Medicaid Guide

A Guide To Help Choose A Health Plan From now on, most people with Medicaid in your county must join a health plan.  What changes is that you now must choose one health plan for you and you family.  Here are some guidelines to follow: You Have 60 Days To Choose If you received a letter accompanying the "You Have 60 Days To Choose A Health Plan" booklet, the letter gives the date by which you must choose a plan. You may choose a health plan at any time before that date. If you already have a health plan, you can stay in it or choose another one. To join, fill out and sign the enrollment form or card that came with the booklet.  Mail it to: Cattaraugus County Department of Social Services, 1701 Lincoln Avenue, Olean, New York 14760---no stamp is required. Send the form back before 60 days, or your LDSS will choose a plan for you. Who is Not Required to Join a Health Plan Some people with Medicaid do not have to join a health plan. They are exempt. This means that they can stay in regular Medicaid or they can join a plan if they wish. You have to tell the LDSS if you think you don't have to join. Here is a list of persons who are exempt and do not have to join: People with HIV infection.  People in long-term alcohol or drug residential programs.  Pregnant women who are getting prenatal care from a provider who is not in any plan.  People who live in facilities for the mentally retarded and people with similar needs. Some developmentally disabled people or physically disabled children who get care at home or in their community through the Care at Home or Community-Based waiver programs, or those who need the same kinds of care as people getting services through those programs.  People with long-term health problems being treated by a specialist who is not in any plan.  Adults who have serious mental illness and children who have serious emotional problems.  Native American persons.  People who cannot find providers in any plan who can serve them in their language.  People who live where a provider is not accessible.  People with Supplemental Security Income (SSI) or Medicaid-only Supplemental Security Income (MA-SSI) (EXCEPT in Westchester County).  People temporarily living outside of the county.  People scheduled for major surgery in the next 30 days, whose provider is not in a health plan.  People with end-stage renal disease.  People who are homeless, depending on the local social services district.  Foster care children depending on the local social services district. Be sure to tell your local DSS if you think you do not have to join a health plan for any of the reasons listed above. Note: Health Plans and HIV People living with HIV may join a health plan or keep regular Medicaid. If you have HIV and want to join a health plan, you can keep seeing your doctor if he or she is in the plan you join. Ask your doctor what plan he or she works with. To keep the health care you have now, apply for an exemption, as explained at the bottom of this page. In order to see a specialist, or receive special services such as x-rays or lab tests, you must be referred by your Primary Care Provider (PCP). You will be referred only to health professionals who belong to your plan. New York State plans to offer special health plans with providers who have treated many persons with HIV You will receive more information on special HIV health plans as soon as they are available.  For more information on HIV, call 1-800-732-9503, Monday through Friday, 9:00 a.m. to 5:00 p.m. Note: Native Americans and Health Plans Native Americans may join a health plan or keep regular Medicaid. If you are a Native American and you join a health plan, you can still go to your tribal health center for care. You can also go to your health plan doctor. If you have been seeing a Medicaid doctor who is not part of a health plan, and who is not working in a tribal center, you will not be able to keep seeing that doctor if you join a plan. If you want to keep seeing that doctor, ask for an exemption so you won't have to join a health plan. To get an exemption, you must have one of the following: An ID card from the Bureau of Indian Affairs, Tribal Health, Resolution, Long House or Canadian Department of Indian Affairs; or Documentation of roll or band number, documentation of parents' or grandparents' roll or band number, together with birth certificates) or baptismal record indicating descent from the parent or grandparent; or Notarized letter from a federal or state recognized American Indian/Alaska Native/Tribe; or Notarized letter from a tribe village office stating heritage or a birth certificate indicating heritage.  Call your LDSS Managed Care Unit for more information. If you think that you are exempt (or don't have to join), call your LDSS Managed Care Unit and ask for a Request for Exemption Form. Anything you say is confidential. Some People Must Stay with Regular Medicaid Some People with Medicaid are not allowed to join a health plan. This means they are excluded from joining a health plan and must stay with regular Medicaid. Here is the list of people who cannot join Medicaid managed care. People in nursing homes, hospices, or long term health care and demonstration programs. Children or adults in state psychiatric or residential treatment facilities. People who live in Family Care Homes licensed by the Office of Mental Health. People who will get Medicaid for less than 6 months except for pregnant women. People who are on Medicaid only after they spend some of their own money for medical needs (spenddown cases). People with other health insurance (if that insurance costs less than Medicaid). Babies under six months old who can get Supplemental Security Income (SSI). Infants living with their mothers in jail or prison. People in the recipient restriction program. People eligible for both Medicaid and Medicare. Blind or disabled children living apart from their parents for 3o days or more. People eligible for TB services only. Foster care children should speak with their LDSS to find out if they are excluded. Call 1-888-ENROLLS for your LOSS phone number. If you become excluded from managed care after you join a health plan, you must disenroll from the health plan. Call your LOSS Managed Care Unit if you think you are excluded from joining a health plan. They will answer your questions and will mail you an Exclusion Form. Family Planning Services Most health plans offer family planning services. Every member of every plan can go to any Medicaid provider for family planning. You do not need a referral from your PCP for family planning. Here is a list of family planning services: Birth control pills, condoms, 1 diaphragms, IUDs, Depo Provera, Norplant and foam Emergency contraception Pregnancy testing and counseling Sterilization Sexually transmitted disease testing and treatment HIV testing and counseling, when it is part of a family planning visit Abortions (that you and your doctor agree are necessary).