Molinalogo

Covers both adult and children

Does not cover cosmetic surgery

Medically necessary services for all members diagnosed with Autism Spectrum Disorder.

1 per year (unless ordered by provider)

26 visits per 12-month period

Colorectal cancer screening starting at age 45 years old based on the American Cancer Society (ACS) guidelines

Limited to members under age 21 who are eligible for services by the Kentucky Commission for Children with Special Health Care Needs

Covers:

• Preventive services
• Diagnostic services
• Dentures
• 2 oral exams for members under 21 if included with a cleaning
• 2 cleanings each 12-months
• 1 set of X-rays every 12-months
• Extractions and fillings
• Oral surgery
• Orthodontic and prosthodontic services

Services and procedures that promote and help the functioning of the kidneys and related organs

• 1 neonatal exam (right after the baby is born)
• 1 exam at 1, 2, 4, 6, 9, 12, 15, 18, 24 and 30 months
• 1 exam each year for children ages 3 to 20 
• Exams at Specialized Children's Services/Child Advocacy Centers for members under age 18. (See below Specialized Children's Services/Child Advocacy Centers)

• Basic life support (BLS)
• Advanced life support (ALS) ambulance services

Provided at routine visits or family planning clinics

Services are available to children from birth to age 3.
Children must have a developmental delay or a physical or mental condition(s) related to a developmental delay.

1 complete hearing evaluation per calendar year

Screenings for:

• Pregnant women
• Those who have an increased risk for the infection
• Anyone who asks for the test

Includes:

• Adults and children
• Flu
• Pneumonia
• Hepatitis B

Cosmetic surgery is not covered (except for post-mastectomy reconstructive surgery)

Used when other means of transportation could cause danger to your health (see Member Handbook section on Transportation)

Includes provider services

2 every 9-months unless your provider orders more (see Family Planning in Member Handbook)

Up to 20 visits per calendar year

Does not cover cosmetic surgery (except for post-mastectomy reconstructive surgery)

Per visit

Up to 20 visits per calendar year.

Routine foot care not covered except for some conditions that need professional supervision

Unlimited prescriptions per month

Wellness visits

Allows for 2,000 hours per year

Includes:

• Specialists
• Provider assistants
• Nurse practitioners
• Nurse midwives
• Office visits
• Medical surgical care and consultations
• Diagnosis and treatment

For children 6 to 21

Intensive facility-based care alternatives to hospitals

These clinics are a partnership between Medicaid and the Department for Community Based Services to provide trauma informed care for children who have been sexually abused.

Exams are covered for members under age 18. They must be medically necessary. They do not need prior authorization. Other services are covered, like counseling and therapy. The provider will give education to the child and non-offending family member.

Up to 20 visits per calendar year

• Targeted Case Management is available for individuals with a Severe Emotional Disability, Severe Mental Illness, Substance Use Disorders, and a Mental Health or Substance Use Disorder with a Co-occurring Chronic or Complex Physical Health Issue. Services must be medically necessary.

Must use a provider in the Passport network

• 1 exam each calendar year
• 1 pair of contacts per year or
• 1 pair of eyeglasses per year, or a second pair if the first pair is broken or if the prescription changes