How To Choose An Mco For Medicaid Maryland

Unitedhealthcare Senior Care Options Plan

Medicaid Managed Care Organization Learning Hub – Medicaid MCO Overview and Financing Presentation

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Over Time The Expansion Of Risk

States incorporate quality metrics into the ongoing monitoring of their programs, including linking financial incentives like performance bonuses or penalties, capitation withholds, or value-based state-directed payments to quality measures. In a 2021 KFF annual survey of Medicaid directors, over three-quarters of responding MCO states reported using at least one financial incentive to promote quality of care as of July 2021 . Financial incentive performance areas most frequently targeted by MCO states include behavioral health, chronic disease management, and perinatal/birth outcomes. These focus areas are not surprising given the chronic physical health and behavioral health needs of the Medicaid population, as well as the significant share of the nations births funded by Medicaid. A number of states reported making changes to their quality incentive programs due to the COVID-19 pandemic, as the pandemic has likely affected clinical practices and timely reporting of quality data. Despite activity in this area, detailed performance information at the plan-level is not frequently made publicly available by state Medicaid agencies, limiting transparency and the ability of Medicaid beneficiaries to assess how plans are performing on key indicators related to access, quality, etc.

Apply For Maryland Medicaid

The agencys mobile app on Apple or Android

After applying for help, you may need to verify your information such as your income, citizenship, Social Security number, or other coverage.

You may also need to print, sign and upload an affidavit to prove your information. Learn more about the types of documents you can use to verify your information and the affidavits you may need to qualify for Medicaid.

Once you apply and qualify for Medicaid, youll choose a doctor and MCO. Search the MCO provider directory to find a doctor.

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My Benefits Have Ended How Do I Renew Them

Heres how you can renew your health benefits:

Online at Create a user account, then go to Start New Application from the Quick Links on the Account Home page
Use the Maryland Health Connection mobile app
Call the Maryland Health Connection Call Center at

In person at your local health department or local Department of Social Services.

Other Health Insurance Options

Housing Authority of Prince Georges County in Maryland

If you dont qualify for Medicaid, there are other low-cost options available. Find health insurance that fits your familys budget and needs. You can get more information from your local health department or Department of Social Services.

You can also dial 2-1-1 to find the best resource for your situation.

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Top Rated Health Insurance Plans In Maryland

Each year NCQA rates more than 1,000 health insurance plans in all 50 states. Below is information on the top health insurance plans in Maryland.

Health insurance ratings from the National Committee for Quality Assurance rate health plans on a scale from 0 to 5, based on clinical quality, member satisfaction and Accreditation survey results.

6 Maryland plans earned a top rating of 4.5 or 5.0.
That means 16 percent of Maryland rated plans earned a top rating, #8 among all states.

Dont see your plan listed here? See all NCQA Health Insurance Plan Ratings.

Private/Commercial

What About Prior Authorizations

MPC members have access to an online web portal that allows access to view claims and prior authorizations, all in real-time. Maryland Physicians Care extends the full benefits of the Maryland Department of Healths HealthChoice program . MPC also offers additional benefits for adult vision and eye care and adult dental services not covered by the HealthChoice Program , along with many other benefits.

As Of July 2019 More Than Two

As of , 53.7 million Medicaid enrollees received their care through risk-based MCOs. Twenty-five MCO states covered more than 75% of Medicaid beneficiaries in MCOs .

Although 2019 data are the most current national data available on Medicaid MCO enrollment, enrollment in Medicaid overall has grown substantially since the start of the coronavirus pandemic in February 2020. This enrollment growth reflects both changes in the economy as well as provisions in the Families First Coronavirus Response Act that require states to ensure continuous coverage for current Medicaid enrollees to access a temporary increase in the Medicaid match rate during the PHE period. KFF analysis of more recent MCO enrollment data, from the subset of states that make these data available, shows growth in Medicaid MCO enrollment during the pandemic tracks overall Medicaid enrollment trends. When the continuous coverage requirements end, states will begin processing redeterminations and renewals and millions of people could lose Medicaid coverage if they are no longer eligible or face administrative barriers during the process despite remaining eligible. CMS has released guidance and strategies for states to help maintain coverage of eligible individuals after the end of continuous enrollment requirements, including guidance outlining how managed care plans can support states in promoting continuity of coverage.

How Do I Enroll In Medicaid In Maryland

How to renew your Medicaid with Maryland Physicians Care

In general, you can enroll for Maryland Medicaid online or in person. See below for specifics, which vary for different eligible groups.

If you are under 65 and dont have Medicare, apply online through SAIL or at www.MarylandHealthConnection.gov.

Seniors and people who have Medicare can apply for Medicaid using this website.
Get an application or apply in person at a local health department or social services office. Call 1-800-456-8900 and have an application mailed to you.
For help applying, call 1-855-642-8572

People who are pregnant are encouraged to apply at a local health department. Call 1-800-456-8900 for information.

