Members up to age 11 are covered for up to $200 per year. This is limited to 1000 enrollees per year.

PRIOR AUTHORIZATION: Plan OK Needed

Vaccine – TdaP

Preventive Service.

COVERAGE/LIMITATIONS: One (1) vaccine per pregnancy

PRIOR AUTHORIZATION: No Plan OK Needed

Vaccine – Influenza

Preventive Service.

COVERAGE/LIMITATIONS: Unlimited.

PRIOR AUTHORIZATION: No Plan OK Needed

Vaccine – Shingles

Preventive Service.

COVERAGE/LIMITATIONS: One (1) per year.

PRIOR AUTHORIZATION: No Plan OK Needed

Vaccine – Pneumonia

Preventive Service.

COVERAGE/LIMITATIONS: Unlimited.

PRIOR AUTHORIZATION: No Plan OK Needed

Waived Copayments

All services, including behavioral health.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: No Plan OK Needed

Medication Assisted Treatment

Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Vaccine – Hepatitis A

Preventive Service.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: No Plan OK Needed

Housing Assistance

Supported Housing, per month.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Non-emergency Transportation - Non-Medical Purposes

Transportation: ancillary: parking fees, tolls, other.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Therapy - Art

Activity therapy, such as music, dance, art, or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more).

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Therapy - Pet

Activity therapy, such as music, dance, art, or play therapies not for recreation, related to the care and treatment of patient's disabling mental health problems, per session (45 minutes or more).

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Hospital Bed

Durable Medical Equipment.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Glucose Monitoring

Durable Medical Equipment.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Assessment Services

Evaluation & Assessments.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Behavioral Health Day Services/Day Treatment

Behavior Health Day Treatment.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Behavioral Health Screening Services

Behavioral Health Screening Services.

COVERAGE/LIMITATIONS: Ages 21+ years old.

PRIOR AUTHORIZATION: Plan OK Needed

Plan Benefits

Addictions Receiving Facility Services

Services used to help people who are struggling with drug or alcohol addiction.

COVERAGE/LIMITATIONS: As medically necessary and recommended by us.

PRIOR AUTHORIZATION: Plan OK Needed

Allergy Services

Services to treat conditions such as sneezing or rashes that are not caused by an illness.

COVERAGE/LIMITATIONS: We cover blood or skin allergy testing and up to 156 doses per year of allergy shots,COPAY: Waived.

PRIOR AUTHORIZATION: No Plan OK Needed

Ambulance Transportation Services

Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities.

COVERAGE/LIMITATIONS: Covered as medically necessary.

PRIOR AUTHORIZATION: No Plan OK Needed

Ambulatory Detoxification Services

Services provided to people who are withdrawing from drugs or alcohol.

COVERAGE/LIMITATIONS: As medically necessary and recommended by us.

PRIOR AUTHORIZATION: Plan OK Needed

Ambulatory Surgical Center Services

Surgery and other procedures that are performed in a facility that is not the hospital (outpatient).

COVERAGE/LIMITATIONS: Covered as medically necessary.

PRIOR AUTHORIZATION: Plan OK Needed

Anesthesia Services

Services to keep you from feeling pain during surgery or other medical procedures.

COVERAGE/LIMITATIONS: Covered as medically necessary.

PRIOR AUTHORIZATION: No Plan OK Needed

Assistive Care Services

Services provided to adults (ages 18 and older) help with activities of daily living and taking medication.

COVERAGE/LIMITATIONS: We cover 365/366 days of services per year.

PRIOR AUTHORIZATION: No Prior Authorization is required when services are rendered in an Assisted Living Facility, Adult family care home, or Residential treatment facility.

Behavioral Health Assessment Services

Services used to detect or diagnose mental illnesses and behavioral health disorders.

COVERAGE/LIMITATIONS: We cover:

  • -  One initial assessment per year
  • -  One reassessment per year
  • -  Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day)

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Behavioral Health Overlay Services

Behavioral health services provided to children (ages 0 – 18) enrolled in a DCF program.

COVERAGE/LIMITATIONS: We cover 365/366 days of services per year, including therapy, support services and aftercare planning.

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Cardiovascular Services

Services that treat the heart and circulatory (blood vessels) system.

