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Example Ms. Lee and her two pre-school children (under the age of 6) apply for MA. The family does not receive TANF. The family's net income is 130 percent of the FPL. The SSR should put all three individuals in the assistance group and select program type AR. After the family's income and other information have been entered, ACEDS will determine that the children are eligible for MA under the Poverty Level Children and Pregnant Women criteria. Ms. Lee, however, is ineligible for MA as part of an AR unit because her income is too high. The SSR should now create an AX unit that includes Ms. Lee and includes provisionally the two children (the children will remain in the AR unit, but they must be included provisionally in the new AX unit so the income eligibility limit for Ms. Lee will reflect 200 percent of the FPL for a family of three). Since the AX unit meets the D.C. Healthy Families Expansion Group for Parent/Caretaker Relatives eligibility criteria, ACEDS will find Ms. Lee eligible for MA as an AX unit.

Benefit Provision 2.2.4

Medicaid recipients (other than those in the QM group who are eligible only for assistance in paying Medicare-related premiums, etc.; see Section 2.2.1: MA Program Types in this Chapter) can access preventative, primary, acute, and chronic care services such as:

 clinic services;  clinical psychologist services;  dental care;  drug and alcohol treatment;  durable medical equipment;  Early Periodic Screening, Diagnosis, and Treatment (EPSDT) for children and adolescents;  emergency care;  family planning services;  immunizations;  in-patient/out-patient hospital care;  inpatient psychiatric hospital care for children and adolescents;  labor and delivery;  laboratory and x-ray services;  nursing home and home health care;  physical and occupational therapy;  physician services;  prenatal care;  prescription drugs;  school physicals; and  vision care.

Most AR/AX Medicaid recipients are required to enroll in one of the managed care organizations that the District has contracted with to provide care to Medicaid recipients. There are a few exceptions, including Foster Care/Department Ward/Adoption Assistance Recipients and HIV-infected persons. Shortly after someone is determined Medicaid eligible under AR/AX, s/he will normally be contacted by the District's Medicaid Managed Care 'Enrollment Broker.' The 'Enrollment Broker' is responsible for educating Medicaid recipients about their managed care provider options, including:

 how to make a managed care provider selection, and  how to obtain services under a managed care delivery system.