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Revision 26-1; Effective Feb. 20, 2026
Managed care organizations (MCOs) must contact all members at enrollment and at least annually thereafter. The MCO must contact the member at least once by phone and at least once face-to-face per year if a member receives long term services and supports (LTSS), has a history of behavioral health issues or substance use disorders (SUD), or is dual eligible. The MCO must visit with the member face-to-face at least twice a year if the member receives the STAR+PLUS Home and Community Based Services (HCBS) program or has a complex medical condition. The MCO must meet with the member face-to-face at a minimum of four times per year if a member lives in a nursing facility (NF).
All applicants or members of LTSS receive service coordination from the MCO. Service coordination is intended to bring together acute care and LTSS. Service coordination includes development of an individual service plan (ISP) with the individual, family members and provider, as well as authorization of LTSS for the member. MCO service coordination is responsible for working with the applicant or member and his or her acute care and LTSS providers to ensure all an applicant or member’s medically and functionally necessary services are provided. This includes referring and helping the applicant or member get appointments with specialists, participating in discharge planning for applicants or members in hospitals, or the NF, referring members to community organizations for services and assistance not covered by Medicaid.