By Peter Becker
PALMYRA TWP. (PIKE)- Persons on Medical Assistance have been informed that they will now have a choice of managed health care programs, rather than one, the ACCESS Plus program which is being discontinued.
About 35 people attended a public meeting Feb. 4th at the Wallenpaupack North Primary School, where those receiving Medical Assistance has the chance to hear about their options and ask questions. Although the open enrollment period to choose a new managed health care program was closing in just three days (Feb. 7), the information was also useful for people newly registering for Medical Assistance.
ACCESS Plus is still in effect through Feb. 28; the newly chosen managed care plan takes over on March 1, 2013. If a Medical Assistance consumer did not make a choice and sign up for a new plan, the consumer will be assigned a new plan, said Mauricio Conde, Operations Manager for Maximus.
The PA Department of Pubic Welfare (DPW) employs the consulting firm Maximus to provide managed care enrollment services for the Medical Assistance program statewide. They oversee the managed care plans to help ensure quality of care for Pennsylvania consumers.
ACCESS Plus, as well as the Voluntary Managed Carte program, is being replaced with the HealthChoices mandatory managed care program in 22 counties of northeast/central Pennsylvania, completing the gradual transition statewide.
Managed health care organizations manage all physical health services for members by bringing primary care doctors, specialists, pharmacies, facilities and suppliers together in a coordinated network of care. Wellness programs and disease management is also provided.
Scott Matlock, Managed Care Expansion Project Manager for DPW, told the group that the change was being made because of the excellent and national recognized track record of HealthChoices in providing access to high quality care. Asked if the transition was being made to save money, he stated that this was not the case.
Under HealthChoices, three contracted plans have been offered, Amerihealth Northeast, Coventry Cares and Geisinger Health Plan.
One woman in the audience asked if her family could still use the same doctors in Boston where her son received successful treatment against Lyme Disease. Conde replied that she would find even more support from the new program and coordination of care.
He stated that Maximus does not promote one plan or primary care physician over another, but they helped consumers make an informed decision. He said each of the plan choices offer the same services as ACCESS Plus, and no benefits would be lost.
Once a plan is chosen, it can still be changed, he said.
Although ACCESS Plus is ending, Medical Assistance consumers will still use their plastic ACCESS card to verify their eligibility for benefits and programs.
A man in the audience wanted to know why it takes four to six weeks to select a new plan. In his case, he suffered a house fire and lots his documentation. Conde stated that it takes administrative time to switch to a new plan, and be sure that the primary care physician and the managed care company is informed in advance. He said if a particular situation demands that the plan b switched sooner, there are mechanisms to expedite the process.
A HealthChoices Consumer Advisory Committee is being organized for the 22- county region, which is known as the New East Zone. The committee will meet three times a year, where consumers and agencies can meet and exchange ideas and opinions.
HealthChoices also includes a Special Needs Unit, to assist consumers and their families with special needs. Program Specialist Eric Ulsh reviewed their services, which have been in place since 1997. He said that HealthChoices goes above and beyond what ACCESS Plus offered those with special needs.
Members receive a handbook on special needs services, and a hotline phone number they can call 24 hours a day.
Some Medical Assistance consumers are exempt from the HealthChoices (physical health) program. These include most dual consumers (Medicare and Medicaid) over 21; most nursing home residents (after the first 30 days), temporary categories such as Spend-down and Health Insurance Payment Program (HIPP) recipients.
Questions about HealthChoices can be directed to the Maximus PA Enrollment Contractor at 1-800-440-3989, or visit online at www.enrollnow.net.
Persons wishing to apply for Medical Assistance should contact their local County Assistance Office.
In Wayne County, call 253-7100 or visit 107-8th St., 2nd floor, Honesdale.
In Pike County, call 296-6114 or stop in at Milford Professional Park, Suite 101, 10 Buist Road, Milford.
The public meeting was coordinated by Lori DeVoe, Regional Coordinator- Northeast Region for the Special Kids Network System of Care.