COVERAGE/LIMITATIONS: We cover the following as prescribed by your doctor:

  • -  Cardiac testing
  • -  Cardiac surgical procedures
  • -  Cardiac devices

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for certain invasive services.

Child Health Services Targeted Case Management

Services provided to children (ages 0 - 3) to help them get health care and other services.

COVERAGE/LIMITATIONS: Your child must be enrolled in the DOH Early Steps program.

PRIOR AUTHORIZATION: No Plan OK Needed

Chiropractic Services

Diagnosis and manipulative treatment of misalignments of the joints, especially the spinal column, which may cause other disorders by affecting the nerves, muscles, and organs.

COVERAGE/LIMITATIONS: We cover:

  • -  24 established patient visits per year, per member
  • -  X-rays

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed after 24 visits per year, up to a maximum of 37 visits.

Clinic Services

Health care services provided in a county health department, federally qualified health center, or a rural health clinic.

COVERAGE/LIMITATIONS: COPAY: Waived to a federally qualified health center or rural health clinic visit.

PRIOR AUTHORIZATION: No Plan OK Needed

Crisis Stabilization Unit Services

Emergency mental health services that are performed in a facility that is not a regular hospital.

COVERAGE/LIMITATIONS: As medically necessary and recommended by us.

PRIOR AUTHORIZATION: No

Dialysis Services

Medical care, tests, and other treatments for the kidneys. This service also includes dialysis supplies, and other supplies that help treat the kidneys.

COVERAGE/LIMITATIONS: We cover the following as prescribed by your treating doctor:

  • -  Hemodialysis treatments
  • -  Peritoneal dialysis treatments

PRIOR AUTHORIZATION: Plan OK Needed

Durable Medical Equipment and Medical Supplies Services

Medical equipment is used to manage and treat a condition, illness, or injury. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches, and other items. Medical supplies are items meant for one-time use and then thrown away..

COVERAGE/LIMITATIONS: Some service and age limits apply. Call 1-866-899-4828 for more information.

PRIOR AUTHORIZATIONp/span> Prior Authorization is required for some Durable Medical Equipment and Medical Supplies.

Early Intervention Services

Services to children ages 0 - 3 who have developmental delays and other conditions.

COVERAGE/LIMITATIONS:

We cover:

  • -  One initial evaluation per lifetime, completed by a team
  • -  Up to 3 screenings per year
  • -  Up to 3 follow-up evaluations per year
  • -  Up to 2 training or support sessions per week

PRIOR AUTHORIZATION: No Plan OK Needed

Emergency Transportation Services

Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency.

COVERAGE/LIMITATIONS: Covered as medically necessary.

PRIOR AUTHORIZATION: No Plan OK Needed

Evaluation and Management Services

Services for doctor’s visits to stay healthy and prevent or treat illness.

COVERAGE/LIMITATIONS:

We cover:

  • -  One adult health screening (check-up) per year
  • -  Well child visits are provided based on age and developmental needs
  • -  One visit per month for people living in nursing facilities
  • -  Up to two office visits per month for adults to treat illnesses or conditions

COPAY: Waived

PRIOR AUTHORIZATION: No Plan OK Needed

Family Therapy Services

Services for families to have therapy sessions with a mental health professional.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 26 hours per year

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Gastrointestinal Services

Services to treat conditions, illnesses, or diseases of the stomach or digestion system.

COVERAGE/LIMITATIONS: We cover:

  • -  Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for invasive procedures.

Genitourinary Services

Services to treat conditions, illnesses, or diseases of the genitals or urinary system.

COVERAGE/LIMITATIONS: We cover:

  • -  Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for invasive procedures.

Group Therapy Services

Services for a group of people to have therapy sessions with a mental health professional.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 39 hours per year

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Hearing Services

Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. This includes hearing aids and repairs.

COVERAGE/LIMITATIONS: We cover hearing tests and the following as prescribed by your doctor:

  • -  Cochlear implants
  • -  One new hearing aid per ear, once every 3 years
  • -  Repairs

PRIOR AUTHORIZATION: Plan OK Needed for Cochlear implants.

