What is "Making Medicaid Better?"
The Department of Health and Hospitals (DHH) has proposed transitioning the Medicaid "delivery system" (the way services are provided) from the current fee-for-service system to BAYOU HEALTH. BAYOU HEALTH Plans are designed to provide better health outcomes for Louisiana residents and will include a stronger focus on managing chronic conditions and improving the quality of health care.
Will all Louisiana Medicaid and LaCHIP recipients enroll with a BAYOU HEALTH Plan?
Most, but not all Medicaid/LaCHIP Recipients will enroll with a BAYOU HEALTH Plan. Approximately 865,000 of Louisiana’s current 1.2 million recipients will be enrolled in a Health Plan. Some recipients will have the option to enroll in a Health Plan or keep their current Medicaid coverage, while some recipients are excluded from the BAYOU HEALTH Plan enrollment.
How will Medicaid/LaCHIP recipients select a BAYOU HEALTH Plan?
Recipients will select a BAYOU HEALTH Plan using any of the following methods to select one of the five participating Health Plans:
- Complete the hard copy Enrollment Packet, which includes the Choice Letter, and return by mail.
- Choose a Health Plan by telephone with or without a counselor TOLL FREE at 1-855-BAYOU-4U (1-855-229-6848).
- Choose a Health Plan via website: bayouhealth.com.
- Choose a Health Plan, with counselor support, at one of the scheduled local area outreach meetings.
What if Medicaid/LaCHIP recipients do not select a BAYOU HEALTH Plan?
Those recipients who do not select a Health Plan during their designated enrollment period will be auto-assigned to one of the five Health Plans.
Will this new BAYOU HEALTH Plan choice process replace the current processes used to determine Medicaid/LaCHIP eligibility, and complete Medicaid/LaCHIP enrollment?
No. The current Medicaid/LaCHIP eligibility and enrollment processes will remain in place. Recipients will choose a Health Plan after eligibility is determined and Medicaid/LaCHIP enrollment is completed.
Will recipients enrolled in a Health Plan still use the current Medicaid/LaCHIP card?
Recipients will have two cards. One will be the standard Louisiana Medicaid card. This card can be used by providers to verify (through the Medicaid fiscal intermediary) eligibility and the patient’s current Health Plan. The second card will be a Health Plan card – providers can use information on this card to contact the Health Plan with questions and problems.
How often can members change BAYOU HEALTH Plans?
Federal requirements allow members to change Health Plans (at will) during the first 90 days of their enrollment. After the 90-day period ends, patients will remain in their chosen Health Plan for another nine months. Enrollees will be allowed to change Health Plans as needed if they have a good reason. Enrollees can also change their plan during their open-enrollment period.
What is the BAYOU HEALTH packet I received in the mail?
The packet is your Bayou Health enrollment packet. If you received a packet you are either required to be enrolled in a health plan or you have the option to enroll in a Health Plan or stay in regular Medicaid. You should review the information contained in the packet carefully. If you do not choose a plan, one will be chosen for you.
If you received a yellow letter from Bayou Health you may opt out and stay in regular Medicaid by calling BAYOU HEALTH. If you do not contact BAYOU HEALTH to choose a Plan or stay in regular Medicaid, you will be assigned to a plan.
BAYOU HEALTH is a new way for most of Louisiana's Medicaid and LaCHIP recipients to receive health care services. The state has contracted with five different Health Plans from which individuals will choose.
What are some of the differences between Medicaid and Bayou Health?
Anyone eligible for BAYOU HEALTH must first be eligible for and enrolled in either Louisiana Medicaid or LaCHIP. In Medicaid, recipients were enrolled in CommunityCARE; and chose their Primary Care Provider. CommunityCARE is ending.
In BAYOU HEALTH, recipients will select one of five Health Plans to manage many of their Medicaid Health Services. Each of the Health Plans will offer special programs for their members who have asthma, diabetes, high-risk pregnancy, or other chronic health condition(s).
BAYOU HEALTH Plans may offer incentives to members for healthy behaviors and getting their recommended Health Screenings.
For adults, a major difference is all five Plans allow unlimited annual visits to the member's PCP.
Enrollees will be given the tools and encouragement they need to make healthier choices through BAYOU HEALTH. For residents enrolled in Medicaid, it will mean that you will have the opportunity to choose a Health Plan that will manage your care to focus on ensuring you get the preventive care and condition management you need.
Which plan is best?
No one Health Plan is best for everyone. This is a personal choice. The following chart compares some of the benefits offered the Bayou Health Plans
How do I know which plan to choose?
