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7.3.1.1 HMO Model
In the HMO model, the STAR+PLUS health plan is responsible for contracting with providers and/or delegated network to create a health-care provider delivery network. SSI clients who reside in one of the SA counties where this model is an option, and who have selected an HMO, are required to select a primary care provider from the HMO provider directory if they are not covered by Medicare. SSI clients who are also covered by Medicare (Dual Eligible clients) must select a STAR+PLUS HMO to receive Medicaid community based long term care.
Children born to STAR+PLUS clients will be enrolled with the STAR plan operated by the same HMO if available. If the STAR+PLUS plan does not also operate a STAR plan, the newborn is automatically enrolled into traditional Medicaid, and the mother is given the opportunity to choose a STAR health plan for the newborn.
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