Home Health Services

Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 4 visits per day for pregnant recipients and recipients ages 0 - 20
  • -  Up to 3 visits per day for all other recipients

COPAY: Waived per provider, per day

PRIOR AUTHORIZATION: Plan OK Needed

Hospice Services

Medical care, treatment, and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free. Support services are also available for family members or caregivers.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary

COPAY: See information on Patient Responsibility for copayment information; you may have Patient Responsibility for hospice services whether living at home, in a facility, or in a nursing facility.

PRIOR AUTHORIZATION: Plan OK Needed

Individual Therapy Services

Services for people to have one-to-one therapy sessions with a mental health professional.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 26 hours per year

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Inpatient Hospital Services

Medical care that you get while you are in the hospital. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you.

COVERAGE/LIMITATIONS:

We cover the following inpatient hospital services based on age and situation:

  • -  Up to 365/366 days for recipients ages 0 – 20
  • -  Up to 45 days for all other recipients (extra days are covered for emergencies)

PRIOR AUTHORIZATION: Plan OK Needed

Integumentary Services

Services to diagnose or treat skin conditions, illnesses or diseases.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Needed for invasive procedures.

Plan Benefits

Laboratory Services

Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary

COPAY: Waived per lab visit, Waived per office visit

PRIOR AUTHORIZATION: Plan OK Needed for genetic testing.

Medical Foster Care Services

Services that help children with health problems who live in foster care homes.

COVERAGE/LIMITATIONS:

Must be in the custody of the Department of Children and Families.

PRIOR AUTHORIZATION: No Plan OK Needed

Medication Assisted Treatment Services

Services used to help people who are struggling with drug addiction.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for Authorization 1-800-294-8642.

Medication Management Services

Services to help people understand and make the best choices for taking medication.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary.

COPAY: Waived

PRIOR AUTHORIZATION: No Plan OK Needed

Mental Health Targeted Case Management

Services to help get medical and behavioral health care for people with mental illnesses.

COVERAGE/LIMITATIONS: Covered as medically necessary.

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642.

Neurology Services

Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system.

COVERAGE/LIMITATIONS: Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for some procedures

Non-Emergency Transportation Services

Transportation to and from all of your medical appointments. This could be on the bus, a van that can transport disabled people, a taxi, or other kinds of vehicles.

COVERAGE/LIMITATIONS: We cover the following services for recipients who have no transportation:

PRIOR AUTHORIZATION: Plan OK Needed

Nursing Facility Services

Medical care or nursing care that you get while living full-time in a nursing facility. This can be a shortterm rehabilitation stay or long-term.

COVERAGE/LIMITATIONS: We cover 365/366 days of services in nursing facilities as medically necessary.

COPAY: See information on Patient Responsibility for room & board copayment information.

PRIOR AUTHORIZATION: Plan OK Needed

Occupational Therapy Services

Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself, and using items around the house.

COVERAGE/LIMITATIONS:

We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap:

  • -  One initial evaluation per year
  • -  Up to 210 minutes of treatment per week
  • -  One initial wheelchair evaluation per 5 years

We cover for people of all ages:

  • -  Follow-up wheelchair evaluations, one at delivery and one 6-months later

PRIOR AUTHORIZATION: Plan OK Needed

Oral Surgery Services

Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary.
  • -  COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for some procedures.

Orthopedic Services

Services to diagnose or treat conditions, illnesses or diseases of the bones or joints.

COVERAGE/LIMITATIONS: Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for Invasive procedures and advanced imaging services (such as MRI or CAT scan).

Outpatient Hospital Services

Medical care that you get while you are in the hospital but are not staying overnight. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you.

COVERAGE/LIMITATIONS:

  • -  Emergency services are covered as medically necessary
  • -  Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over

COPAY: Waived for non-emergency services at an emergency room and Waived for all others

PRIOR AUTHORIZATION: Plan OK Needed for some invasive procedures and overnight hospital observation.

Pain Management Services

Treatments for long-lasting pain that does not get better after other services have been provided.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary. Some service limits may apply

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for Invasive procedures.

Physical Therapy Services

Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition.

COVERAGE/LIMITATIONS: We cover for children ages

0-20 and for adults under the $1,500 outpatient services cap:

  • -  One initial evaluation per year
  • -  Up to 210 minutes of treatment per week
  • -  One initial wheelchair evaluation per 5 years

We cover for people of all ages:

Follow-up wheelchair evaluations, one at delivery and one 6-months later

PRIOR AUTHORIZATION: Plan OK Needed except for initial evaluation and re-evaluations.

