New Apple Health Managed Care Enrollment Policy

HCA Apple Health

PROVIDER ALERT

This is the last 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 new or renewing clients into an agency-contracted managed care organization (MCO) the same month that they are determined eligible for managed care enrollment. 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 and procedures 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 are renewing their eligibility and 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 – March 17, 2016

Please join us for our webinar, scheduled for March 17, 2016 from 2:00-3:00 pm.
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 are located here.

Provider Frequently Asked Questions (FAQ)

A Provider FAQ will be available this week. The agency will update the FAQ with new questions as they are received.