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.
Who can join a health plan?
- Temporary Assistance recipients
- Safety Net recipients
- Medicaid recipients without a spenddown
- SSI recipients
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.
Who are mandated (required) to join a health plan?
- Temporary Assistance recipients
- Safety Net recipients
- Medicaid recipients without spenddown
- SSI recipients
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.
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.
How does one enroll in a health plan?
- Once a plan is chosen, an enrollment form must be completed
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.
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.
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
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.
Related Links:
New York State Department of Health Managed Care
Medicaid Managed Long-Term Care
Who may be required to join a Managed Long-Term Care Plan?
If you are over 21 years of age, have both Medicare and Medicaid, and receive home care, adult day care, or other long-term care services for more than 120 days you may soon be required to choose a Managed Long-Term Care Plan to cover these Services.
What does a Managed Long-Term Care Plan cover?
A Long Term Care Plan provides services topeople with a disability or long-lasting health problem.Your plan will make sure you get the long term care services you need. Long term care includes help with day-to-day and personal activities, home health aides, adult day health and other services.
Who does not have to join a plan?
Some Medicaid members do not have to join a Long Term Care Plan to receive their services. They can join a plan if they want to. You can see a complete list of who does not have to join a Long Term Care Plan. Call New York Medicaid Choice to learn more.
How can I get more information regarding a managed long-term care plan or choosing a plan?
For more information or assistance, please contact NY Medicaid Choice Managed Long-Term Care at 1-888-401-6582 (TTY: 1-888-329-1541) or click on NY Medicaid Choice:
http://www.nymedicaidchoice.com/ask/about-long-term-care-plans
