If you qualify for Medicaid because you receive payments from either
Supplemental Security Income (SSI) or Temporary Cash Assistance (TCA), or as a result of
the Medicaid application process, you would likely be eligible for HealthChoice.
HealthChoice enrollment is administered by the DHMHs contracted Enrollment Broker. The Enrollment Broker handles outreach, education
and the enrollment of all eligible beneficiaries. If eligible for HealthChoice, you
will be sent materials regarding each MCO available in your county of residence so that
you can choose your own provider. The information packet that you receive will include:
- the names and addresses of participating providers;
- a schedule of the benefits offered, including any benefits
offered beyond the basic required package;
- a narrative description of the clinical expertise and
experience of the MCOs network for special needs populations;
- any forms necessary to select an MCO (including a health
risk assessment form);
- and the toll-free telephone number of the enrollment unit.
The Enrollment Broker is available to
assist you with any aspect of the enrollment process. You may enroll by mail, telephone,
and face-to-face meeting, if requested, or if medically necessary. For assistance in
making an application for HealthChoice, please contact the HealthChoice Enrollment Line at
(800) 977-7388. You may call Monday-Friday
7:00 a.m.- 7:00 p.m.
| How Soon Do I Have To Choose an MCO?
If you are an MCO
eligible beneficiary, you have 21 days to select an MCO from the day the Department mails
its eligibility notification and information packet to you. If the recipient is a child in
foster care or kinship, you have 60 days. If you do not pick an MCO, the State will pick
one for you. If you select a specific primary care provider when you choose your MCO, the
MCO is advised of this choice. Within 10 days of the effective date of enrollment, an MCO
will notify the enrollee of their Primary Care Provider (PCP) assignment.
If you are new to the Program, you
will be issued a fee-for-service Medical Assistance card to use until you are actually
enrolled in the MCO that you select and you receive your HealthChoice card with a new
member enrollment packet.
| What is the Health Risk Assessment Form?
The Health Risk Assessment is a series of questions which is used as
part of the HealthChoice enrollment process to identify people who may need immediate care
because of their health problems. The health risk assessment is completed at the time of
enrollment or within 5 days of enrollment. The information is transmitted to your MCO
within 5 business days. The MCO is responsible for ensuring that if you are a new enrollee
who needs special or immediate health care services, you receive them in a timely manner.
| Can I Change my MCO or be Disenrolled?
An MCO enrollee may elect to change MCOs
annually, on the anniversary date of initial enrollment in an MCO.
Enrollee-initiated Dis-Enrollment for Cause occurs:
- when an enrollee moves to another county;
- to maintain the family unit;
- when special provisions involving children in
State-supervised care or children in foster care need to be made; or
- to maintain continuity of care with their PCP when the
PCPs contract with the enrollees MCO, MCOs management group or its
subcontractor is terminating for reasons specified in COMAR 10.09.63.06.
Department-initiated Dis-Enrollment occurs when an
- becomes institutionalized for more than 30 successive days
in a LTC facility or an IMD institution;
- is institutionalized for more than a total of 60 days in a
calendar year in an IMD;
- is admitted to an ICF-MR;
- is determined eligible for the REM program;
- or loses Medicaid eligibility.
HealthChoice Enrollment Forms
Enrollment Form (Spanish)
-HealthChoice Enrollment Agreement
-HealthChoice Enrollment Agreement
Health Services Need Form
Health Services Need Form (Spanish Version)