H12-047– Information
July 5, 2012
TO: / Home and Community Services (HCS) Division Regional AdministratorsDivision of Developmental Disabilities (DDD) Regional Administrators
Area Agency on Aging (AAA) Directors
FROM: / Bill Moss, Director,Division of Home and Community Services
Linda Rolfe, Director, Division of Development Disabilities
SUBJECT: /
Delay of Enrollment of SSI/SSI related Blind/Disabled Clients into the Health Care Authority (HCA) Healthy Options Managed Medical Care Program. Update of MB-12-035
Purpose: / To notify field staff of the delay in enrolling Blind and Disabled SSI/SSI related clients into the Healthy Options managed care program.Background: / The Healthy Options program is a managed medical care program that serves over 600,000 Medicaid clients statewide. The Healthy Options program is administered by the Health Care Authority and, via contracts with managed care health plans, provides comprehensive medical care including preventative, primary, specialty and ancillary health services to all eligible clients in the state.
The state is taking this step toward managed care expansion to prepare for the upcoming transition into Health Care Reform in 2014.
Effective dates for enrollment have changed.
What’s new, changed, or
Clarified / Medicaid-only blind/disabled clients living in Eastern Washingtonthat are in the G02, G03, S01, S02 and S08 ACES coverage groups were auto-enrolled into Healthy Options effective July 1, 2012.
Individuals that are in the L21 or L22 ACES coverage groups did not receive enrollment materials and were not auto assigned to a managed care plan. Individuals in L21/L22 are Categorically Needy (CN) clients on a DDD or HCS Waiver/RCL program and are standard SSI recipients. These individuals in L21 and L22 coverage groups will receive enrollment materials and be enrolled in a Healthy Options managed care plan at a later date. Additional information will be issued before that is scheduled to occur.
Enrollment of eligible individuals in Western Washington, except for King, Pierce and Clark counties is now scheduled to begin September 1st (these counties were previously scheduled to enroll August 1st).
Enrollment of eligible individuals in King, Pierce and Clark counties has been delayed until November 1st (these counties were previously scheduled to enroll September 1st).
Enrollment of L21 and L22 clients in all Western Washington counties will be delayedfurther and additional information about client notification and auto-assignment dates will be issued at a later date.
Eligible clients in all Western Washington Counties may choose to enroll in Healthy Options before they are assigned by using the client portal website or calling HCA Customer Service.
A number of individuals are not eligible for Healthy Options auto-enrollment and can or will be exempt:
Exceptions to Healthy Options Eligibility: All Medicaid-only blind/disabled clients must be enrolled, except clients:
- Residing in medical institutions (SNF, State Hospitals, ICF/ID, etc)
- Enrolled in, or who choose to enroll in, the Program of All Inclusive Care for the Elderly (PACE) program
- Enrolled in the Washington Medicaid Integration Partnership (WMIP) program (These clients can remain in WMIP or choose to enroll in Healthy Options).
- Enrolled in a DSHS or HCA Chronic Care Management program such as ADSA’s AAA Chronic Care Management Program, King County Care Partners or Cowlitz County Rethinking Care Project. (These clients can remain in CCM or choose to enroll in HO).
- Who are on Hospice will not be auto enrolled (if a client is enrolled and then begins Hospice they will remain enrolled)
- Who are “aged” (65 or over)
- Who have Medicare coverage
- American Indians/Alaska Natives
- Who reside in a “Voluntary County”: Skamania, Klickitat, or Clallam
- Who are in the Address Confidentiality Program
- Who are Homeless
Clients must contact their assigned health plan first. The plan will work with the client and the providers to provide care. If the client is not satisfied or is unable to get services through the plan, they will work with the plan to complete a “Disenrollment Request Form”. The plan will send this form to HCA and the client can then call HCA Customer Service at 1-800-562-3022 and request an exemption. Exemptions are granted based on specific medical necessity criteria and are granted by HCA on a case-by-case basis.
Clients can request to transfer plans:
Clients can use the ProviderOne Client Portalor call the HCA Customer Service Center to request a transfer to another plan in their service area. The request will be made for the next available month.
Clients with other insurance:
Clients who currently have “comparable” third party insurance entered into the ProviderOne system will not be auto enrolled into Healthy Options. To find out if a client has comparable third party insurance or to cancel third party insurance, the client or their representative can contact the HCA Coordination of Benefits Unit by calling the call center (1-800-562-3022) press 1 for English, then press 3 for Other Private Insurance.
ACTION: / Although clients are directed to call the health plans or the Health Care Authority (Toll free 1-800-562-3022) they will also likely call their case manager and ask questions.
To assist clients, case managers may:
- Refer clients to their current health plan or future health plan;
- Refer clients to the HCA toll free number (1-800-562-3022) to enroll in or transfer health plans;
- Direct clients to contact providers they want to keep seeing and ask which health plans they will be contracting with;
- Direct clients to the health plans available in their county;
- Send clients instructions, ( change enrollment via the ProviderOne Portal,
Related
REFERENCES: / Healthy Options Website
Management Bulletin H12-035
ATTACHMENT(S):
CONTACT(S): / Kristi Knudsen, Program Manager
(360) 725-3213
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