Medicaid to transition children into MississippiCAN managed care program
Mississippi routinely ranks as one of the poorest and unhealthiest states in the country. The state has a population of almost three million people, and more than a quarter of them are currently enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
Of those, the largest percentage of beneficiaries is children. Making matters worse, the United States has the highest health-care costs among industrialized nations in the world.
That’s why the Mississippi Division of Medicaid (DOM) is in the process of transitioning all Medicaid-eligible children in the state, with a few exceptions, into its managed-care program, Mississippi Coordinated Access Network (MississippiCAN), by the end of the summer.
“The three goals of MississippiCAN are to increase access to coverage, make sure we’re addressing cost-effectiveness and improve our quality of care,” said Sharon Jones, director of the Office of Coordinated Care at DOM.
Authorized by the Mississippi Legislature in 2011, MississippiCAN was established to create more efficiency and provide better access to health services, making Mississippi one of at least 26 other states to adopt a managed-care approach.
“One of the things it offers is case management,” Jones said. “For example, if there is a need for a beneficiary to receive assistance from a nurse then that opportunity is available at any time. They will have a 24-hour-a-day nurse phone line for any medical questions. Or if they need help setting up an appointment with a specialist or need to arrange for someone to help get medications, they will have case managers who can assist them.”
Ultimately, the goal is to produce improved health outcomes, she added.
The transition overview
Between May 1 and July 31, 2015, children up to the age of 19 are set to be transitioned from regular Medicaid to MississippiCAN, with the exception of those who are on Medicare, waivers, or reside in institutions. Starting in March, notifications have been sent to those beneficiary households that will likely be affected.
For those children being transitioned, this does not change their coverage and there is no loss of benefits. However, there are important differences that both beneficiaries and providers need to be aware of.
Unlike fee-for-service Medicaid, MississippiCAN is administered by two coordinated-care organizations. Upon receiving notices in the mail, beneficiaries must choose between Magnolia Health or UnitedHealthcare as their health plan.
MississippiCAN notices will be mailed to affected households from March through May and will include a letter and form to mail back in the provided pre-paid envelope. If the form is not completed and returned, the beneficiary is automatically assigned to one of the plans.
Those who are automatically assigned will have 90 days to switch plans. If they don’t, any changes will have to wait until the annual open enrollment period in October, for an effective date of January 1, similar to the process with any other insurance provider.
Likewise, health-care providers who serve children covered by Medicaid or CHIP should verify their patients’ eligibility and plan at each date of service and make sure they are in their provider network.
Mississippi Medicaid includes multiple programs
It is important to note Mississippi Medicaid health benefits encompasses multiple programs administered by DOM: Medicaid, MississippiCAN and CHIP. The agency encourages all providers to enroll in Medicaid, MississippiCAN with Magnolia Health, MississippiCAN with UnitedHealthcare, CHIP with Magnolia Health and CHIP with UnitedHealthcare.
“We are able to do this because the 2014 Legislature authorized us to include eligible children of all ages in our managed care program,” said Dr. David J. Dzielak, DOM executive director. “I think it’s the most promising route to keeping children in Mississippi healthy.”
The eligibility of each Mississippi Medicaid beneficiary is reviewed yearly. DOM works to let all beneficiaries know how important it is that the agency has their correct mailing address and contact information. If there has been a change throughout the year, beneficiaries might not receive important notifications which could impact their coverage. Beneficiaries need to contact their regional office caseworker to update their mailing address or contact information.
Whether you are a health-care provider or a Mississippi resident, you can learn all the information you need by calling toll-free 1-800-884-3222.