New Apple Health Managed Care Enrollment Policy

HCA Apple Health

PROVIDER ALERT

This is the second of three Provider Alerts on the Health Care Authority’s (the agency’s) future Washington Apple Health managed care enrollment policy. 

Beginning April 1, 2016, the agency will implement a new managed care enrollment policy that enrolls clients into an agency-contracted managed care organization (MCO) the same month that they are determined eligible as a new or renewing client. This new policy will eliminate a person being placed temporarily in fee-for-service while they are waiting to be enrolled in an MCO or reconnected with a prior MCO.  

  • New clients are those initially applying for benefits or those with changes in their existing eligibility program that consequently make them eligible for Apple Health Managed Care. 

  • Renewing clients are those who have been enrolled with an MCO but have had a break in enrollment and have subsequently renewed their eligibility.

This change will require providers to know when a client is successfully enrolled with an MCO.  MCOs will have retroactive authorization and notification policies in place.

Clients currently in fee-for-service or who are currently enrolled in an MCO are not affected by this change. Clients in fee-for-service who have a change in their eligibility program may be enrolled into Apple Health Managed Care depending on the program. In those cases, the new enrollment policy will apply.

Upcoming webinar

A webinar is scheduled for March 17, 2016. All interested stakeholders are invited to attend.  A recorded version of the webinar will be available by March 28, 2016. Instructions on how to participate in the webinar will be shared in a future notice.

Send in questions for webinar and Q&A document

The agency welcomes stakeholder questions. These questions will be used in the webinar and in a pre-implementation Q&A document. Send questions to hcamcprograms@hca.wa.gov.

The agency will send another notice to providers on March 15th regarding this new enrollment policy.