IMPORTANT MESSAGE TO OUR PROVIDERS REGARDING FOSTER CARE

Meeting the Health Care Needs of Children/Youth Placed in Foster Care:
Children/youth placed in foster care may have Medicaid or SNP coverage. MetroPlus will cover all services covered by the Medicaid Managed Care benefit package.

Providing access to comprehensive, high quality health care is an essential goal of transitioning the care of children in foster care from fee-for-service Medicaid to Managed care. To accomplish this, MetroPlus has made special provisions to ensure immediate access to services upon a youth’s placement in foster care without interruption in the provision of ongoing services:

  • To meet the requirement for an initial medical required health assessment, MetroPlus will allow members to see any participating primary care physician (PCP) or other qualifying provider for the first 30 days of placement.
    • Because changes in placement may occur requiring additional health assessments, MetroPlus will allow members to see participating PCP providers not listed on their ID card
      • Call MetroPlus Customer Services 800-303-9626 to verify coverage and notify about need for future visits
  • MetroPlus will cover these pharmacy issues:
    • A 30- day supply (transition fill) for non-formulary or Prior Auth (PA) required drugs within the first 90 days of enrollment,
      • If the member requires an additional transition fill because of new placement, providers should send the request to CVS and indicate the reason
    • Members can receive “refill-too-soon” overrides when transferring between foster homes
    • Members can fill prescriptions at pharmacies that are out of network when they are placed out of our service area

For more information, click here.

last updated: December 21, 2021

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