Member Managed Care Update
June 2013 - Members may now search one place to confirm which networks physicians and other health care providers have joined. Search for providers by using the Online Provider Search.
January 2013 - A letter in English with information regarding contacting and changing their MCO has been mailed to members in Region 3.
January 2013 - Federal regulations allow members to change their enrollment through a process called “Disenrollment for Cause”. This process is for members who want to change their current MCO and are not within their 90-day timeline to change. View the How to change your MCO.
Beginning Jan. 1, 2013, four MCOs have also been awarded contracts to provide coverage for the 175,000 Medicaid recipients in Louisville and 15 surrounding counties, also known as Region 3. Those MCOs are:
The counties in Region 3 are: Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties.
Kentucky is moving to a managed care model across the state. Kentucky Medicaid has contracted with three new managed care organizations (MCOs) to begin coordinating health care for most Medicaid members beginning Nov. 1. The MCOs are:
- CoventryCares of Kentucky, a Medicaid product of Coventry Health and Life Insurance of Delaware, which provides services in eight states;
- Kentucky Spirit Health Plan, a subsidiary of Centene Corporation, which is based in Missouri and provides services in 12 states; and
- WellCare of Kentucky, a part of WellCare Health Insurance of Illinois, which provides services in seven states.
Not all members will be affected by this change. Members who receive coverage through waiver programs or are in nursing homes will not move to managed care.
However, most Medicaid members across the state will receive coverage through the new system. Medicaid members will be assigned to an MCO based on medical needs or current primary care physician. Members will be notified by letter of the MCO assignment, and will have the opportunity to choose another MCO, if desired. The deadline has been extended to Oct. 5. Members will also be able to change MCOs within 90 days after managed care begins on Nov. 1. After that, members will have an opportunity to switch MCOs annually, similar to private health insurance open enrollment. Members will experience no reduction in benefits or covered services, though MCOs may choose to offer additional services. The MCOs cannot charge more than the current Medicaid co-payments, but may choose to charge less.
For more information or assistance, visit the frequently asked questions by members or call the Medicaid Managed Care Hotline at 1 (855) 446-1245 from 8 a.m. to 6 p.m. Eastern Time, Monday through Friday. Medicaid members also may wish to visit the MCOs' websites or call MCOs' member hotlines.