If a recipient has Medicaid, can they have both Medicaid FFS and Medicaid HMO?

A recipient cannot have both Medicaid Fee-for-Service (FFS) and Medicaid Health Maintenance Organization (HMO) coverage simultaneously because these are two distinct methods of administering Medicaid benefits. Medicaid FFS allows recipients to access any Medicaid-approved provider without restrictions on which healthcare professionals they can see, while Medicaid HMO requires members to receive care through a network of providers to manage costs and coordinate services.

The structure of Medicaid is designed to ensure that patients are not enrolled in conflicting types of coverage that could complicate billing, service usage, and overall healthcare management. Therefore, the system is set up to prevent dual enrollment in FFS and HMO for a recipient.

Enrollees can choose between these types of plans, but once they select one, they must adhere to that model. The limitations on simultaneous enrollment help to streamline processes for both the providers and beneficiaries, ensuring clarity in how services are delivered and funded.