Podiatry Services

Medical care and other treatments for the feet.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 24 office visits per year
  • -  Foot and nail care
  • -  X-rays and other imaging for the foot, ankle and lower leg
  • -  Surgery on the foot, ankle or lower leg

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for Invasive surgery.

Prescribed Drug Services

This service is for drugs that are prescribed to you by a doctor or other health care provider.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to a 34-day supply of drugs, per prescription

Refills, as prescribed

PRIOR AUTHORIZATION: Some medicationspequire Prior Authorization. All covered medications are $0 copay.

Private Duty Nursing Services

Nursing services provided in the home to people ages 0 to 20 who need constant care

COVERAGE/LIMITATIONS: We cover up to 24 hours per day

PRIOR AUTHORIZATION: Plan OK Needed

Psychological Testing Services

Tests used to detect or diagnose problems with memory, IQ or other areas

COVERAGE/LIMITATIONS: We cover:

  • -  10 hours of psychological testing per year

COPAYWaived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642

Psychosocial Rehabilitation Services

Services to assist people re-enter everyday life. They include help with basic activities such as cooking, managing money and performing household chores.

COVERAGE/LIMITATIONS: We cover:

  • -  Up to 480 hours per year

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642

Radiology and Nuclear Medicine Services

Services that include imaging such as x-rays, MRIs or CAT scans. They also include portable x-rays.

COVERAGE/LIMITATIONS:

  • -  Covered as medically necessary

COPAY: Waived per portable x-ray visit; Waived per office visit

PRIOR AUTHORIZATION: Plan OK Needed for advanced imaging such as MRI or CAT scans. No Plan OK Needed for x-rays

Regional Perinatal Intensive Care Center Services

Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions.

COVERAGE/LIMITATIONS: Covered as medically necessary

PRIOR AUTHORIZATION: No Plan OK Needed

Reproductive Services

Services for women who are pregnant or want to become pregnant. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family.

COVERAGE/LIMITATIONS:

We cover family planning services. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. You do not need prior approval for these services. These services are free. These services are voluntary and confidential, even if you are under 18 years old.

PRIOR AUTHORIZATION: No Plan OK Needed

Respiratory Services

Services that treat conditions, illnesses or diseases of the lungs or respiratory system.

COVERAGE/LIMITATIONS: We cover:

  • -  Respiratory testing
  • -  Respiratory surgical procedures
  • -  Respiratory device management

COPAY: Waived

PRIOR AUTHORIZATION: Plan OK Needed for some invasive procedures and devices.

Respiratory Therapy Services

Services for recipients ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease.

COVERAGE/LIMITATIONS: We cover:

  • -  One initial evaluation per year
  • -  One therapy re-evaluation per 6 months
  • -  Up to 210 minutes of therapy treatments per week (maximum of 60 minutes per day)

PRIOR AUTHORIZATION: Plan OK Needed except for initial evaluation and re-evaluations.

Plan Benefits

Specialized Therapeutic Services

Services provided to children ages 0 - 20 with mental illnesses or substance use disorders.

COVERAGE/LIMITATIONS:We cover the following:

  • -  Assessments
  • -  Foster care services
  • -  Group home services

PRIOR AUTHORIZATION: Please contact Carisk for Authorization at 1-800-294-8642

Speech-Language Pathology Services

Services that include tests and treatments help you talk or swallow better.

COVERAGE/LIMITATIONS:We cover the following services for children ages 0 - 20:

  • -  Communication devices and services
  • -  Up to 210 minutes of treatment per week
  • -  One initial evaluation per year

We cover the following services for adults:

  • -  One communication evaluation per 5 years

PRIOR AUTHORIZATION: Plan OK Needed except for initial evaluation and re-evaluations.

Statewide Inpatient Psychiatric Program Services

Services for children with severe mental illnesses that need treatment in the hospital.

COVERAGE/LIMITATIONS:Covered as medically necessary for children ages 0-20

PRIOR AUTHORIZATION: Please contact Carisk for Authorization at 1-800-294-8642

Therapeutic Behavioral On-Site Services

Services provided by a team to prevent children ages 0-20 with mental illnesses or behavioral health issues from being placed in a hospital or other facility.

