Member Enrollment and Contractor Selection. Hoosier Care Connect applicants shall have the opportunity to select a MCE at the time of Medicaid application. The State’s Enrollment Broker will provide information and assistance with MCE selection to applicants. In accordance with 42 CFR 438.10(e), the State must provide potential members with general information about the basic features of managed care and information specific to each MCE operating in the potential member’s service area. At minimum, this information will include factors such as MCE service area, benefits covered, cost-sharing and network provider information. The State shall provide information on Hoosier Care Connect MCEs in a comparative chart-like format. Once available, the State also intends to include Contractor quality and performance indicators on materials distributed to facilitate MCE selection. The State reserves the right to develop a rating system advertising Contractor performance on areas such as consumer satisfaction, network access and quality improvement. To facilitate State development of these materials, the Contractor must comply with State, or its designee, requests for information needed to develop informational materials for potential members. Members who do not select an MCE at the time of application, and Supplemental Security Income (SSI) recipients who are not required to submit a Medicaid application, shall receive information from the State or its designee describing the process to select an MCE. Individuals who do not select a Contractor within sixty (60) calendar days of the enrollment mailing will be auto-assigned to a Contractor in accordance with an auto-enrollment algorithm to be designed by the State. The State reserves the right to revise the timing and strategies employed to facilitate member selection. Additional information on the auto-assignment process can be found in Contract Exhibit 4.
Member Enrollment and Contractor Selection. Healthy Indiana Plan applicants have an opportunity to select an MCE on their application. MCEs are expected to conduct marketing and outreach efforts to raise awareness of both the program and their product. The Enrollment Broker is available to assist members in choosing an MCE. Applicants who do not select an MCE on their application will be auto- assigned to an MCE according to the State’s auto-assignment methodology. The State reserves the right to amend the auto-assignment logic and may incorporate HEDIS or other quality indicators into the auto-assignment logic at a future date. Default auto-assignment will not be available to any MCE who does not successfully complete readiness review. Members that lose Medicaid eligibility for the HIP program for a period of three (3) months or less shall be automatically reenrolled with the Contractor, 42 CFR 438.56(g). Members will have the opportunity to change their MCE at the following intervals:
Member Enrollment and Contractor Selection. Hoosier Care Connect applicants shall have the opportunity to select an MCE at the time of Medicaid application. The State’s Enrollment Broker will provide information and assistance with MCE selection to applicants. Members that lose Medicaid eligibility in the Hoosier Care Connect program for a period of two (2) months or less shall be automatically reenrolled with the Contractor in accordance with 42 CFR 438.56(g). Members who do not select an MCE at the time of application, and Supplemental Security Income (SSI) recipients who are not required to submit a Medicaid application, shall receive information from the State or its designee describing the process to select an MCE. Individuals who do not select a Contractor within sixty (60) calendar days of the enrollment mailing will be auto-assigned to a Contractor in accordance with an auto-enrollment algorithm to be designed by the State. The State reserves the right to revise the timing and strategies employed to facilitate member selection. Additional information on the auto- assignment process can be found in Contract Exhibit 4 Responsibilities of the State. Members will have the opportunity to change their MCE at the following intervals: ▪ Within ninety (90) days of starting coverage ▪ Once per calendar year for any reason ▪ At any time using the just cause process (defined below) ▪ During the Medicare open enrollment window (mid-October-mid December) to be effective the following calendar year Any Medicaid member may change their MCE for Just Cause. The “for cause” reasons are described in 42 CFR 438.56(d)(2). Determination as to whether a member has met one of these reasons is solely the determination of the Enrollment Broker and FSSA. The reasons include, but not limited to, the following: ▪ Receiving poor quality of care; ▪ Failure to provide covered services; ▪ Failure of the Contractor to comply with established standards of medical care administration; ▪ Lack of access to providers experienced in dealing with the member’s health care needs; ▪ Significant language or cultural barriers; ▪ Corrective action levied against the Contractor by the office; ▪ Limited access to a primary care clinic or other health services within reasonable proximity to a member’s residence; ▪ A determination that another MCE’s formulary is more consistent with a new member’s existing health care needs; ▪ Lack of access to medically necessary services covered under the Contractor’s contract with the State; ▪ A service is...
