STATE OF WASHINGTON

DEPARTMENT OF SOCIAL AND HEALTH SERVICES

Aging and Long-Term Support Administration

Home and Community Services Division

PO Box 45600, Olympia, WA 98504-5600

H13-060 – Information

August 27, 2013

TO: / Home and Community Services (HCS) Division Regional Administrators
Developmental Disabilities Administration (DDA) Regional Administrators
Area Agency on Aging (AAA) Directors
FROM: / Bea Rector, Director, Home and Community Services Division
Don Clintsman, Deputy Assistant Secretary, Developmental Disabilities Administration
SUBJECT: /
Enrollment of L21/L22 Categorically Needy Clients into the Health Care Authority (HCA) Healthy Options (HO) Managed Medical Care Program
Purpose: / To notify field staff that clients in the L21/L22 Medicaid coverage groups will be enrolled into Healthy Options (HO) managed care effective September 1, 2013.
Background: / The HO program is a managed medical care program that serves over 800,000 Medicaid clients statewide. This program is administered by the Health Care Authority (HCA) 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. On July 1, 2012, blind and disabled clients began to enroll into Healthy Options plans statewide via an auto enrollment process.
“L21/L22 clients” are Categorically Needy (CN) clients on a DDA or HCS Waiver, New Freedom or Roads to Community Living (RCL) program.
What’s new, changed, or
Clarified / Individuals that are in the L21 or L22 ACES coverage groups were not auto-enrolled to a managed care plan when other blind and disabled clients began enrolling last July.
These individuals in L21 and L22 coverage groups began receiving enrollment materials the week of July 22, 2013 and will be auto-enrolled in a Healthy Options managed care plan available in their region, beginning September 1, 2013.
These clients will continue to receive their waiver services on a fee-for-service basis through HCS/AAA/DDA; only Healthy Options covered services will be provided by the managed care plan assigned to each client.
Exceptions to Healthy Options Enrollment: All Medicaid-only blind/disabled clients must be enrolled, except clients:
·  Residing in an institutional setting at the time of enrollment (SNF, ICF/ID, State Hospital);
·  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;
·  Who are on Hospice at the time of enrollment (if a client is enrolled and then begins Hospice, they will remain enrolled);
·  Who are “aged” (65 or over);
·  Who have Medicare or “comparable” third party medical insurance coverage.
Clients who are in the following categories can choose to stay enrolled in HO or choose to be fee-for-service:
·  American Indians/Alaska Natives;
·  Who reside in a “Voluntary County”: Skamania, Klickitat, or Clallam;
·  Who are in the Address Confidentiality Program;
·  Who are homeless.
Client requesting an exemption allowing them to disenroll:
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, the client can call HCA Customer Service at 1-800-562-3022 and change to a different plan or 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 Portal or 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, (http://www.hca.wa.gov/documents/managed_care/ChangePlanEnrollment.pdf) to change enrollment via the ProviderOne Portal.
Additional information will continue to be distributed as it becomes available.
Related
REFERENCES: / Healthy Options Website
Management Bulletin H12-047
Management Bulletin H12-035
ATTACHMENT(S): / Healthy Options Plans – Contact Information:

Client Assignment Letter:

CONTACT(S): / Kristi Knudsen, Managed Care Program Manager
Home and Community Services Division
(360) 725-3213

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