Nebraska’s Medicaid program will be undergoing big changes through Heritage Health, Nebraska’s new Medicaid managed care program.
“Managed care” is a term used to describe when the state contracts with private insurance companies to manage Medicaid coverage and arrange for Medicaid services. In other words, people with Medicaid will receive their Medicaid coverage through a private insurance company. Medicaid enrollees will still get full Medicaid benefits — Heritage Health just changes the way they will get benefits starting January 1, 2017.
How is Heritage Health different from current coverage?
Right now, Medicaid or CHIP enrollees have their physical health benefits managed by one of three different companies, depending on where they live: Aetna Better Health of Nebraska, United HealthCare, or Arbor Health.
Behavioral health benefits are managed by another company – Magellan. Pharmacy benefits are managed through a state pharmacy plan. Under Heritage Health, enrollees will choose one plan to take care of physical health, behavioral health, and pharmacy benefits — one plan for all three types of services. Enrollees will be able to choose between Nebraska Total Care, WellCare of Nebraska, and United HealthCare. Services outside of behavioral health, physical health, or pharmacy will be covered through the state.
A helpful comparison of the three plans can be found on the Nebraska DHHS website. All three plans provide full Medicaid benefits, but the plans may go about administering those benefits in different ways. For example, plans may have different out of pocket costs or offer additional benefits not usually included in Medicaid, like special programs for kids. Also, doctors may not be “in network” with all of the plans, meaning that they may not take all three kinds of insurance. So, it’s important for Medicaid enrollees to pick a plan where the doctor they see is in network.
Who will have to enroll in a Heritage Health plan?
Almost everyone on Medicaid or CHIP will be in Heritage Health, but some people will not experience coverage changes. These are people enrolled in Program for All-Inclusive Care for the Elderly (PACE), people with Medicare coverage for whom Medicaid only pays co-insurance and deductibles, individuals eligible only for emergency Medicaid, and people who have a share of cost/spend down.
How do I enroll in Heritage Health?
Medicaid enrollees who will participate in Heritage Health will start receiving information packets in the mail about how to choose one of the three different insurance plans. The packet should provide information about what to do next and the deadline for picking a plan and contain documents like this sample letter and this sample enrollment form.
Medicaid enrollees can pick a plan online, by phone, by fax, or by mail. Medicaid enrollees will also have the option to select a primary care provider (PCP). This will help make sure that a person’s PCP accepts the plan they choose. If a person doesn’t select a plan or PCP by the deadline, they will be automatically enrolled in one of the three plans and have a PCP selected for them. After someone picks a plan, they will receive an information packet from that plan. All members will have 90 days to change plans after January 1, 2017.
Automated Health Systems, or AHS, is Heritage Health’s “enrollment broker.” This is the service that can help people pick the best plan for them. They are impartial, meaning they don’t work with or prefer any of the companies. They can provide assistance in English, Spanish, or other languages.