Health Care Services Covered by Medicare HMO's

Part 4, Chapter 13: Specialized Situations: Programs for Children and Adults with Disabilities and Special Health Care Needs Page 7

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Medicaid HMOs may also allow medical tests and services to be delivered in a more organized manner, since all medical care is generally coordinated by the individual's primary care physician. Medicaid HMOs may offer coverage for preventive services, as well. In addition, the establishment of Medicaid HMOs may provide significant cost savings for the government.

However, the transition to managed care may create a great deal of confusion for some Medicaid recipients. For example, it may take time for each Medicaid recipient to choose a primary care physician and to learn the somewhat complex rules of managed care.

Managed care programs generally require prior approval from the primary care physician before a participant visits a hospital emergency room -- except perhaps for a serious emergency -- consults a specialist, or schedules medical tests. Such programs may also require that participants use only network providers. It may take time for some Medicaid recipients to adjust to the new rules.

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