Medicaid Care Management

If you are "exempt", you will continue to get your care through Medicaid Fee For Service.

You are "exempt" if you:

• Get benefits from the Veterans Administration
• Get "In-and-out" Medicaid assistance, also known as "Spend Down"
• Are a Qualified Medicare Beneficiary (QMB) only or a Special Low Income Medicare Beneficiary (SLMB) recipient, and have no other kind of Medicaid coverage at all
• Are a Qualified Disability Working Individual (QDWI) recipient, and have no other kind of Medicaid coverage at all

Being in Medicaid Managed Care and picking a Health Plan does not affect your ability to get other services. 

Your LTC supports and services or waiver services will still to be covered under the regular Medicaid program just as they are now, but many of your other services will be covered by your Health Plan.

Some of the services that will be covered by your Health Plan include: medical services, adult medical day, personal care services and private duty nursing. Your Health Plan will help you get these and other services you need to stay healthy. Even if you are a resident in a nursing home, you will get some medical services from a Health Plan.

Children's dental is covered under Medicaid Fee For Service just as it is now. 

If you do not act when you complete your Medicaid application, a Health Plan will be chosen for you. You will be told which Health Plan has been "auto-assigned" to you.

After you pick a Health Plan, you will get a letter from DHHS confirming your selection or "auto-assigned" Health Plan. The Health Plan will send you a Welcome Packet with Plan information.

If you haven't already selected a primary care provider (PCP), your Health Plan will select one for you. You may change your PCP at any time. A PCP is the provider that will manage most of your care. It is the provider you see for regular check-ups or when you are sick.

You may choose the PCP you already use, or choose a different PCP as long as the provider you select is in network with your Health Plan.

Your Health Plan will also ask you questions about your health so they can better help you get the care you need.

Your Health Plan will also send you a Member ID card. Don't throw your Medicaid ID card away. You will still need it. You will still use your Medicaid ID card for some services, so show both cards to your provider or pharmacist at each visit.

You can change your Health Plan for any reason during the first 90-days you are initially eligible for Medicaid. You can also change Health Plans during the annual open enrollment period. You may also be able to change your Health Plan "with cause". Check your Health Plan Member Handbook for details under "Ending your plan membership".

If you believe you have a "with cause" reason, contact your Health Plan and file a grievance first. After the Health Plan addresses your grievance and if you are still dissatisfied, you may contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET to see if you are eligible to switch "with cause".

If you want to keep your same provider, you must pick a Health Plan that your provider is in network with. If your provider is in one of the Health Plans, you may want to choose that Health Plan.

If your provider is in network with more than one Health Plan, pick the one with the services and programs you like best.

If you have a number of doctors and providers in network with different Health Plans, pick the Health Plan that works with the providers you most want to keep.

If your provider does not work with any of the Health Plans, we can help you pick a plan, and then your Health Plan can help you find a new provider that will give you the care that is right for you.

You may still need to use your Medicaid ID card for some services, so show both cards to your provider at each visit.  Services still covered by regular Medicaid include children's dental care, Long Term Care (LTC), and waiver services.

If you are not happy with a service or decision, you have the right to tell the Health Plan by filing a grievance or an appeal.

Complaints and Grievances
A grievance is a formal way to tell a Health Plan about a problem with something like customer service or quality of care. Want to know more about your right to file a grievance? Look in your Health Plan Member Handbook under "What to do if you want to appeal or file a grievance".

Appeals
An appeal is a way to ask to change a decision made by a Health Plan. An example of an appeal is when a Health Plan does not approve a request for a service. Not happy with the result of your Health Plan appeal? You can appeal to a unit within the Department whose main job is to hear appeals. Look in your Health Plan Member Handbook under "What to do if you want to appeal or file a grievance" or visit the Administrative Appeal Unit for more information.

Yes, transportation assistance may be coordinated by the Medicaid Health Plan. Look in your Health Plan Member Handbook under "Important phone numbers" or contact the phone number on the back of your Health Plan Member ID card to learn about transportation coverage.

If you need help in another language, call the Medicaid Health Plan Member Services Center:

• AmeriHealth Caritas New Hampshire: 1-833-704-1177 (TTY: 1-855-534-6730)
• NH Healthy Families: 1-866-769-3085 (TTY/TDD: 1-855-742-0123)
• Well Sense Health Plan: 1-877-957-1300 (TTY/TDD: 711)