Members

Your Member Handbook

handbook

Please read your Member Handbook.

It tells you: 

  • About your health plan
  • About your benefits
  • About what is covered
  • How to get the services you need
  • How to get help with special health care needs
  • How to contact us
  • Your rights and responsibilities as a member 
     

Read your Member Handbook today


Need your Member Handbook in a different language or format?
You can get your member handbook and other information on our website in paper form or another alternate format at no cost. Call Member Services at (866) 449-6849. Molina will send you a paper copy of your requested material within 5 days.

 


CMS-0057 Prior Authorization Annual Reporting

This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. For services that require prior authorization, refer to (link to PA Guide pdf)

STAR+PLUS Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 94%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 6%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 65%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 69%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 48%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 59%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 86%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 14%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 52
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP RSA Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 85%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 15%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 100%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 65%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 93%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 7%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 45
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 26

STAR Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 83%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 17%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 54%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 48%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 60%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 77%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 91%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 9%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 44
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP PERINATE RSA AT OR BELOW 185% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 95%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 5%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 100%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 67%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 81%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 91%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 93%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 8%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 53
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 37

 

CHIP PERINATE MHT AT OR BELOW 185% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 96%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 4%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 42%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 67%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 88%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 12
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 59
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP PERINATE MHT 186% TO 200% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 100%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 0%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. NA
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA

 

CHIP Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 83%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 17%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 78%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 50%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 60%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 89%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 11%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 47
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 25

CHIP PERINATE RSA 186% TO 200% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 67%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 33%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. NA
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA