SMMC 3.0 Transition: Pharmacy Continuity of Care

The Agency for Health Care Administration (Agency) contracts with health and dental plans to provide Medicaid services to health plan enrollees. The Agency recently entered into new contracts with health and dental plans effective February 1, 2025. Under the new Statewide Medicaid Managed Care (SMMC) contracts, plans are still required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. To ensure a smooth transition of enrollees from the fee-for-service (FFS) delivery system or a health plan to another health plan, the Agency fiscal agent pharmacy system will support point of sale messaging to all pharmacies attempting to process claims during the transition period. To ensure no disruption in current services, health plans will allow enrollees to continue to receive their prescriptions through their current provider, for a minimum of 90 days, until their prescriptions can be transferred to a provider in the plan’s network.

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