The second phase of the New Hampshire’s statewide managed care program, sometimes referred to as “Medicaid Expansion,” began earlier this month and the Gail Garceau, general manager of one of the two Managed Care Organizations (MCOs) involved in the New Hampshire Health Protection Program (NHHPP) was reminded of its value during a recent encounter with a local craftsman.
The man’s arm was hastily bandaged and Garceau asked if he should have it looked it. The man said it would be fine. Garceau saw signs of infection and knew medical attention was needed. The man didn’t have health insurance. In fact, he’d never had health insurance.
“He has never been able to have health insurance,” Garceau said. “That’s the story here.”
NHHPP is available to eligible recipients ages 19 to 65 who are not currently eligible for Medicaid and whose incomes are between 133 percent to 138 percent of the Federal Poverty Level (approximately $16,000 a year for an individual and $32,000 for a family of four).
Enrollment began July 1 and coverage for recipients is expected to begin August 15. Well Sense is one of two MCOs that will begin providing coverage on September 1.
“Say someone is a Type 1 diabetic, which has a whole host of secondary effects,” Garceau said. “That person now can get into a program, have coverage and be able to be helped. There is someone there now to manage their care and help them for the very first time.”
The NHHPP is part of the state’s transition from fee-for-service Medicaid to managed care. Well Sense is one of two MCOs contracted by the state and the only not-for-profit. The Manchester-based company attained the state’s highest technical score when it was awarded its managed care contract.
The initial phase of this transition to MCOs began in September when the state’s Medicaid recipients – upwards of 130,000 people statewide – began enrolling with Well Sense.
The final phase will actually be a two-step process to transition long-term and mental health care recipients and begins in 2015.
The NHHPP differs from the other two phases because the 50,000 or so eligible recipients are new to the Medicaid system. Guiding them through the process to insure proper health care is a challenge for which Garceau says Well Sense is prepared.
To speak with Gail Garceau, General Manager for Well Sense, contact Kristin Hagerman at 603-647-8606 x209
Click here for more on the New Hampshire Health Protection Program.
WHO IS ELIGIBLE: Adults ages 19 to 65 who are not currently eligible for Medicaid and whose income are between 133 percent and 138 percent of the Federal Poverty Line. For a single person that has an annual income of in the range $15,856 to $16,105. For a household of four, that income is $32, 913.
HOW MANY ARE ELIGIBLE: The New Hampshire Department of Health and Human Services estimates upwards of 50,000 people are expected to be eligible for this plan.
ELIGIBILITY: Eligibility is determined by an applicant’ Modified Adjust Gross Income from their most recent income tax filings and how many people are in their household.
ENROLLMENT: The NHHPP, sometimes referred to as “Medicaid Expansion,” began enrolling members July 1. Members will have state provided fee-for-service coverage for two weeks starting August 15 before the two managed care organizations contracted with the state begin providing coverage on September 1.
HOW DO YOU ENROLL: Through the New Hampshire’s Electronic Application System (NH Easy) at: https://nheasy.nh.gov.
HOW IS THE NHHPP BEING FINANCED: The federal government will pay 100 percent of the coverage costs for this 16-month bridge program. Members will then be covered under the Affordable Care Act.