Medicaid Managed
Care Program
All
individuals under
65 who are Medicaid eligible are required to enroll in a Medicaid Managed
Care Plan unless they have been identified as either exempt or
excluded.
What is Medicaid Managed Care?
Medicaid Managed Care provides Medicaid
eligible individuals access to health care through Medicaid Managed Care
Plans. These plans provide the majority
of Medicaid services such as primary, specialty, ancillary and inpatient services that may not be available
through traditional Medicaid fee-for-service system. Medicaid services such as pharmacy and dental will continue to be
provided through the traditional Medicaid system.
Who must join?
All
Medicaid eligible individuals under 65 unless they are determined to be exempt
or excluded.
Who is exempt or excluded from Managed Care?
Exempt [not
required to enroll, but may enroll voluntarily]:
SSI or SSI-related
Seriously and persistently mentally ill [SPMI]
Seriously and emotionally disturbed [SED]
Individuals currently being treated for a chronic medical
condition
Native Americans
Excluded [not
eligible to enroll, even voluntarily]:
Individuals who are dually eligible [Medicare/Medicaid]
Medicaid Spenddown recipients
Foster children in the placement of a voluntary agency
Individuals in the Recipient Restriction Program
These
examples represent the most common exempted/excluded categories of individuals.
What does Medicaid Managed Care cost?
There
is no cost
to enroll.
What services are covered?
Physician services
Inpatient and outpatient health care
Lab tests and x-rays
Vision, speech and hearing services
Short term rehabilitation
Durable medical equipment
Emergency room and emergency ambulance services
Mental health/alcohol and substance abuse treatment [as
medically necessary]
Family planning
Radiation therapy, chemotherapy, hemodialysis
How
is care provided?
Medicaid
Managed Care is provided through various Medicaid Managed Care Plans.
How does a person enroll in Medicaid Managed Care?
For
information on how to enroll and what plans are available, please contact the
Erie County Department of Social Services Managed Care office at [716] 858-8666.
Participating
Managed Care Plans:
HealthNow/Community Care
1901
Main Street
Buffalo,
New York 14208
[716]
887-7520
1-800-888-5407
Fidelis Care of New York
40
John Glenn Drive
Amherst,
New York 14228
1-888-343-3547
Independent Health/MediSource
511
Farber Lakes Drive
Buffalo,
New York 14221
[716]
631-1355
1-800-453-1910
Univera Community Health/Plus Med
205
Park Club Lane
Buffalo,
New York 14221
[716]
847-0881
1-800-427-8490
Child
Teen Health Plan [C/THP]:
What is the Child Teen Health Plan?
Child
Teen Health Plan is a preventive health care program featuring periodic
comprehensive medical examinations for children under 21 who are active under the
Medicaid program. The frequency of
examinations is based upon the recommendations of the American Academy of
Pediatrics. C/THP will assist in finding
a physician to perform these examinations.
In addition, you may be eligible for transportation assistance with bus
tokens to attend your appointments. If
you have any questions or need additional information, please contact the Child
Teen Health Plan office at [716] 858-8666.