Page 18

c. LTSS recipients residing in institutional or home and community- based settings including those qualifying for the level of care provided in a nursing facility and intermediate care facility for persons with intellectual disabilities (ICF-ID) – such as nursing facility, assisted living and ID group home residents as well as those residing in their own homes; and d. Persons with End Stage Renal Disease (ESRD) at the time of enrollment. 2. MME beneficiaries are entitled to Medicaid State Plan and Section 1115 waiver services that are not covered by Medicare. 3. Excluded Beneficiaries – Certain Medicaid beneficiaries are excluded from participating in the MMP as indicated below: a. Beneficiaries excluded from the MMP. b. Medicare beneficiaries who are not eligible for Medicaid health coverage, including partial dual eligible beneficiaries who participate in the Medicaid Premium Payment Program (MPP) as Qualified Medicare Beneficiaries (QMBs), Specified Low-Income Beneficiaries (SLMBs), and Qualifying Individuals (QIs). c. Dual Eligible beneficiaries who are not qualified to enroll in all segments of Medicare. d. Medicaid beneficiaries residing in Tavares, Eleanor Slater, or out- of-State hospitals. e. Beneficiaries who are in hospice on the effective enrollment date. Enrollees who elect hospice care after they are enrolled in the MMP can remain in the MMP. f. Beneficiaries who reside out-of-State for six (6) consecutive months or longer. g. Beneficiaries who are eligible for the Medicaid Buy-In Program for Working People with Disabilities (known as the “The Sherlock Plan” in Rhode Island). h. Dual eligible beneficiaries who are between the ages of nineteen (19) and twenty (20) are exempt from enrollment in managed care and receive all Medicaid health coverage on a fee-for-service basis. i. Beneficiaries who are determined eligible as medically needy for Community Medicaid due to excess income and resources are exempt from enrollment in managed care.