When an individual qualifies for Medical Assistance (MA) benefits, they are placed in one of the following to pay for their medical services.
Providers may use the Eligibility Verification System (EVS) to verify if an individual qualifies for MA. The EVS response will tell the provider the name and phone number of the plan in which the individual is enrolled.
Health Choices and community HealthChoices Managed Care Organizations (MCOs) are paid a monthly capitation fee to manage an individual’s medical services and needs. The goals of the MCOs are to ensure the following:
Medical Assistance (MA) recipients have access to quality medical care.
Medical services are rendered in a cost-effective way.
More information about eligibility for plans and enrolling in a plan can be found in Section 386.2, Plan Enrollment Process.
Fee-For-Service (FFS) allows an individual who cannot be enrolled into a HealthChoices or Community HealthChoices MCO to receive payment for medical services on a per-service basis. The following MA recipients will be FFS:
An individual eligible only for a Non-Continuous Eligibility (NCE) period.
An individual eligible only for a retroactive period.
New applicants until MCO coverage begins.
Certain non-citizens.
Updated August 26,2025, Replacing March 11,2013