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How Do I Enroll In Or Change My Medicaid Managed Care Organization

If you are enrolling in Medicaid for the first time or if the state automatically assigned you to an MCO, you may change your MCO one time within 90 days. You may change MCOs for any reason within the first 90 days of initial enrollment.

If you do not change within 90 days, you must remain with your MCO for 12 months before you can change again. You can change your Medicaid MCO once a year.

You also may change MCOs in select circumstances, such as combining all household members or children into the same MCO, or if you moved and your current MCO does not provide service in the county where you now live.

Finding the Right Plan with MHC

If I’m enrolled in a plan this year, do I need to shop again for next year?

In Recent Years Many States Have Moved To Carve In Behavioral Health Services Pharmacy Benefits And Long

Although MCOs provide comprehensive services to beneficiaries, states may carve specific services out of MCO contracts to fee-for-service systems or limited benefit plans. Services frequently carved out include behavioral health, pharmacy, dental, and long-term services and supports . However, there has been significant movement across states to carve these services in to MCO contracts. While the vast majority of states that contract with MCOs report that the pharmacy benefit is carved in to managed care , five states report that pharmacy benefits are carved out of MCO contracts as of July 2021 . Three states report plans to carve out pharmacy from MCO contracts in FY 2022 or later .

What Is A Managed Care Organization

A Managed Care Organization is a health plan with a group of doctors and other providers who work together to provide your care as a member.

Your Maryland Medicaid MCO provides much more than seeing a doctor when you are ill. Your Medicaid MCO also offers:

Well care for you, your children, pregnant women, and babies

Skilled Nursing ServicesHelp to choose doctors
Information about how to get rides to doctor visitsInformation to help you learn about specific health topics
Answers to your medical questions

Assistance with other questions

Does Anyone In Your Family Have Special Needs

If you or a family member is in a special needs population, you can receive additional services to receive the right type of care.

MPC has a Special Needs Coordinator on staff to provide education on conditions and support services. A case manager may also be assigned when you select Maryland Physicians Care. This person will help develop a patient-centered plan that addresses the treatment services needed.

If Im Enrolled In Medicaid Which Plans Can I Choose

In Marylands HealthChoice program, health care services are provided through managed health care organizations, called MCOs.

If you do not pick an MCO within 28 days, you will be automatically assigned to one.

Ask your doctors which MCOs they accept, or use the MCO provider search tool.

Finding the Right Plan with MHC

If I’m enrolled in a plan this year, do I need to shop again for next year?

Referrals Are Required For Most Specialty Services

The links below provide more information on our referral requirements including how to submit online referrals.

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

Promote quality of care

Strengthen efforts to reform the delivery of care to individuals covered under Medicaid and Childrens Health Insurance Plans
Strengthen program integrity by improving accountability and transparency
Enhance policies related to program integrity

With the Medicaid Managed Care Rule, CMS updated the type of information managed care organizations are required to include in their care provider directories.

PCP Membership Reports

The best way for primary care providers to view and export the full member roster is using the CommunityCare tool, which allows you to:

Identify Medicaid recipients who need to have their Medicaid recertification completed and approved by the State Agency in order to remain eligible to receive Medicaid benefits

See a complete list of all members, or just members added in the last 30 days
Export the roster to Excel
View most Medicaid and Medicare SNP members plans of care and health assessments

Enter plan notes and view notes history
Obtain HEDIS information for your member population
Access information about members admitted to or discharged from an inpatient facility

Access information about members seen in an Emergency Department

Reporting Fraud, Waste or Abuse to Us

UnitedHealthcare Dual Complete® Special Needs Plan

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Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Within Broad Federal And State Rules Plans Often Have Discretion In How To Ensure Access To Care For Enrollees And How To Pay Providers

Maryland Physicians Care (MPC) | Benefits

To help ensure participation, many states require minimum provider rates in their contracts with MCOs that may be tied to fee-for-service rates. In a 2021 KFF annual survey of Medicaid directors, about two-thirds of responding states with MCO and/or limited benefit contracts reported a minimum fee schedule that sets a reimbursement floor for one or more specified provider types . Additionally, over half of responding states that contract with managed care plans reported a uniform dollar or percentage increase payment requirement in place as of July 2021, most commonly for hospitals. In response to the COVID-19 pandemic, states have options and flexibilities under existing managed care rules to direct/bolster payments to Medicaid providers and to preserve access to care for enrollees. More than one-third of responding MCO states implemented new provider payment and/or pass-through requirements on MCOs in response to the COVID-19 emergency in FY 2021.

