Medicaid Managed Care

Medicaid Managed Care

Updated July 2017

With the recent passing of SB 155, implementation of Step 2 Phase 2 of managed care has been delayed until 2019. This legislation now requires those receiving Long Term Supports and Services (LTSS) through the Choices for Independence (CFI) waiver and Nursing Facility Services to be moved into managed care by July 1, 2019. Those individuals receiving services through the Developmental Disability (DD), Acquired Brain Disorder (ABD) and In-Home Supports (IHS) waivers are to be moved into managed care after July 1, 2019. In the meantime, the NH Association of Counties has received funding to explore alternative options for providing long term services to individuals eligible for Medicaid with a nursing home level of care including those in the CFI waiver. A preliminary report is due by March 1, 2018 and a final report by July 1, 2018.

NEW CHANGES IN APPEAL AND GRIEVANCE RIGHTS

Beginning July 1, 2017, the timeframe for filing a “first level appeal” with an MCO has been increased from 30 calendar days to 60 calendar days from the date of the written notice of the MCOs adverse decision. The timeframe for filing for a State Fair Hearing (“second level appeal”) has been increased from 30 calendar days to 120 calendar days from the date of the written notice of the MCOs adverse decision on the “first level” appeal. Remember: If you want your benefits to remain in place, you MUST STILL REQUEST in writing THEY REMAIN IN PLACE AND FILE YOUR APPEAL WITHIN 10 CALENDAR DAYS FROM THE DATE YOU RECEIVE THE MCOs WRITTEN NOTICE. This must be done for each level of appeal.

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What is Medicaid Managed Care?

In a Medicaid managed care system, Medicaid recipients are provided health care coverage from a company under contract with the state.  Managed care companies, or MCOs agree to provide Medicaid benefits to recipients in exchange for a monthly payment from the state.  The State of New Hampshire currently contracts with two MCOs  to provide health care coverage for most New Hampshire Medicaid recipients. The remaining companies are: NH Healthy Families and Well Sense Health Plan.

Problems with Managed care? Read this:

KNOW YOUR RIGHTS New Hampshire Medicaid Managed Care Health Plans: Your Right To Appeal Or File A Grievance, or call Disability Rights Center - NH at 1-800-834-1721 for more information about the grievance and appeal processes or for advice and/or representation in a Medicaid fair hearing.

You have the right to voice any concerns to New Hampshire Medicaid at any time. You may contact New Hampshire Medicaid Client Services by phone at 800-852-3345, ext 4344 or 603-271-4344.

Link to the NH DHHS website for the NH Medicaid Managed Care program

The managed care health plans are:

Resources:

The Law:

Policy information: