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Working with MO Health Net & Managed Care Organizations
United Healthcare, MissouriCare, Home State Health
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Eligibility People Eligible for Medicaid Pregnant Women
Children in state custody through Children’s Division or Department of Youth Services Children adopted through Children’s Division Refugees Individuals or families within certain income levels Aged, blind, disabled How to Apply Contact closest Family Support Division Office If working, bring most recent pay stub Bring SSN or Green card number Following determination of eligibility, will receive a PIN and directions for enrollment
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Enrollment How: Receive enrollment packet with PIN
Online: Phone: TTY: 771 Mail: MO HealthNet Division P.O. Box Jefferson City, MO 65110 Choices at Enrollment Choose MCO Choose PCP If member does not choose, he/she is auto-assigned Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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MO Medicaid Division Fee for Service SSI Members Hospice
Waiver Programs Members in these populations can choose to be in an MCO plan instead Managed Care Medicaid Home State Health WellCare/MissouriCare United HealthCare Some services are only paid for by FFS but the members are MCO BH services for COA 4 children (foster/adopt/juvenile custody) Pharmacy services IEP/IFSP services Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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How It Works Members go to FSD locations to apply for Medicaid
Select plan or are auto-assigned All members can be in MCO MO HealthNet governs rules for MCO’s MCO’s follow MO HealthNet FFS provider manuals/guidelines & fee schedules Per contractual agreement with MO HealthNet, MCO’s engage in care management with specific populations Per contractual agreement with MO HealthNet, MCO’s provide specific benefits to members The above is consistent across MCO’s and monitored by MO HealthNet through reports Additional benefits are provided and can be different among the MCO’s – these are called value adds Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Steps in Care Management
Identification Outreach Consent or Not If Yes… Assessment & Enrollment Care Plan Development Care Coordination Monitoring & Follow-up When resolved or dependent upon program rules, close case If No…Close Case Talk briefly about difference between case management & care management Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Care Management Programs
Environmental Lead Poisoning High Risk Pregnancy ER Diversion Foster Care Chronic Illness Behavioral Health Special Health Care Needs Dual Special Needs Program Substance Use Disorders Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Additional Programs/Services
Special Programs – Coordination of IFSP/IEP therapy services with outpatient therapy services Lock-In Program – Pharmacy/Provider or Both – Member who is potentially struggling with misuse of benefits may be “locked” into a provider or pharmacy or both to help better monitor their use and have better coordination of services. Member education is provided Housing – provides members who are homeless with assistance obtaining housing Employment – provides members who are under- or unemployed assistance with obtaining employment Transportation – provides free transportation for healthcare appointments Interpreter Services – provides free interpreting services for non-English speaking or ESL members, including in-person assistance at healthcare appointments Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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How to Refer to Care Management
Who can Refer? Members Providers School Personnel Caregivers/Family How to Refer Talk to the caregiver about care management services Look up the care management services/contact information in NurseLink Contact the respective MCO’s contact line/member services & request care management services United Healthcare TTY 711 Missouri Care Home State Health Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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Questions Proprietary Information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
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