10 Things to Know about Heritage Health — New Medicaid Delivery System Begins Jan. 1
Note to Editors: Included in the following link is helpful information for you about Nebraska Medicaid and Long-Term Care’s Heritage Health managed care program to help answer your questions and provide contacts for the 230,000 participating Nebraskans.
Lincoln –Nebraska’s new Medicaid managed care program Heritage Health begins on Jan. 1, and will cover over 230,000 Nebraska Medicaid clients. There are ten important points for clients, providers, and stakeholders to remember during this transition, according to Calder Lynch, director of the Division of Medicaid and Long-Term Care in the Department of Health and Human Services.
- Managed Care Experience. While Heritage Health is the new name of our program, managed care is not new for Nebraska Medicaid, which has administered managed care programs for some services and populations for the past twenty years. Heritage Health will better serve Medicaid clients by combining physical health, behavioral health and pharmacy services into a single comprehensive and coordinated system for Nebraska’s Medicaid and CHIP clients. However, Heritage Health does not include long-term care services like nursing home or in-home supports, which are not changing as part of Heritage Health. A general fact sheet on Heritage Health can be found here.
- Three Plans Available. There are three health plans that are included in Heritage Health that are available to Medicaid members across the state. A health plan comparison chart is available for download here. The three plans include:
- Nebraska Total Care
- UnitedHealthcare Community plan of Nebraska
- WellCare of Nebraska
- Plans Now Assigned/Chosen. All Medicaid members who will be enrolled in Heritage Health (which include nearly all Nebraska Medicaid members) have by now either chosen their health plan or have been assigned to one. All members should have received or will receive their health plan assignment letter and member ID cards prior to Jan. 1. The Heritage Health member guidebook is available here.
- May Switch Plans. If members want to switch to a different health plan, they have 90 days after Jan. 1 to do so. Otherwise, members will have the opportunity to change plans during an annual open enrollment period. Questions regarding health plan and enrollment and requests to change plans should be directed to the enrollment broker, which is available:
- Online at www.neheritagehealth.com
- By phone: 1-888-255-2605 (7am-7pm CT Monday-Friday).
- TTY/TTD users call 711
- More Included in Plan. Heritage Health includes about 41,000 Medicaid enrollees previously excluded from the physical health managed care program (have never chosen a health plan before) that will now receive the benefits of care coordination through Heritage Health. A general fact sheet for members new to managed care is available here, while one focused specifically on members who are enrolled in both Medicare and Medicaid (referred to as dual-eligibles) can be found here for members and here for providers.
- Value to Taxpayers. As we bring more services and populations into managed care, it creates better budget predictability resulting in a greater value to Nebraska taxpayers. Heritage Health is an important component in the state’s strategy to help ensure Medicaid cost growth remains sustainable.
- Coordination with Providers/Members. The Heritage Health plans are required to work with providers and members to ensure that members do not experience unnecessary disruptions to care during this transition. A provider bulletin describing the state’s continuity of care policy is available here.
- Plans Are Ready. DHHS has completed extensive readiness reviews of each of the Heritage Health plans, including desk reviews and onsite evaluations of electronic and claims payment systems, provider networks, staff training, and policies. The state has now signed off on each plan’s readiness to begin operations on Jan. 1.
- Outreach to Continue. The state has and will continue to conduct aggressive communication and outreach regarding the changes coming with Heritage Health. As an example of past efforts:
- Medicaid leadership hosted town hall meetings, provider meetings and webinars, reaching nearly 2,500 people.
- Heritage Health plans hosted 14 provider orientation sessions with a combined attendance of over 2,000 individuals.
- Medicaid’s enrollment broker, AHS, connected with nearly 2,300 individuals during member and stakeholder outreach efforts.
- Medicaid convened three primary advisory groups to guide the implementation and operations of Heritage Health, which collectively include 144 members who have met 15 times since this spring.
- Over 230,000 Medicaid clients received letters, fact sheets and Heritage Health member handbooks through the mail.
- Ensuring Smooth Transition. DHHS is committed to ensuring a smooth transition for members and will be hosting open conference calls targeted to specific provider and stakeholder groups daily for at least the first two weeks of January as part of its “rapid response” plan.
“Our goal for Heritage Health is simple: improved health outcomes for our members,” Lynch said. “Our ability to achieve that goal requires great care and planning for a successful transition. I want thank the DHHS staff, the health plans, our providers, members, and stakeholders for participating in this readiness phase and I look forward to a successful program launch.”