HealthChoices · immigrants might be eligible COMMUNITY HEALTHCHOICES (CHC) Individuals ages 21 and...
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EAP-OP-120-0001 (3082013)
Transcript of HealthChoices · immigrants might be eligible COMMUNITY HEALTHCHOICES (CHC) Individuals ages 21 and...
EAP-OP-120-0001 (3082013)
What is HealthChoices?
The Medical Assistance (Medicaid) program for
Pennsylvania.
Consumers choose a physical health plan and
primary care provider (PCP).
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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HealthChoices Map
HealthChoices Plan Options
Lehigh/Capital North East North West Southeast Southwest1. Aetna Better
Health Plan
2. AmeriHealth
Caritas
3. Gateway
Health Plan
4. United
HealthCare
Community
Plan
5. UPMC for You
1. Aetna Better
Health Plan
2. AmeriHealth
Caritas
Northeast
3. Geisinger
Health Plan
1. Aetna Better
Health Plan
2. AmeriHealth
Caritas
3. Gateway
Health Plan
4. UPMC for You
1. Aetna Better
Health Plan
2. Health
Partners
3. Keystone First
4. United
HealthCare
Community
Plan
1. Aetna Better
Health Plan
2. Gateway
Health Plan
3. United
HealthCare
Community
Plan
4. UPMC for You
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
For more information about each plan or to find participating providers, please visit: www.enrollnow.net
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HealthChoices vs. Community Health Choices (CHC)
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HEALTHCHOICES
Pennsylvania’s mandatory managed care program for 2.2 million Medical Assistance participants.
Participants receive quality medical care and timely access to all appropriate physical and behavioral health services and/or drug and alcohol services.
COMMUNITY HEALTHCHOICES (CHC)
Pennsylvania’s mandatory managed care for dual-eligible individuals and individuals with physical disabilities
CHC provides coverage for participants who are eligible for both Medicare and Medicaid.
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HealthChoices vs. Community Health Choices (CHC)
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HEALTHCHOICES
Children up to, and including 20 years old
Adults Pregnant women Some women with breast
and/or cervical cancer Lawfully present
immigrants might be eligible
COMMUNITY HEALTHCHOICES (CHC)
Individuals ages 21 and older who are dually eligible for Medicare and Medicaid
Individuals ages 21 and older who need the level of care provided by a nursing facility
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HealthChoices vs. Community Health Choices (CHC) Contact
Information
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
HEALTHCHOICES
www.enrollnow.net
Phone: 1-800-440-3989
TTY: 1-800-618-4225
COMMUNITY HEALTHCHOICES (CHC)
www.enrollchc.com
Phone: 1-844-824-3655
TTY: 1-833-254-0690
PA Enrollment ServicesWe are here to help consumers choose the best health plans and doctors for you and your family.
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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County Assistance Office Determines Eligibility
PCP -- Primary Care Physician
Physical Health Plan
Behavioral Health Plan
PA Enrollment Assistance Program
Overview
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PA Enrollment Services Process For Newly Eligible Members
Daily Eligible File
Enrollment Packet
Reminder Letter
Outbound Calls
Outbound Blast Message
Automated Outbound
Dialer
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PA Enrollment Services Process
Continued
Enrollment Choice
Send Confirmation
Letter
And Post Enrollment Brochure
No Enrollment Choice
Send Auto-Assignment
Letter
And Post Enrollment
Letter
Enrollment Methods
Once approved for Medical Assistance, consumers will receive information from PA Enrollment Services with plan choices and enrollment options.
Website – www.enrollnow.net Access to information, enrollments, plan changes
Mail – Welcome packet, personalized Enrollment Form, Health Plan Comparison Charts, Self-Addressed Stamped Envelope
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
Enrollment Methods
Phone - Toll-free number: 1-800-440-3989TTY: 1-800-618-4225
Translation services available in your language!
Hours of operation: Monday through Friday 8:00 AM to 6:00 PM*
Secure Fax- 717-540-6202
Face- to – Face – upon request and availability.13
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
*Closed on all state and federal holidays.
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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Plan Transfers
PA - EAP handles MCO Health Plan changes for consumers. This can be completed at anytime.
