Primary Adult Care (PAC): An Overview

1. Primary Adult Care (PAC):An Overview Alice Middleton Planning Administration Department of Health and Mental Hygiene March 27, 2009

2. What is PAC? • The Primary Adult Care (PAC) Program began in July 2006 • A Medicaid program providing a limited benefit package for adults, including primary care, pharmacy, and outpatient health benefits to those over age 21 • Eligible individuals must have incomes below 116% of the Federal Poverty Level (FPL) • Administered through several participating Managed Care Organizations (MCOs)

3. Who is eligible for PAC? • Adults without dependent children between 21 and 64 years old who are: • Maryland residents, • Not on Medicare, and • U.S. Citizens • Previous income requirements were 116% FPL and $4,000 in assets for an individual and 100% FPL and $6,000 in assets for households of more than one • April 1, 2009 - regulations will change to exclude asset requirements and income requirements will be 116% FPL for all family sizes • Enrollees do not need to have a medical disability to qualify

4. PAC Eligibility Income Limits Person(s)Monthly Income 1 $1,046 2 $1,408 3 $1,769 4 $2,131 5 $2,493 6 $2,854 7 $3,216 8 $3,577 • Beginning April 1, 2009, monthly incomes limits will be 116% FPL for all family sizes, and asset standards will be eliminated

5. Medical Assistance Program Coverage(Effective 02/01/09) Pregnant Women 300 300 Employed Individuals with Disabilities Program (EID) MCHP Premium 250 ~ 225 200 Home and Community-Based Waivers (only for very specific populations) 185 MCHP 133 135 Percent Federal Poverty Level 116 SLMB – Premium only. Medicaid for Parents and Caretaker Relatives & PAC Program 100 100 QMB-Premium & Cost Sharing Medicaid 40 Dual Eligible Medicare & Medicaid PW 0 1 6 19 Age 19 to 64 Age 65 and Over+ Poverty Level: 1 person = $10,830 2 persons =$14,570 4 persons = $22,050 As of 1/23/2009 Note: This chart is for illustrative purposes only. Each coverage group has specific eligibility and some asset requirements, which are not shown. 5

6. Applying for PAC • How to apply: • Applications are available for download at http://dhmh.state.md.us/mma/pac/ , or • Call 1-800-226-2142 to have an application sent to you • Send applications to the PAC office: Primary Adult Care P.O. Box 386 Baltimore, MD 21203-0386 • A decision regarding the application will be made within 45 days

7. Which health services are covered? • PAC Covers the following health services: • Free primary health care • Small pharmacy co-payment • Up to $2.50 for generic drugs and $7.50 for brand name drugs • Free in-office mental health services through a counselor or psychiatrist • Limited lab and diagnostic services • Some benefits are carved out and covered fee for service, including Specialty Mental Health System services and HIV/AIDS drugs

8. How are services provided? • Managed Care Organizations receive a monthly capitation payment for each enrollee • 4 MCOs currently provide services to PAC enrollees • Maryland Physicians Care • Priority Partners • United • Jai (Baltimore City & County only) • Beginning May 1, 2009, Amerigroup will be a participating PAC MCO • To search participating providers by MCO online: https://encrypt.emdhealthchoice.org/searchable/main.action

9. Can I Change My MCO? • Can enrollees change MCOs or be Disenrolled? • An MCO enrollee may elect to change MCOs annually, on the anniversary date of initial enrollment in an MCO. • An enrollee may also change MCOs “for cause” if one of the following occurs: • an enrollee moves to another county; • to maintain the family unit; • when special provisions involving children in State-supervised care or children in foster care need to be made; or • to maintain continuity of care with their PCP when the PCP’s contract with the enrollee’s MCO, MCO’s management group or it’s subcontractor is terminating for certain reasons

10. Enrollee Responsibilities • PAC enrollees are required to report any changes in status immediately, including income, household size, etc. • Eligibility must be determined annually • PAC enrollees must complete and return a redetermination packet to the PAC office

11. PAC Enrollment • Total of 25,858 PAC enrollees, as of December 2008 • In Frederick County, 571 enrollees • Other Counties • Allegany: 664 • Carroll: 200 • Garrett: 204 • Howard: 375 • Montgomery: 1,278 • Washington: 540

12. How do Providers enroll with a MCO? • Call each MCO to enroll and participate: • Maryland Physicians Care • 800-953-8854 ext. 3111 • Priority Partners • 800-654-9728 (Option 4 = Provider Services) • United • 1-877-842-3210 • Jai • 410-433-2200 (Attn Michael Melvin) • Amerigroup (beginning May 1, 2009) • 800-454-3730 (Option 2 = Provider Services)

13. PAC Expansion of Services • PAC was scheduled to expand services to enrollees in July 2009, but this has been delayed due to budget limitations • Tentative Schedule for PAC Expansion • July 2010 – specialty and ER services • July 2011 – outpatient services • July 2012 – inpatient services • July 2013 – full Medicaid benefits

14. Important Contacts • To request a PAC application or for questions • 1-800-226-2142 • Enrollment Help Line • 1-866-676-5880 • MCOs • Maryland Physicians Care – 1-866-651-7835 • Priority Partners – 1-800-654-9728 • UnitedHealthcare – 1-800-318-8821 • Jai Medical Systems – 1-888-524-1999

15. Additional Information http://www.dhmh.state.md.us/mma/pac Alice Middleton Planning Administration Medical Care Programs Maryland Department of Health and Mental Hygiene amiddleton@dhmh.state.md.us 410.767.3419