South Carolina Healthy Connections Choices

1. South Carolina Healthy Connections Choices Helping Your Patients Make the Most of Their Medicaid Benefits

2. SC Healthy Connections Choices Agenda • Overview of South Carolina Healthy Connections and South Carolina Healthy Connections Choices • Benefits of Joining a Health Plan • South Carolina Healthy Connections Choices Goals • Review the Health Plan Enrollment Process • Your Role in the Enrollment Process • Questions

3. Overview of SC Healthy Connections Choices • South Carolina Healthy Connections is South Carolina’s Medicaid program. • Currently there are just under one million members in SCHC (2/2013). • In SC Healthy Connections there are three Medicaid Eligibility Categories • Assignable (Managed Care Only) • Regular Medicaid (Fee-for-Service) • Non-Assignable (can choose to be in Managed Care or regular Medicaid) • SCHCC is the part of SCHC that helps Medicaid members in choosing a managed care health plan. • SCHCC serves Medicaid members in the Assignable and Non-Assignable Eligibility Categories. • 835k Medicaid members are eligible for Managed Care participation (7/2013) • 637k of those are enrolled in a Health Plan South Carolina Healthy Connections (SCHC) South Carolina Healthy Connections Choices (SCHCC)

4. Benefits of Health Plans • Some of the benefits of being in a health plan are: • Members have a medical home that provides accessible, comprehensive, family-centered care led by a primary care physician who knows them and their medical history. • The same core services as regular Medicaid plus they have access to additional and enhanced services. • Greater access to preventive and primary care services. • An ally to help them navigate the complex medical system providing better coordination of care, including finding the appropriate specialist when one is needed. • Improved understanding of how to access services and the appropriate use of the emergency room. • Access to a “live voice” 24 hours a day, 7 days a week. As a results members have: • Better health care and health outcomes • Greater investment in their own health care • Other Benefits • Reduced use of the emergency room for non-emergencies • Lower overall costs by reducing acute medical care and disease-related conditions

5. SC Healthy Connections Health Plans • Current Health Plans • MCOs • Absolute Total Care • BlueChoice Medicaid Health Plan • First Choice by Select Health • United Healthcare Community Plan • MHNs • Carolina Medical Homes • Palmetto Physician Connections • South Carolina Solutions • Health Plans after the Transition from MHNs to MCOs is Complete • Absolute Total Care 803-933-3638 • Advicare (formerly PPC) 888-781-4371 • BlueChoice Medicaid Health Plan 800-327-3183, ext. 25151 • First Choice by Select Health 843-569-4872 • South Carolina Solutions 888-793-0006 • WellCare(Effective 9/1/2013) 888-588-9842

6. We want to help members: Understand benefits of health plans and various plan options Choose a health plan that their doctor of choice accepts Enroll in a health plan by making the process easy Take an active role in their health care by Choosing their own Primary Care Provider (Medical Home) Getting preventive and primary health care Taking children to well-child visits SC Healthy Connections Choices Goals Goals of SCHCC • Increased voluntary enrollment rate (minimize auto assignment) • Decreased churn from one health plan to another • Greater satisfaction with health care services • Improved access to and use of preventive and primary care • Improved overall health outcomes • Improved efficiency and effectiveness of the program

7. Health Plan Enrollment Process • Initial Enrollment Period (at least 30 days) • An enrollment packet is mailed to all Assignable Medicaid members who are required to select a Managed Care Health Plan. • We send out reminders to encourage members to make their choice. • If members do not choose a plan by the end of the Initial Enrollment Period they will be automatically assigned to a plan. • An outreach packet is mailed to all Non-Assignable Medicaid members who can choose to select a Managed Care Health Plan or regular Medicaid. • If the member does not choose a health plan they remain in regular Medicaid. • Members in regular Medicaid, can switch to a health plan at any time.

8. Health Plan Enrollment Process • Once enrolled, members stay in their health plan for 12 months unless one of the following happens: • They become ineligible for Medicaid and/or Managed Care enrollment. • They requests transfer within the first 90 days • They make a written For Cause Transfer Request after the Choice Period • Annual Right to Change • Managed Care Health Plan members will receive an enrollment packet 30 to 60 days prior to their anniversary date for their Annual Right to Change. • At this time, they can remain in their current health plan or they can transfer to a different health plan. On the day after their Anniversary Date, they are transitioned to a 90 Day Annual Right to Change Period.

9. Health Plan Enrollment Process • Enrollment Process: Newborns • If the mother has Medicaid, her baby is automatically eligible. • In the MCO structure the baby is enrolled in the same health plan as her/his mother. • The baby enters the 90 Day Choice Period and her/his health plan can be changed one time within the first 90 days after birth. Primary Care Providers Members can change their PCP at any time by contacting the Member Services Department of their Health Plan.

10. Enrolling in a Health Plan • There are three ways a member can enroll in a health plan: • Online: www.SCchoices.com • Available in English and Spanish • Takes 5-10 minutes • Easy, step-by-step instructions • We also have a webinar explaining how to use the website for online enrollments. • Mail or fax the completed health plan selection form to SCHC • Mailing Address SC Healthy Connections Choices PO Box 8691 Columbia, SC 29202-9255 • Fax: 1-877-552-4672 • Call our Customer Service Center at 1-877-552-4642

11. Your Role in the Enrollment Process • Talk with your patients about the benefits of enrolling in a health plan, especially: • Newly eligible members • Non-Assignable Medicaid members who have chosen regular Medicaid • Mothers of newborns • Encourage Members to enroll in a plan • Process is easy • Online step-by-step instructions • Tell Members which plans you participate with • Use the “Prescription for Better Health Care” sheet • Put up SCHCC posters in your waiting room and other high traffic locations

12. Your Role in the Enrollment Process

13. Your Role in the Enrollment Process

14. Your Role in the Enrollment Process

15. Your Role in the Enrollment Process Maximizing Your Participation in Medicaid Managed Care • Consider participating with all the health plans available in your county as it makes your practice more flexible for patients. • When a Medicaid member calls for an appointment ask for their Medicaid ID # (MAID) and check the Medicaid WebTool to verify that they are in a health plan your practice participates with AND that you are their Primary Care Provider (PCP). • If you are a Pediatric practice, make sure totake the SCHCC “Prescription for Better Health” sheet to the hospital when doing newborn visits. • Consider providing opportunity for your patients to contact us while at your office via our website, www.scchoices.com. • Make use of the Medicaid Managed Care Educational Classes that the Provider Services Center makes available to your staff.You can find classes on the Provider Services website, www.MedicaidELearning.com.

16. Questions? • SCHCC Provider Outreach Team Tom Dalik Phone: 843-754-8322 Email: TDalik@mximus.com Allendale, Bamberg, Beaufort, Berkeley, Calhoun, Charleston, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Florence, Georgetown, Hampton, Horry, Jasper, Lee, Marion, Marlboro, Orangeburg, Sumter, and Williamsburg Counties Michelle LeMoine Phone: (803) 834-9956 Email: MLemoine@maximus.com Abbeville, Aiken, Anderson, Barnwell, Cherokee, Chester, Edgefield, Fairfield, Greenville, Greenwood, Kershaw, Lancaster, Laurens, Lexington, McCormick, Newberry, Oconee, Pickens, Richland, Saluda, Spartanburg, Union, and York Counties