Health Care For Families
§ 40-8.4-19 Managed health care delivery
systems for families.
(a) Notwithstanding any other provision of state law, the delivery and
financing of the health care services provided under this chapter shall be
provided through a system of managed care. "Managed care" is defined as systems
that: integrate an efficient financing mechanism with quality service delivery;
provide a "medical home" to assure appropriate care and deter unnecessary
services; and place emphasis on preventive and primary care.
(b) Enrollment in managed care health delivery systems is
mandatory for individuals eligible for medical assistance under this chapter.
This includes children in substitute care, children receiving Medical
Assistance through an adoption subsidy, and children eligible for medical
assistance based on their disability. Beneficiaries with third-party medical
coverage or insurance may be exempt from mandatory managed care in accordance
with rules and regulations promulgated by the department of human services for
(c) Individuals who can afford to contribute shall share
in the cost. The department of human services is authorized and directed to
apply for and obtain any necessary waivers and/or state plan amendments from
the secretary of the U.S. department of health and human services, including,
but not limited to, a waiver of the appropriate sections of Title XIX, 42
U.S.C. § 1396 et seq., to require that beneficiaries eligible under this
chapter or chapter 12.3 of title 42, with incomes equal to or greater than one
hundred fifty percent (150%) of the federal poverty level, pay a share of the
costs of health coverage based on the ability to pay. The department of human
services shall implement this cost-sharing obligation by regulation, and shall
consider co-payments, premium shares, or other reasonable means to do so in
accordance with approved provisions of appropriate waivers and/or state plan
amendments approved by the secretary of the United States department of health
and human services.
History of Section.
(P.L. 2008, ch. 100, art. 17, § 4; P.L. 2009, ch. 68, art. 22, § 2;
P.L. 2009, ch. 69, § 2.)