Ch. 47, § 7

Participant Disenrollment Process. (a) The Department will review and approve all requests by the CME to disenroll youth based on the medical necessity of the HFWA service plan. An individual may be disenrolled from the CME if: (i) The youth is no longer Medicaid eligible; (ii) The youth moves out of the State; (iii) The youth ages out of the program; (iv) The youth is incarcerated; (v) The youth is no longer financially eligible; (vi) The youth is no longer clinically eligible; (vii) The youth is determined eligible for any excluded program/population pursuant to Section 4; (viii) The youth is in out-of-home placement longer than one hundred eighty (180) days; (ix) The youth needs related services (for example a cesarean section and tubal ligation) to be performed at the same time; not all related services are available within the network; and the youth's Primary Care Provider (PCP) or another provider determines that receiving the services separately would subject the youth to unnecessary risk; or (x) Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the youth's specific health care needs. (b) A participant may voluntarily disenroll from the CME without cause at any time.