MEDICAID MANAGED CARE
What is Managed Care?
Managed Care is a comprehensive health care program
which integrates the services of doctors, hospitals and
health care specialists into a health plan network whose
goal is to manage the health care of its enrollees. Under
managed care, Medicaid beneficiaries
are entitled to the same benefits as fee-for-service
Medicaid, but receive them through their managed care
plan.
Nassau has six healthplans available to Medicaid beneficiaries
- AFFINITY, FIDELIS, HIP, HEALTHFIRST HEALTHPLUS AND
AMERICHOICE BY UNITEDHEALTHCARE.
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Who can join a health plan?
In July, 1997, the federal government
granted New York State a “waiver” permitting
the State to require all Medicaid beneficiaries
(with some exceptions) join a Medicaid Managed
Care Plan. There are many Medicaid consumers
who voluntarily enroll in the County’s Managed
Care Program. The County has completed the required
review process with New York State and the Federal Government,
which allows for mandated enrollment of medicaid recipients
into its’ managed care program. Mandatory
enrollment in the County started in 2001.
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Who are mandated (required) to join a health
plan?
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Will Medicaid benefits change?
No. But the client will
need to use their Medicaid card
for certain services that are not included in the plan’s
benefit package, such as pharmacy.
Nassau County uses the services of an enrollment broker,
who is responsible for informing the consumer about their
health plan option, educating them about their rights
and responsibilities and assisting them to enroll in
a healthplan.
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How will the consumer choose a plan?
- If
the consumer has a primary care provider who belongs
to any Nassau County contracted health plan, they can
choose that plan.
- They
can call any doctor. If that doctor belongs to
any Nassau County contracted health plan, they can
choose that one.
- They
can look at the list of providers for each health plan
and choose from the list.
- If
consumer still needs help in deciding, they can contact
New York Medicaid Choice (the enrollment broker)@ 1-800-505-5678
and an enrollment counselor will assist them in selecting
a managed care plan.
- If
the consumer does not choose a health plan voluntarily
within 60 days of notice to do so, they will automatically
be assigned to a health plan.
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How does one enroll in a health plan?
- Once
a plan is chosen, an enrollment form must be completed
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Where can enrollment forms be obtained?
- At
a New York Medicaid Choice education and enrollment
session at the DSS center in Uniondale or call
New York Medicaid Choice to request an enrollment
packet (1-800-505-5678)
- Call
the Nassau County Department of Social Services
Managed Care Unit @ (516) 277-8056
- A
health plan marketing representative can supply
the enrollment form. A consumer can request
this form directly from the marketing representative
or they can call the health plan of choice.
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How does one know that the enrollment is complete
and they can start using the plan?
- New
York Medicaid Choice will send a notice.
- The
selected managed care plan will send the new
enrollee a Member ID card directly to them
along with a welcome letter and a plan handbook
explaining the benefits.
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Information or complaints
- New
York Medicaid Choice - 1-800-505-5678
- Contact
the individual plan’s member services
dept.
- Call
the NYSDOH Complaint Helpline @ 1-800-206-8125
- Call
the Nassau County Dept. of Social Services
Managed Care unit @ (516) 227-8056
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Exclusions and exemptions
Not all Medicaid recipients
will be required to join a managed care plan. These
recipients will either be excluded or exempt from the
program. Individuals who have an exemption may
choose to join a plan, but will not be required to do
so. Those recipients who are excluded from the
program cannot join a plan, even if they wanted to.
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Related Links:
New
York State Department of Health Managed Care
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