COVERAGE/LIMITATIONS:We cover:

  • -  Up to 9 hours per month

COPAY: Waived

PRIOR AUTHORIZATION: Please contact Carisk for information at 1-800-294-8642

Transplant Services

Services that include all surgery and pre- and post-surgical care.

COVERAGE/LIMITATIONS:Covered as medically necessary

PRIOR AUTHORIZATION: Plan OK Needed

Visual Aid Services

Visual Aids are items such as glasses, contact lenses and prosthetic (fake) eyes.

COVERAGE/LIMITATIONS:We cover the following services when prescribed by your doctor:

  • -  Two pairs of eyeglasses for children ages 0 - 20
  • -  Contact lenses
  • -  Prosthetic eyes

PRIOR AUTHORIZATION: Please contact 20/20 for Authorization at 1-877-296-0799

Visual Care Services

Services that test and treat conditions, illnesses and diseases of the eyes.

COVERAGE/LIMITATIONS:Covered as medically necessary

COPAY: Waived

PRIOR AUTHORIZATION: Please contact 20/20 for Authorization at 1-877-296-0799

Birth, Baby, and Beyond Benefits

Prenatal care keeps pregnancies on a healthy track. It is important to see a doctor as soon as you are pregnant, and Community Care Plan (CCP) can help with that and more.

Benefits for Pregnant Medicaid Members

Find a Doctor for You and Your Baby

Making Early Prenatal Care and Postpartum Appointments

Getting Transportation

Prenatal Classes, Housing, Food, Baby Supplies, and Breastfeeding Help

Educational Facts and Info About Family Planning, Caring for Your Baby, and Safety

Making Delivery Plans


 

Telehealth Benefits

 

See a health care provider from your computer,
tablet or smartphone – anytime, anywhere.

What Is Telehealth?

 

The Department of Health and Human Services describes telehealth (also known as telemedicine) as the use of electronic information and telecommunication technologies to offer care when you and your doctor aren’t in the same place at the same time.

Telehealth helps you and your family get the care you need when you can’t make it to the doctor.

Visit with your doctor from home or the place that works best for you.

Here’s a short video to learn more about what telehealth is, how it works, and how our Medicaid members can use.

What Types of Care Can I Get with Telehealth?

During the state of emergency related to the COVID-19 pandemic, Medicaid has expanded the services offering telehealth care.

Covered services include routine, primary care visits as well as the following services:

  • Well-child visits
  • Behavior analysis services
  • Early intervention services
  • Specified behavioral health and therapy services
    • Individual and family therapy
    • Individual therapy for mental health and substance abuse
    • Medication management
    • Medication-assisted treatment services

For a list of covered benefits and services, click here to view our Medicaid Member Handbook.

Find Out If Your Doctor Offers Telehealth

 

More and more doctors are offering telehealth to help care for their patients.

To find a doctor who offers telehealth, try these options:

Reach out to your doctor. Many of Community Care Plan providers offer telehealth services. Contact your doctor for more information.

Use Teladoc This is a service offered by Community Care Plan to treat non-emergency issues (allergies, flu, eye issues, sinus infections, rashes, sore throat, and more).

Teladoc provides virtual visits or care with a licensed doctor from a smartphone or computer 24 hours/day, seven days/week.

For more information or to sign up, visit Teladoc.com.

What Do I Need for a Virtual Visit?

 

For many, virtual appointments are new, and it may be your first time seeing a doctor through a screen.

Here is what you will need and some tips to keep in mind before your visit:

  • A computer, tablet or smartphone, based on your type of visit
  • A strong internet connection, to avoid the video or call does not drop.
  • A way to chat with your doctor after your appointment, if needed (text or email are most common)
  • Important health records or medications, so you can reach them quickly and provide the information or review them with your doctor

Need Help?

Call Community Care Plan’s Member Services at 1-866-899-4828 or TTY at
1-855-655-5303 Monday to Friday, 8 a.m. to 7 p.m.

Watch this Video Example of How Telehealth Works

 

Curious about how telemedicine or telehealth works? You may live much closer to a doctor than Jennifer but watch this video for an example of how telemedicine or telehealth works.

Jennifer’s Story

Community Care Plan is a Managed Care Plan with a Florida Medicaid contract in Broward County. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co- insurance may change.