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Special Services

Our Care Managers can coordinate your care

Some members may need services that are not offered as a Prestige Health Choice benefit. These are known as carved-out services. If you qualify, our Care Managers can refer you to these services. They can organize your care.

To find out if you or a family member qualifies for carved-out services, call our Rapid Response and Outreach Team at 1-855-371-8072 (TTY 711), Monday through Friday, from 8 a.m. to 5 p.m. You can also speak with your Prestige Health Choice-assigned Care Manager.

Learn more about Prestige Health Choice carved-out-services (PDF).

Some examples of carved-out services include:

  • Prescribed pediatric extended care (PPEC). This is skilled day care for up to 12 hours. PPEC is for members from birth through age 20. It includes nursing services, personal care, developmental therapies, and caregiver training.
  • iBudget home- and community-based services (HCBS). HCBS lets members get care at home. To receive HCBS services, a member must have a qualifying physical disability or mental illness. This service is for members age 3 and older.
  • Medicaid-certified school match program services. This provides medically necessary services for children under age 21 in a school setting. Services include nursing care, medication administration, therapy, and social work services.
  • Intermediate care facility services. These are 24-hour care services for members of any age. These services can be done at home. Members must have both intellectual and developmental disabilities to qualify.
  • Behavior analysis (BA). This service is for members under age 21. To qualify, members must have a diagnosis of autism or autism spectrum disorder.
  • Dental benefits. Effective December 1, 2018, you will be required to enroll in a dental plan. For more information, please contact Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856)