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.