Molina Clinical Policy

For Benefit Interpretation Policies, please click here (for Marketplace only).

For Medicare, click here to access additional third-party criteria Molina uses for medical necessity decisions.

Behavioral Health Behavioral Health
Medical Medical
Pharmacy Pharmacy

     

    • For Marketplace, please refer to Marketplace Pharmacy Policies located here. Select your State at the top right of the page.
    • For Medicaid policies, please review your State specific webpage via the MolinaHealthCare.com main page – select your State at the top of the page. For further questions, please contact Member Services.
    • For Medicare policies, please review your State specific webpage via the MolinaHealthCare.com main page – select your State at the top of the page.

Surgery Surgery
Transplant Transplant
 

State Specific Sites

This page lists Corporate Molina Clinical Policies (MCPs). Please check your State’s website for policies that contain State-specific language or requirements in addition to what is listed in the Corporate policy. Applicable information is listed in the Appendix at the end of policies.