Working with MO Health Net Managed Care Organizations

Working with MO Health Net & Managed Care Organizations United Healthcare, Missouri. Care, Home State Health

Eligibility People Eligible for Medicaid • Pregnant Women • Children in state custody through Children’s Division or Department of Youth Services • Children adopted through Children’s Division • Refugees • Individuals or families within certain income levels • Aged, blind, disabled How to Apply • Contact closest Family Support Division Office • If working, bring most recent pay stub • Bring SSN or Green card number • Following determination of eligibility, will receive a PIN and directions for enrollment

Enrollment How: • Receive enrollment packet with PIN • Online: https: //dss. mo. gov/mhd/participants/mc/how-to-enroll. htm • Phone: 1 -800 -348 -6627 TTY: 771 • Mail: MO Health. Net Division P. O. Box 104928 Jefferson City, MO 65110 Choices at Enrollment • Choose MCO • Choose PCP • If member does not choose, he/she is auto-assigned 3 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

MO Medicaid Division Fee for Service • SSI Members • Hospice • Waiver Programs • Members in these populations can choose to be in an MCO plan instead Managed Care Medicaid • Home State Health • Well. Care/Missouri. Care • United Health. Care Some services are only paid for by FFS but the members are MCO • BH services for COA 4 children (foster/adopt/juvenile custody) • Pharmacy services • IEP/IFSP services 4 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

How It Works Members go to FSD locations to apply for Medicaid • Select plan or are auto-assigned • All members can be in MCO • MO Health. Net governs rules for MCO’s • MCO’s follow MO Health. Net FFS provider manuals/guidelines & fee schedules • Per contractual agreement with MO Health. Net, MCO’s engage in care management with specific populations • Per contractual agreement with MO Health. Net, MCO’s provide specific benefits to members • The above is consistent across MCO’s and monitored by MO Health. Net through reports • Additional benefits are provided and can be different among the MCO’s – these are called value adds 5 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Steps in Care Management Identification Outreach Consent or Not If Yes… Assessment & Enrollment Care Plan Development Care Coordination Monitoring & Follow-up When resolved or dependent upon program rules, close case If No…Close Case 6 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Care Management Programs Environmental Lead Poisoning High Risk Pregnancy ER Diversion Foster Care Chronic Illness Behavioral Health Special Health Care Needs Dual Special Needs Program Substance Use Disorders 7 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Additional Programs/Services • Special Programs – Coordination of IFSP/IEP therapy services with • • • outpatient therapy services Lock-In Program – Pharmacy/Provider or Both – Member who is potentially struggling with misuse of benefits may be “locked” into a provider or pharmacy or both to help better monitor their use and have better coordination of services. Member education is provided Housing – provides members who are homeless with assistance obtaining housing Employment – provides members who are under- or unemployed assistance with obtaining employment Transportation – provides free transportation for healthcare appointments Interpreter Services – provides free interpreting services for non-English speaking or ESL members, including in-person assistance at healthcare appointments 8 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

How to Refer to Care Management Who can Refer? • Members • Providers • School Personnel • Caregivers/Family How to Refer • Talk to the caregiver about care management services • Look up the care management services/contact information in Nurse. Link • http: //www. schoolnurselink. com/ • Contact the respective MCO’s contact line/member services & request care management services • United Healthcare 1 -866 -292 -0359 TTY 711 https: //www. uhccommunityplan. com/mo/medicaid/mo-health-net. html • Missouri Care www. missouricare. com • Home State Health https: //www. homestatehealth. com/ 9 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.

Questions 10 Proprietary Information of United. Health Group. Do not distribute or reproduce without express permission of United. Health Group.