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Mandatory enrollment into Medicaid managed care for homeless and undomiciled New Yorkers

30 Aug, 2012

If you are homeless and have Straight Medicaid (also known as “regular” Medicaid), your Medicaid will be changing soon. You may have already received a letter from New York Medicaid CHOICE (NYMC) telling you that you have to enroll in a health plan. If you haven’t gotten this letter, you will get it sometime in the next four months Do not ignore this letter! It is important that you enroll in a plan that works for you so that you don’t lose access to the medical care you need.

You will still be able to get all the care you need from your new plan; the only thing that is changing is how you get your care. Medicaid Managed Care plans are required to cover everything Straight Medicaid covers.

Why? New York has one of the most generous and expensive Medicaid programs in the country. Asking everyone on Medicaid, including homeless families and individuals, to enroll in managed care plans is one of the strategies to save money.

Who: Most people in NYS on Medicaid are enrolled in a managed care plan. In the past, adults and families in shelter who asked to keep Straight Medicaid or who were reported as homeless by a City Shelter did not have to enroll in a plan. Now the law has changed and homeless people who have Straight Medicaid must choose a plan. Also, anyone who doesn’t have Medicaid right now and enrolls in Medicaid has to choose a plan right away.

When: People are being asked to enroll over a 6 month time frame. If you are homeless and in Straight Medicaid, you will probably get a letter between now and September if you haven’t already. If you’re not sure whether Medicaid has the right mailing address for you, this is a good time to check and make sure!

Time to Enroll: You will have 30 days to pick a plan which begins when you get the NYMC letter asking you to enroll. Don’t wait for your letter to do your homework.

What is the enrollment like? Depending on where you live, you will soon receive an enrollment packet from NYMC.   The packet will explain what Medicaid managed care is and what you should think about when choosing a plan. Workers from NYMC will be visiting shelters to talk about the change and to help you enroll.

What happens if I do not choose a plan? If you do not choose a plan, you will be assigned to a plan automatically. Don’t let this happen! You may not be able to stay with a doctor or clinic that you like. The biggest mistake you can make is ignoring the letter asking you to choose.

What happens if I miss or don’t get this letter? The State has assured us that they will not hold it against someone if the enrollment letter sent to them is returned to them as undeliverable or if they do not have a mailing address for someone. But, sometimes mail that goes to the wrong address doesn’t get sent back right away, so it’s possible that you can get auto-assigned even if you didn’t get a letter. If you get auto-assigned and did not get the mail, call us at Legal Aid and we will try and help you. Also, even if you don’t get enrolled because of a bad address, if Medicaid is unable to locate you, your case could eventually be closed, so it’s important to check that Medicaid has a good address for you.

How can I choose a plan? NYMC has been hired by the Department of Health to help you choose a plan and fill out all the paperwork to be enrolled in a plan. You need to do your research or homework before you call NYMC. Contact: 1-800-505-5678 TTY/TDD (800) 329-1541  Make a list of the doctors or clinics you see or the type of doctors that you need to see. The NYMC enrollment specialists can help you find a plan your doctors or clinic accepts. If you do not have a doctor that you see regularly, ask other people you know where they get their medical care or ask the NYMC folks to help you. If you are in a shelter and you want to be able to see a doctor in the shelter, ask at the shelter about which plans that doctor takes.

What if my family’s doctors are not all in the same plan? You do not need to be in the same plan as your family members. If you have a child who sees a specialist but you use your local clinic, it is not a problem to be in different plans. What you cannot do is have doctors in different plans for the same person. All of your doctors have to be in the network or list for the plan you choose.

Are there exceptions to being in a plan? Before last year, there were a number of reasons why a person with Medicaid could ask to be excused from joining a managed care plan. After April 2012, the following groups can ask to or are not allowed to choose a managed care plan:

  • folks with a Spend-Down,
  • folks who are covered under The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
  • foster care children,
  • folks with Medicaid and Medicare (also known as "Dual eligibles"(not for long - in 2014 this will change - see this article),
  • people with a chronic medical condition who are in active treatment with a specialist who does not accept any MMC plan may request an exemption for up to 6 months) and
  • people in nursing homes or receiving hospice services;
  • Native Americans
  • people with limited Medicaid eligibility (for example, Medicaid for the treatment of an emergency condition for undocumented immigrants, tuberculosis (T.B.) related services, Breast and Cervical Cancer);
  • See complete list of exemptions and exclusions here

Who can I call if I still need help? You can call the Legal Aid Society's Health Law Unit on Tuesday Mornings before 10:30 am at 212-577-3303 for 

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