1. IDD Participant Enrollment/Integration in Bayou Health Plan Kathy H. Kliebert Secretary

2. 2 BACKGROUND Bayou Health Physical Health Effective 12/1/15 mandatory – SSI recipients under age 19 – Family Opportunity Act enrollees – Medicaid enrollees with an OCDD SOA who are not receiving waiver or ICF services – “Unless in the Chisholm class (under 21, on Medicaid, and on the registry(“waiting list”) for waiver services.” Waiver recipients (without Medicare) began Bayou Health opt-in in July 2014 and continue with opt-in choice Chisholm Class began Bayou Health opt-in July 1, 2015 and continue with opt-in choice Behavioral Health Integration Effective 12/1/15, Magellan will provide services only to CSoC enrollees Specialized behavioral services will be provided by one of the five Bayou Health Plans: – Aetna Better Health – Amerigroup Real Solutions – AmeriHealth Caritas – Louisiana Healthcare Connections – United Healthcare LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS2

3. What does this mean for me? Are you already enrolled in Bayou Health? Are you receiving SSI benefits or enrolled in the Family Opportunity Act program? Are you residing in an ICF or have Medicare? Are you receiving HCBS services or on the registry (Chisholm Class member)? LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS3

4. Individuals Already in Bayou Health Bayou Health plan will coordinate benefits Benefits include: Physical health, specialized behavioral health, pharmacy and NEMT Exceptions:  Children who qualify for and enroll in CSOC  Magellan will manage all specialized behavioral services for the CSOC services in coordination with Bayou Health plan  Bayou Health plan will coordinate all remaining services HCBS enrollees continue to receive waiver services as they do now LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS

5. Individuals New to Bayou Health for Medicaid Benefits Groups included – Children receiving SSI who had opted out – Children enrolled in the Family Opportunity Act program who had opted out Access all services through the Bayou Health Plan -- Physical health, specialized behavioral health, pharmacy and NEMT CSoC exception remains the same when enrolled LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS5

6. Individuals New to Bayou Health for Specialized Behavioral Health & NEMT Children (under 21)residing in an ICF & Medicare dual eligibles Bayou Health plan coordinated benefits: – Specialized behavioral health services – Non-emergency transportation to ANY Medicaid service (waiver, non waiver, dentist, physical or Specialized BH) Continued Medicaid Fee for Service/Medicare: – Physical health providers – Waiver services – Facility services – Pharmacy CSoC exception remains the same when enrolled LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS6

7. Individuals receiving HCBS services or Chisholm Class members Bayou Health plan coordinates benefits if and when you need them: – Specialized behavioral health services – Non-emergency transportation to ANY Medicaid service (waiver, non waiver, dentist, physical or Specialized BH) – Children will receive transportation to any provider under EPSDT. CSoC exception remains the same when enrolled  You can CHOOSE to receive your other benefits from your Bayou Health plan too.  You can also CHOOSE to return to Fee for Service Medicaid for your other benefits. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS7

8. Enrollment Process Ask your providers what plans they accept Choose a plan – Bayou Health can help Last day to choose a plan for December 1 enrollment is November 6. Participants can enroll: – Online at www.bayouhealth.comwww.bayouhealth.com – By phone at 1-855-BAYOU-4U (1-855-229-6848). – By fax at 1-888-858-3875. – By mail using an Enrollment Form. – In person at the local Medicaid eligibility office. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS8

9. Important things to understand Enrollment in a Bayou Health Plan continues for one year or until the next Open Enrollment period. Participants can change plans within the first 90 days after enrollment (Feb 26 th ). It is possible to change plans for cause after Feb 26th. Key action point: Ensure that current providers are contracted with the Bayou Health plan that you choose Ask your providers Ask Maximus (enrollment broker) LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS9

10. If a participant doesn’t choose… Participants who don’t select a plan will be auto- enrolled in one of the five plans regardless of whether they are currently receiving specialized behavioral health services. Any participant who is currently receiving Medicaid specialized behavioral health services through a provider should be strongly encouraged to: – Ask their providers which plans they are enrolled in. – Ask Bayou Health (the enrollment broker) which plans the providers are enrolled in. LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS10

11. Additional Considerations for HCBS Enrollees and Chisholm Class members All plans offer care coordination which can assist with challenges accessing and coordinating services Plans contract with non-Medicaid providers & specialists to ensure access to services Plans have the flexibility to pay for services that Medicaid cannot – Types of medical equipment or supplies not traditionally allowable Each plan offers a set of value added services – All plans offer basic adult dental services – All plans offer some type of adult vision services – Additional items include weight loss support, cash incentives for participating in wellness programs, and even free cell phones – No 12 visit restriction for adults LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS11

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