Individuals Must Currently Have Both Masshealth and Medicare

January 6, 2014

Do you have Medicare and MassHealth because of a behavioral health diagnosis? If so, you are likely eligible for the new ONE CARE program.

Effective October 1, 2013, most MassHealth recipients who are also covered by Medicare have the option to join a OneCare Plan, linking their benefits under one umbrella. As of 2008, 64% of OneCare eligible individuals had behavioral health diagnoses. If you have MassHealth and Medicare and there is a OneCare Plan that covers the region you live in, you should have received information in the mail from MassHealth. It is very important that you read this material and respond. If you do not respond, MassHealth may automatically move you into a OneCare Plan.

Please read this important information regarding OneCare as this will impact many of the NAMI Mass population.

·  To Qualify:

·  Individuals must currently have both MassHealth and Medicare

·  Be between ages 21-64

·  Be currently enrolled in MassHealth Standard or CommonHealth

·  Live in a geographic region covered by a OneCare Plan

·  Choosing a Plan:

·  Check with the Plan to make sure it covers all your prescriptions and that you can continue receiving services from the providers you respect and utilize most.

·  Plans are regionally based:

·  Commonwealth Care Alliance – Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth (except East Wareham, Lakeville, Marion, Mattapoisett, Wareham, and West Wareham), Suffolk, and Worcester.

·  Fallon Total Care – Hampden, Hampshire, and Worcester.

·  Network Health Unify – Suffolk and Worcester.

·  Plans have varying coverage – MEMBER PACKETS ARE AVAILABLE ONLINE:

·  Commonwealth Care Alliance – www.commonwealthonecare.org

·  Fallon Total Care – www.fallontotalcare.com

·  Network Health Unify – www.NetworkHealthUnify.org

·  Auto Assignment:

·  Over the next year, all OneCare eligibles living in regions of the state with a minimum of two OneCare Plans will be auto assigned to a Plan unless action is taken.

·  You must actively “opt out” of One Care by mail or phone if you are in one of these regions.

·  You can opt out by calling MassHealth at: 1-800-841-2900

·  Once Enrolled:

·  For the first 90 days of your enrollment all prescription drugs and current providers will continue to be covered.

·  Within 90 days you will receive a comprehensive evaluation to determine all of your medical and long-term service and support needs (e.g. personal care attendant services, day services, peer services, etc.).

·  You will have the right to request an Independent Living Long-Term Service Coordinator (IL-LTSS).

·  The IL-LTSS coordinator has expertise in independent living and the recovery model of care. They may help facilitate getting services such as home care, wellness programs, and durable medical equipment and more.

The Benefits of Choosing A OneCare Plan:

·  Your Care Team – Made of People You Want!

·  Your Care Team can include Peer Specialists to support in advocating for your needs!

·  You can also include family or others of your choice.

·  Service providers of any kind can be a part of your care team; such as community based mental health/ substance abuse service programs, social service agencies, DMH, DDS, DPH, MRC, etc.

·  The Care Team also has a Care Coordinator who will link you with providers, services, and equipment you need.

·  Expanded Dental Coverage!

·  OneCare Dental Coverage to Include:

o  All Fillings; Dentures (including repairs); Crowns (including repairs); Periodontic Services; Endondontic Services; Oral Surgery; Extractions; Routine Cleanings; Exams; X-Rays; Emergency Services

o  Per MassHealth: “Each OneCare plan may have different coverage rules or limits on dental services, such as prior authorization requirements, limits on the number of visits in a year, and restrictions to medically necessary care. Please consult each plan for details about benefits, coverage rules, and the network of dental services providers.”

·  Find out More:

·  Contact SHINE (Healthcare information hotline – Serving the Health Information needs of Elders) - 1-800-544-5242

·  Contact Healthcare For All at www.hcfama.org or 1-617-350-7279

·  Contact MassHealth Customer Service at www.mass.gov/masshealth/onecare or 1-800-841-2900

Ø  KEY REMINDERS:

o  Not all providers / medical facilities / agencies are enrolled in OneCare! Your current providers may change once enrolled in OneCare plan!

§  Provider lists can be accessed by contacting OneCare plans either on the phone or researching online.

§  If your provider is not in the OneCare network, you can ask the Plan and your provider to talk about joining the OneCare network.

o  You can opt out or change your OneCare plan at any time, without penalty!

§  By opting out, you will receive same MassHealth and Medicare benefits as you currently do.

§  When opting out of a OneCare Plan or joining a new one, the change will be effective on the first day of the month following your notification of MassHealth. For example, if you notify MassHealth on January 15th, 2014 that you want to opt out or change to a different OneCare Plan, the effective date would be February 1, 2014.