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In Fy 2020 Payments To Comprehensive Risk

In FY 2020, state and federal spending on Medicaid services totaled over $662 billion. Payments made to MCOs accounted for about 49% of total Medicaid spending , an increase of almost three percentage points from the previous fiscal year. The share of Medicaid spending on MCOs varies by state, but over three-quarters of MCO states directed at least 40% of total Medicaid dollars to payments to MCOs . The MCO share of spending ranged from a low of about 2% in Colorado to 88% in Kansas. State-to-state variation reflects many factors, including the proportion of the state Medicaid population enrolled in MCOs, the health profile of the Medicaid population, whether high-risk/high-cost beneficiaries are included in or excluded from MCO enrollment, and whether or not long-term services and supports are included in MCO contracts. As states expand Medicaid managed care to include higher-need, higher-cost beneficiaries, expensive long-term services and supports, and adults newly eligible for Medicaid under the ACA, the share of Medicaid dollars going to MCOs will continue to increase.

Legislation Introduced In 2022 To Add Adult Dental Coverage To Maryland Medicaid

Since the early 1990s, Maryland has not provided coverage for adult dental care through its Medicaid program . Legislation has been introduced in 2022 that would add an adult dental benefit to the states Medicaid program as of 2023.

Children with Medicaid already have coverage for dental care in Maryland, as is the case nationwide. And Maryland did implement a program in 2019 to provide dental benefits to Maryland residents age 21-64 who are dually enrolled in Medicaid and Medicare . But the state estimated that fewer than 39,000 people would be eligible for benefits under this program. If HB6/SB150 were to be enacted, a far larger population of low-income residents would gain access to dental care.

The legislative session in Maryland ends April 11, 2022, and the crossover deadline is March 21. Both bills were still in committee in their originating chambers as of early March.

Prior Authorization And Notification Resources

Hours of Operation: 8:00 am – 6:00 pm ESTProvider Call Center: 877-842-3210Member Services Number: 800-318-8821 , Monday-Friday, 8:00 am to 7:00 pm EST

Mailing Address:

Salt Lake City, UT 84131

Utilization Denial & Appeals Department Mailing Address:UM Denial & Appeals DepartmentSalt Lake City, UT 84131

Claims Appeals Mailing Address:Salt Lake City, UT 84131

Credentialing Updates:

Facility/Hospital-Based Providers, Group/Practice Providers and Individually-Contracted Clinicians

The state-specific requirements and process on how to join the UnitedHealthcare Community Plan network is found in the UnitedHealthcare Community Plan Care Provider Manuals.

Visit UHCCommunityPlan.com/MD for current member plan information including provider directories, dental plans, vision plans and more.

Plan information is available for:

Medicaid Coverage And Qualifications

Most individuals enrolled in Medicaid have access to a Managed Care Organization to cover doctor visits, pregnancy care, prescription drugs and hospital and emergency services. Learn more about other services covered by Medicaid.

The income qualifications may vary each year. Check the latest guidelines for your situation.

How Does Medicaid Provide Assistance To Medicare Beneficiaries In Maryland

Many people with Medicare receive help through Medicaid with Medicare premium costs, prescription drug expenses, and expenses that Medicare doesnt cover such as long-term care.

Our guide to financial resources for Medicare enrollees in Maryland provides an overview of those programs, including Medicare Savings Programs, nursing home benefits, and income guidelines for assistance.

Children And Adults Are More Likely To Be Enrolled In Mcos Than Seniors Or Persons With Disabilities However States Are Increasingly Including Beneficiaries With Complex Needs In Mcos

As of July 2021, 37 MCO states reported covering 75% or more of all children through MCOs . Of the 38 states that had implemented the ACA Medicaid expansion as of July 2021, 31 states were using MCOs to cover newly eligible adults and the large majority of these states covered more than 75% of beneficiaries in this group through MCOs. Thirty-four MCO states reported covering 75% or more of low-income adults in pre-ACA expansion groups through MCOs. In contrast, only 19 MCO states reported coverage of 75% or more of seniors and people with disabilities. Although this group is still less likely to be enrolled in MCOs than children and adults, over time, states have been moving to include seniors and people with disabilities in MCOs.

Who Is Eligible For Medicaid In Maryland

Marylands Medicaid program, which is also called Medical Assistance, has higher income limits than many other states when it comes to Medicaid eligibility for children and people who are pregnant. Individuals with family income up to the following levels are eligible for Medicaid :

322% of the federal poverty level for children ages 0-18
264% of FPL for someone who is pregnant
138% of FPL for parents and other adults

Aged, blind, and disabled individuals may also qualify for Medicaid see the income and asset guidelines in the FAQs of the Maryland Department of Health and Mental Hygiene website.
Maryland helps pay for long-term care for qualifying individuals see the eligibility criteria and application information.

For ease of reference, the Maryland Connector website shows the monthly income limits in terms of dollar amounts rather than percentage of FPL.