Here are Tips for choosing a Health Plan
a. If you have a doctor now: Make a list of the doctors, clinics, hospitals, and other providers you use now. Decide which ones are important to you and which ones you want to keep using. Find out which Health Plans the providers work with: Either Search for the providers to find out, or call the doctor, or call BAYOU HEALTH to ask.
b. If you don't have a doctor, choose a Plan first.
By comparing Plans, you can see which Plans offer services you want. All Plans offer the same basic benefits and health management programs, and some offer extra services as well. See which Plans have programs and services you want. Some examples of programs and services are: help managing your asthma or diabetes, rewards for staying healthy or getting checkups for your children, etc.
Will I lose some of my Medicaid benefits?
No, the Health Plans must provide the same services that the regular Medicaid Program covers and in the same "amount, duration, and, scope." The Plans can add benefits, but they cannot reduce them. Also, the Plans cannot charge co-pays unless regular Medicaid has a co-pay.
Do people with Private Health Insurance also have to pick a plan if Medicaid is their secondary?
Yes, unless the primary insurance is Medicare. The other recipients with a primary insurance other than Medicaid who are excluded from BAYOU HEALTH are those people enrolled in LaHIPP.
What if there isn’t a particular type specialist in my plan?
If you are a member of the two Shared Savings Plans, those Plans only include Primary Care Providers in their networks. The specialists members can see are those that are enrolled in Louisiana Medicaid who agree to accept them as a patient.
Prepaid Plans (Louisiana Healthcare Connections, LaCare, Amerigroup) are required to have all specialties in their provider network.
If my PCP & Specialist are in different plans what do I do?
You can only see physicians in the network in which they enroll. In some cases it may be necessary to change your PCP or specialist. It is your choice as to which doctor-patient relationship is most important for you to maintain.
When does the new plan take affect?
Recipients can start using their Health Plan's services on the first day of the month after they enroll (but not before Feb. 1 for recipients who live in GSA "A" - Regions 1 and 9; April 1 for recipients who live in GSA "B" - Regions 2, 3, and 4 and June 1 for recipients who live in GSA "C" - Regions 5,6,7, and 8.
Can a recipient choose a specialist as their PCP?
DHH's Contract with the Health Plans includes language that Health Plans can allow members to have a specialist as their PCP if the specialist is willing to perform the responsibilities of a PCP.
The member should contact member services for the Health Plan in which they are enrolled to request a specialist be assigned as their PCP, as this preference is not an option when enrolling through the Enrollment Center.
If a recipient goes to the ER, can they go to any hospital? If they need to be admitted, how would they be covered if their PCP/specialists doesn’t have admission rights at that hospital?
If someone is a member of a shared savings plan, all hospitals enrolled in Louisiana Medicaid can be reimbursed for services (non-emergency services subject to authorization and approval of the Plan).
If someone is a member of a prepaid plan, the Plan will pay out-of-network hospitals as well as network hospitals for emergency care (that meets the definition of an emergency - not just received at the ER). For non-emergencies (surgery for example) the hospital would need to be in-network unless the Plan has made special arrangements with the out-of-network hospital in order to be reimbursed.
Which Medicaid recipients will be excluded from participation in BAYOU HEALTH?
The populations that are excluded and will be in fee-for-service are
- Medicare Dual Eligibles (people who have both Medicare and Medicaid)
- Recipients who resident in a nursing facility, development center, or group home
- Recipients enrolled in a Medicaid Home and Community Based Waiver (NOW, Children's Choice, Supports, Adult Day Health Care, Residential Options, Elderly & Disabled Adult (new name Community) or PACE
- Recipients with limited eligibility periods of 3 months or less (Spend-down Medically Needy)
- Recipients receiving a single service (family planning, for example)
New Medicaid and LaCHIP enrollees will be excluded for any retroactive period, the month they are added to the eligibility file, and up to two months following, until they are enrolled in a BAYOU HEALTH Plan (which will always be the first day of a month, except for newborns).
Which Medicaid recipients will have the option to participate in BAYOU HEALTH or remain in Medicaid fee-for-service?
The populations that are voluntary and can choose to stay in regular Medicaid if they wish. If they don't opt out, they will be enrolled in a BAYOU HEALTH Plan.
- Children with Medicaid who are under age 19 and receive SSI or Family Opportunity Act because of a physical and/or mental disability.
- Foster children and children in other out of home placement.
- Native Americans who verify membership in a federally recognized tribe.
Children receiving services through OPH's Children's Special Health Services Clinics.
