Medicaid Select FAQ's
- What is Medicaid Select?
Answer: Medicaid Select is a new managed care program for the aged, blind and disabled. Members will select a doctor to serve as their Primary Medical Provider (PMP). The PMP will be responsible to provide or coordinate most of the member’s care.
- Who is eligible for this program?
Answer: The following individuals will be required to enroll in Medicaid Select: aged, blind, the physically and mentally disabled, children receiving adoptive services, Medicare/Medicaid dual eligibles, MedWorks participants and individuals receiving Room and Board Assistance.
- Who will not be included in the program?
Answer: The following individuals are excluded from enrollment in Medicaid Select: breast and cervical cancer group, wards, foster children, persons in nursing homes, ICF/MRs and state operated facilities, persons on waivers, persons receiving hospice services and individuals for whom Medicaid pays only the Medicare premiums.
- Who is eligible to be a Primary Medical Provider (PMP) for this program?
Answer: Medicaid Select will have five standard PMP categories – Family Practice, General Practice, Internist, Pediatrician and OB/GYN. In addition, any physician specialist such as a cardiologist, psychiatrist, urologist, etc. may serve as a PMP.
- Will I need to complete another application or contract?
Answer: To serve as a PMP for Medicaid Select members, you must first be enrolled as an Indiana Health Coverage Programs (IHCP) provider. You will be required to sign a Medicaid Provider Agreement Addendum to provide services to Medicaid Select members and complete the appropriate paperwork to provide information about you and your location.
- What panel size is allowed?
Answer: Traditional PMP types (General Practitioners, Family Practitioners, Internists, Pediatricians and OB/GYNs) will be allowed panels of 50 - 1000. All specialist provider types will be allowed panels of 1 - 1000. A specialist may enroll as a PMP to see only one or two existing patients.
- Can this panel be combined with my Hoosier Healthwise Panel?
Answer: No, the panels will be maintained separately.
- Will there be any payment to serve as a PMP?
Answer: There will be an administrative fee payment of $4.00 per member/per month.
- How will I be reimbursed?
Answer: In addition to the administrative fee, PMPs will be reimbursed, as usual, based on the fee-for-service schedule. Claims will be submitted to the state’s fiscal agent, EDS, for processing and payment.
- What networks will be available?
Answer: The program will start with only a Primary Care Case Management (PCCM) system. OMPP intends to procure risk-based managed care organizations in the future.
- Will members be auto-assigned?
Answer: Yes, auto-assignment is a requirement for Medicaid managed care. However, members will have 60 days to select a PMP before they are auto-assigned. Members will only be auto-assigned to the five traditional PMP types or to a non-traditional PMP type (specialist) if they have previously been linked to that physician in the Medicaid Select program. Members may also be linked to a non-traditional PMP type (specialist) on a self-selection basis. Members will be able to change their PMP if they are auto-assigned or choose to see a different doctor than originally selected.
- May I continue to see members that I already see?
Answer: Only if you enroll as a PMP and the member selects you as their PMP or you receive a referral from the assigned PMP.
- What services are available to members?
Answer: Covered services will not change under the Medicaid Select program.
- Will all services require a referral?
Answer: Some services will be self-referral out and will not require PMP authorization. These services include: chiropractic, mental health, dental, family planning and pharmacy – the same services as those designated as self-referral under the Hoosier Healthwise program.
- Will this affect the specialists that members may see?
Answer: Members may continue to see specialists that provide services under IHCP. However, members enrolled in Medicaid Select will be required to obtain a referral from their PMP to see that specialist.
- Will this change available hospitals or pharmacies?
Answer: No, members will be able to access services at the same hospitals and fill their prescriptions at the same pharmacies.
- Will members continue to use the Hoosier Health Card?
Answer: Members will continue to have the same ID number and will use the same Hoosier Health Card.
- How will I provide referrals for these members?
Answer: You will be required to provide a referral by phone or in writing. This will also require the release of your Provider ID number and a special 2 digit certification code that will allow the rendering provider to bill and receive reimbursement. If you are a PCCM Provider in both Hoosier Healthwise and Medicaid Select, your certification code will be the same for both programs.
- Who do I call for prior authorizations?
Answer: That process is the same as it is today for individuals receiving Medicaid fee-for service coverage or Hoosier Healthwise coverage. For the PCCM network, Health Care Excel provides prior authorization. Please see the IHCP manual for instructions.
- Who do I call to get more information or to enroll?
Answer: You can contact a Provider Services Representative at AmeriChoice (formerly Lifemark) to get additional information or request enrollment forms. Please use the following chart to identify the Representative that can assist you.
| County | Contact |
|---|---|
| Adams, Allen, Blackford, DeKalb, Delaware, Elkhart, Grant, Hamilton, Hancock, Henry, Howard, Huntington, Jay, LaGrange, Madison, Marion, Noble, Randolph, Steuben, Tipton, Wabash, Wayne, Wells, Whitley | Jill Long (317) 655-3446 |
| Benton, Boone, Carroll, Cass, Clinton, Fountain, Fulton, Hendricks, Jasper, Kosciusko, Lake, LaPorte, Marshall, Miami, Montgomery, Newton, Parke, Porter, Pulaski, Putnam, St. Joseph, Starke, Tippecanoe, Vermillion, Warren, White | Arteaga Vinson (219) 738-2278 |
| Bartholomew, Brown, Clark, Dearborn, Decatur, Fayette, Floyd, Franklin, Harrison, Jackson, Jefferson, Jennings, Johnson, Morgan, Ohio, Ripley, Rush, Scott, Shelby, Switzerland, Union, Washington | Heather Hitchings (317) 655-3447 |
| Clay, Crawford, Daviess, Dubois, Gibson, Greene, Knox, Lawrence, Martin, Monroe, Orange, Owen, Perry, Pike, Posey, Spencer, Sullivan, Vanderburgh, Vigo, Warrick | Matt McGarry (317) 655-3445 |
