 An existing policy within our Medi-Cal program  The use of MERs was expanded when SPDs were required to enroll in managed care  Permits a beneficiary to opt out of managed care if s/he has a relationship with a doctor/nurse midwife/licensed midwife who is not part of a health plan  In California, this is a narrow document and the MER only lasts 12 months  When new populations are added to mandatory managed care, MERs are typically added to legislative language Medical Exemption Requests
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