Louisiana Medicaid or LaCHIP RecipientsBAYOU 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.
The new BAYOU HEALTH model includes two Medicaid managed care models, to be implemented simultaneously:
The prepaid model is a traditional risk-based, managed care model in which Health Plans establish networks of providers. The Health Plan receives a monthly fee for each member enrolled to provide core benefits and services, with prior authorizations and claims payment handled directly by the Health Plan. See the brochures for the three prepaid health plans:
The shared savings model is an enhanced primary care case management plan in which the Plan establishes a network of primary care providers and receives a monthly per-member fee to provide enhanced care management services. This gives network providers the opportunity to share in cost savings that result from coordinating care. In this model, the state will continue processing claims while the Plan will be responsible for prior authorizations and pre-processing of claims for core benefits and services in addition to primary care. See the brochures for the two shared savings health plans:
When it is time to make a choice about your or your family's health care, the Department of Health and Hospitals will notify you. Please be sure to keep us informed of any address or phone number changes.
The Department of Health and Hospitals is working to improve the coverage provided by Medicaid and LaCHIP to:
CHOoSING THE BEST HEALTH CARE FOR YOUR FAMILY
When it comes to making a decision about your family’s health, those decisions can be difficult. When it is time for you and your family to choose a new health care plan, we can help you make an informed choice. We will provide you one-on-one guidance from a choice counselor to help you pick the best health plan for your needs.
A choice counselor will work with you to find the health plan that best meets your family’s health priorities and preferences. Your counselor cannot work for a Health Plan—so his or her job is focused on helping you make the best decision.
Choice counselors will be familiar with every option available to you. They can answer any questions you may have about health plans and doctor options, from special language needs to what hours the clinics and doctor’s offices are open.
Once you make your choice, the counselor will connect you to your chosen BAYOU HEALTH Health Plan.
For Medicaid and LaCHIP enrollees who prefer using the Web, Louisiana will offer a Web site that will provide detailed Health Plan and doctor options. You can then make an informed decision and select your Health Plan either online or by calling a toll free number.
We will notify you by mail when we begin enrollment for new health plans.
Why you should make the choice:
* No one knows your health care needs better than you.
* It’s fast.
* It’s easy.
* People who make their own health care choices have better long-term health.
Important Information About BAYOU HEALTH for Medicaid Waiver Recipients
All Medicaid recipients enrolled in one of the Louisiana Medicaid waivers (New Opportunities or NOW, Children's Choice, Supports, Adult Day Care, Community -- formerly called Elderly and Disabled Adult or EDA) are not included in BAYOU HEALTH implementation. These recipients will not be enrolled in one of the five Health Plans.
Medicaid waiver services recipientswill continue to access their health services through the "regular" Louisiana Medicaid Program, just as they do now.
One key change is that waiver recipients age 21 and older will no longer be enrolled in CommunityCARE once BAYOU HEALTH goes live in the Regions in which they reside (February 1 for Regions 1 and 9; April 1 for Regions 2, 3 and 4; and June 1 for Regions 5, 6, 7 and 8.) Once BAYOU HEALTH takes effect, waiver recipients willno longer need a referral to see a specialist, unless the specialist requires one. DHH anticipates that the overwhelming majority of current Medicaid providers will continue providing health care services to recipients through the regular Medicaid program as well as to those who are enrolled in a Medicaid Health Plan through BAYOU HEALTH.You can contact yourprovider's office directly to find out whether he or she plans to continue seeing regular Medicaid patients once BAYOU HEALTH takes effect.
Some physicians have or will mail letters to their patients who have Medicaid coverage urging them to select a BAYOU HEALTH plan. The physicians do not have any way of identifying their Medicaid patients who are not included in BAYOU HEALTH and not required to enroll in a Health Plan, so waiver enrollees may receive one of these letters from a physician.
Recipients who are supposed to select a Health Plan as part of BAYOU HEALTH will receive an Enrollment Packet from the BAYOU HEALTH Enrollment Center. These packets are sent directly to the recipients, and contain information about each of the Health Plans. If you are a Medicaid waiver services recipient, you are not included in BAYOU HEALTH, will not receive an Enrollment Packet, and do not need to select a Health Plan. Please disregard any letters you receive from a physician urging you to pick a plan if you are a waiver services recipient.
Recipients between the ages of 3 and 21 who are on the Registry (waiting list) for the Children's Choice and/or NOW Medicaid waiver are not included in BAYOU HEALTH and will not receive an Enrollment Packet from the BAYOU HEALTH Enrollment Center.
Questions regarding BAYOU HEALTH implementation and Medicaid waiver recipients can be directed to bayouhealth@la.gov.
USEFUL INFORMATION