• No Lock-In Period• Change in Health Plan = Change in Start Date• Health Plan Coverage until Change Effective
* PCP only changes are processed by his/her health plan
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Plan Reinstatements
A HealthChoices consumer who lost Medical Assistance eligibility and regains coverage within six (6) months.• Automatically Re-Enrolled in Previous Health Plan• Health Plan Starts Day Re-Instated• PCP Selection – Consumer Needs to Contact Health
Plan
The consumer is sent a Reinstatement Letter
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Children In Substitute Care
PA Enrollment Services has a Special Needs Coordinator who works with county Children & Youth Agencies (CYA) and Juvenile Probation Offices (JPO) to process enrollments and plan transfers.
In order to process these changes, a county CYA submits a CY60 Form to the CAO office to change the placement code. This must occur prior to the enrollment or plan transfers.
Special Needs Coordinator – Patsy Jackson 717-540-6217
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ACCESS/EBT Card
Consumers eligible for Medical Assistance will be issued an Access or EBT card that PCPs and other providers use to verify the eligibility for Medical Assistance benefits and programs.
Consumers must KEEP THIS ACCESS CARD even after receiving a Health Plan ID card.
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ACCESS/EBT Card Continued
During the HealthChoices enrollment window: Consumers will receive medical services through the Fee-
for-Service program using their Access or EBT card as the form of eligibility.
After enrollment into a HealthChoices plan & PCP choice: Providers continue to verify consumers Medical Assistance
eligibility and enrollment status using their Access or EBT Card.
The Access or EBT Card is also needed to seek and receive services from: Behavioral Health Plan Medical Assistance Transportation Program (MATP)
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Services not provided by PA Enrollment Services
We do not provide information about: Medical Assistance benefits package; Medicare; Health Insurance Premium Plan (HIPP); Children’s Health Insurance Program (CHIP); Or any other Medical Assistance benefit program.
We cannot change Medical Assistance categories or benefits.
We do not issue plan ID cards or Access/EBT cards.
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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Services not provided by PA Enrollment Services Continued
We cannot change PCPs. Consumers can request the PCP transfer, directly from their plan.
We are not part of the Federal Market Place (ACA)
We do not process enrollments for Community HealthChoices
We do not process enrollments for waiver programs
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Important Reminders
PA–EAP = ENROLL, Voluntary Health Plan Selection
If consumers do not choose a physical health plan and a PCP by the date on their enrollment form, they will be automatically assigned to a physical health plan.
PA Enrollment Services cannot change PCPs once consumers are already enrolled in a plan.
Eligibility for Behavioral Health services starts at the time the consumer is eligible for Medical Assistance.
HealthChoices Consumer Advisory Committee Meetings
Three meetings a year: April, July and October
Purpose: To involve and educate consumers and the community about HealthChoices.
Opportunity for provider feedback.
HealthChoices Consumers can receive reasonable reimbursement for your travel costs to and from the meetings.
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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PA Enrollment Services Webinar Series
The Webinar Series will provide consumers and stakeholders access to educational information about topics related to the HealthChoices program
Webinars available in 2018
Visit: www.enrollnow.net for information about upcoming webinars. The webinar series are phone and web based.
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
1-800-440-3989TTY: 1-800-618-4225
www.enrollnow.net
Hours of operation:Monday through Friday 8:00 AM to 6:00 PM
Translation services available in your language!
*Closed on all state and federal holidays.
Pennsylvania Enrollment Services
• Bobbie Jo Comes, NW & SW Zones – 724-822-2994• [email protected]
• Cameron Davis, L/C Zone – 717-540-3148• [email protected]
• Cinthia Acencio, NE Zone – 267-974-2856• [email protected]
• Melissa Burkholder, NE Zone – 717-540-3149• [email protected]
PA Enrollment Services Outreach Team
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
• Wenidhxa Sanchez-Hernandez, SE Zone – 215-834-5467• Wenidhxa [email protected]
• Patsy Jackson, Special Needs Coordinator -- 717-540-6217 • [email protected]
• Teresa McDonnell, Operations Manager -- 717-540-6214• [email protected]
PA Enrollment Services Outreach Team
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PA Enrollment Services 1-800-440-3989 www.enrollnow.net
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