This bill amends Section 458 of the Human Services Code, specifically addressing enrollment limitations in managed care plans for eligible persons. The amendment introduces a structured process for maintaining enrollment, stipulating that individuals must remain enrolled for at least twelve months unless a waiver is granted. It allows for changes to managed care plans under specific conditions: without cause during a 90-day period following initial enrollment or notice of enrollment, during an annual enrollment opportunity with prior notice, or for good cause at any time. The bill outlines what constitutes "good cause," including moving out of the service area, moral or religious objections to covered services, and other significant disruptions in care.

Additionally, the bill emphasizes that requests for disenrollment based on poor quality of care must be supported by objective evidence, and it prohibits general dissatisfaction as a valid reason for changing plans. The Department of Human Services is tasked with establishing procedures for notice, review, and appeals regarding plan-change requests. The bill also mandates the Secretary to seek necessary federal approvals to implement these changes, ensuring compliance with federal law. The act is set to take effect 60 days after its passage.

Statutes/Laws affected:
Printer's No. 1776 (Jun 05, 2026): P.L.31, No.21