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Issue Alert - 06-04-10

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Date:

Apr 27, 2006

Program Area:

Medicaid

Issue Summary:

Medicaid recipients in Medicaid Health Plans (MHPs) are able to switch plans during the month of May; Some MHPs will begin charging new co-payments for services in July 2006; Some MHPs have changed the counties that they serve

Persons Affected:

Medicaid recipients who are enrolled in Medicaid Health Plans (managed care)

For More Information:

Center for Civil Justice
320 S. Washington, 2nd Floor
Saginaw, MI 48607
(989) 755-3120, (800)724-7441 Fax: (989) 755-3558
E-mail: info@ccj-mi.org


Background

Most Medicaid recipients in Michigan are enrolled in managed care Medicaid Health Plans (MHPs).  The plans vary in terms of their provider networks (which doctors, hospitals, and other providers are available to recipients enrolled in the MHP), their drug formularies (which prescription medications are covered by the MHP), and whether they charge co-payments  for certain services.

 

Recipients who must enroll in a managed care plan are offered a choice of Plans when they first become eligible for Medicaid.  After their first three months in a Plan, they generally are locked in with that Plan until the annual open enrollment period.   

 

This year, recipients should be especially attentive to the open enrollment materials they receive because certain MHPs will be charging new co-payments beginning in July 2006.

What's Happening?

Open Enrollment

Medicaid beneficiaries may change health plans during May, 2006. The effective date of an open enrollment plan change is July 1, 2006. Beneficiaries who live in a mandatory county that have been enrolled in a Medicaid health plan for more than 90 days will receive a letter from Michigan ENROLLS at the end of April telling them their plan options.

 

Co-payments charged by certain Medicaid Health Plans effective July 2006

Currently a few MHPs charge co-payments for prescription medications.  Beginning July 1,2006, more MHPs will charge co-payments for more services.  MHPs are not permitted to charge co-payments that are not charged to recipients who have Medicaid fee-for-service (FFS,  non-managed care) coverage.

 

MHP Copays effective 7/1/06

Service

State FFS

PHPMM-FamilyCare

PHP Southwest

Health Plus Partners

Priority

UP

McLaren

Pharmacy  (Generic)

$1.00

$1.00

$1.00

$1.00

$1.00

$1.00

$1.00

Pharmacy  (Brand Name)

$3.00

$3.00

$1.00

$3.00

$3.00

$3.00

$3.00

Vision

$2.00

$2.00

None

$2.00

$2.00

$2.00

$2.00

Chiropractor

$1.00

$1.00

None

$1.00

$1.00

$1.00

$1.00

Podiatrist

$2.00

$2.00

None

$2.00

$2.00

$2.00

$2.00

Hearing Services

$3.00

$3.00

None

$3.00

$3.00

$3.00

$3.00

Dental

$3.00

NA

NA

NA

NA

NA

NA

 

 

 

 

 

 

 

 

Physician Office Visit

$2.00

$2.00

None

$2.00

None

$2.00

$2.00

Non-Emergent ER Visit

$3.00

$3.00

None

$3.00

$3.00

$3.00

$3.00

Day 1 of Inpatient

$50.00

$50.00

None

$50.00

$50.00

$50.00

$50.00

Outpatient Hospital

$1.00

$1.00

None

$1.00

$1.00

$1.00

$1.00

Last revised 03/2006

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The following categories are EXCLUDED for Co-payment requirements:

 

 

 

 

Persons under 21 years of age

 

 

 

 

Medicare dual eligibles

 

 

 

 

 

Persons enrolled in CSHCS

 

 

 

 

 

Nursing facility residents

 

 

 

 

 

Family planning and pregnancye-related stays and service

 

 

Mental health services provided through CMHSPs

 

 

 

 

 

 

 

 

 

 

 

 

Health Plan Service Area Changes Effective May 1, 2006

·         Midwest Health Plan is adding St. Clair County to its service area.

·         Community Choice Michigan is the preferred provider for Leelanau. Leelanau is now a Preferred Option County.

 

Health Plan Service Area Changes Effective April 1, 2006

   Health Plan of Michigan is adding Clinton County to its service area.

   PHP MidMichigan is terminating Clinton and Eaton counties from its service area. Members have received a letter advising them they will be transferred to McLaren Health Plan unless they respond within 30 days.

 

Health Plan Service Area Changes Effective March 1, 2006

   Molina Healthcare of Michigan has terminated Alpena County from its service area. Members received a letter advising them they were transferred to Community Choice Michigan unless they responded within 30 days. Alpena County is a Preferred Option County with Community Choice Michigan as the preferred option.

   McLaren Health Plan is adding Ionia County to its services area. Ionia County is no longer a Preferred Option County

   Molina Healthcare of Michigan is the preferred provider for Otsego. Otsego is now a Preferred Option County.

 

Preferred Option Counties

Beneficiaries who live in specified counties with only one Medicaid health plan receive an enrollment packet from Michigan ENROLLS. Beneficiaries are advised that they can enroll in the single plan or remain in Fee-for-Service Medicaid. They are also advised that unless they call to select Fee-for-Service Medicaid, they will automatically be enrolled in the single health plan. Beneficiaries in Preferred Option counties can disenroll from the health plan and enroll in Fee-for-Service Medicaid for the next available month. Members need to respond to the Michigan ENROLLS packet or they will be auto-enrolled in the health plan.

 

The Preferred Option counties are:

§         Alpena

§         Antrim

§         Barry

§         Charlevoix (new)

§         Grand Traverse

§         Isabella

§         Leelanau (new)

§         Otsego (new)

§         Wexford

What Should Advocates Do?

o Check the Department of Community Health website to find out which MHPs operate in your service area. (go to Michigan.gov/mdch, click on “Health Care Coverage,” then click on “Medicaid” to find a list of materials about Michigan Medicaid Health Plans, including lists of the MHPs that operate in each county.

o Alert Medicaid recipients to the co-payments that will be charged by any MHPs in your service area

o Encourage Medicaid recipients to carefully evaluate whether they should change Plans

What Should Clients Do?

o Pay attention to materials they receive from Michigan Enrolls
o Change MHPs during Open Enrollment if you are not satisfied with your current MHP or if your MHP will be charging co-payments that you cannot afford.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee.

You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org.

You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.