1 WV Medicaid Managed Care Helping Government Serve the People ®

2 Agenda Medicaid Overview Managed Care Updates Member Enrollment Services & Benefits Medicaid Verification Outreach & Education

3 Medicaid Overview On average there is approximately 580,000 of West Virginia’s Population covered by Medicaid.  Medicaid Managed Care – 70%  Medicaid Fee-for-Service – 30%

4 Medicaid Overview Fee-for-Service (MOLINA) - All Medicaid members who are exempt from managed care are served through a Fee-for-Service delivery system administered by Molina. Mountain Health Trust & WV Health Bridge – West Virginia Medicaid managed care program. Enrollment Broker (MAXIMUS) – Coordinates member enrollment into managed care organizations. Managed Care Organization's (MCOs) – Often referred to as “a” health plan the coordinates the provision of health services through networks and case management.

Managed Care Updates As of February 1, 2017, approximately 50,000 SSI Medicaid members will be transitioned from Medicaid Fee-for-Service to Medicaid managed care. Coventry Cares of WV is now AETNA Better Health of WV. All 4 MCOs are available in all WV counties. In June 2016, the Physician Assured Access System (PAAS) program ended. All former PAAS members are now members of an MCO.

6 Member Enrollment Call us at We are here Monday through Friday from 8:00 a.m. to 6:00 p.m. For hearing Impaired (TTY) please call You can mail your completed enrollment form to us at: West Virginia Mountain Health Trust 231 Capitol Street, Suite 310 Charleston, WV You can use our website to find answers to your questions, compare your health plan options, search for your provider, or enroll in a health plan at

7 Managed Care Who must enroll:  Medicaid expansion (Adults)  Children  Most parents  Most caretakers Fee-for-Service Exempt from managed care:  Aged/Disabled Waiver  I/DD Waiver  SSI* - Transitioning to managed care as of Feb 1,  TBI Waiver  Medicare  Live in a long term care facility  Foster Care  Spend down program Member Enrollment

8 Alternative Benefit Plan Only Medicaid Expansion members, also known as WV Health Bridge, qualify for ABP. to%20Medicaid%20%202016Final.pdf Traditional Benefit Plan Specific types of basic health services a State must provide beneficiaries in order to have a valid Medicaid program. to%20Medicaid%20%202016Final.pdf Medicaid Managed Care Service & Benefits

9 Managed Care Members should utilize their MCO health plan benefit when receiving healthcare services. Members should provide both their annual State Medicaid card and their MCO health plan membership card. Providers should bill the members MCO health plan for health services provided and bill Fee-for-Service (Molina) for “ carved out services like personal care services.” Fee-for-Service Members who are exempt from managed care should utilize their Fee-for-Service benefit when receiving healthcare services. Members should have their annual State Medicaid Card. Providers should bill Fee-for-Service (Molina) for health services provided. Medicaid Verification

10 Outreach & Education