Page 34

State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 33 MediKids MediKids children are enrolled in Medicaid managed care plans and MediPass, a primary care case management program. MediKids children have the following choices: • In counties with no managed care plans, the family can select a MediPass primary care provider. • In counties with one managed care plan, they also have the choice of selecting a MediPass primary care provider. • In counties with two or more managed care plans, the child must be enrolled in one of the managed care plans.

The managed care plan or MediPass provider will provide the same services to a MediKids-enrolled child that a Medicaid-enrolled child receives, except for Medicaid waiver services (e.g., AIDS waiver, and other home and community-based services waivers). State law explicitly prohibits MediKids from providing interim benefits to a MediKids-eligible child until the child is officially enrolled in a managed care organization or MediPass. Therefore, since the managed care plan selection is part of the eligibility process it is vital that families make a choice as quickly as possible. In order to expedite this part of the eligibility process, the Agency for Health Care Administration sends a letter to the family advising them of their health plan choices. The letter advises them that a choice has been made for them, but that they can call the MediKids Helpline to discuss their options and change managed care plans. If their child is approved for MediKids, they will be assigned to their selected health plan when coverage begins. MediKids children also have the option of changing managed care plans at any time, since they are not subject to a lock-in period Children under age one in the Medicaid expansion population are not part of the MediKids program, therefore, this policy does not apply to them. The Medicaid expansion children are treated like Medicaid, and the plan selection is made after coverage begins. Healthy Kids FHKC contracts with commercially licensed health and dental plans. These plans are selected through a competitive bid process conducted by FHKC. Beginning in 2004, FHKC was required to contract in the most cost-effective manner consistent with the delivery of quality medical care. Previously, the contracting guidelines required FHKC to select plans based primarily on quality criteria.