Unless it is an emergency, the patient should be referred to the PCP the Health Plan has assigned him/her, if the patient knows who the PCP is. If not, the patient can be referred to the Health Plan’s Member Services toll-free number. The name of the patient's Health Plan can be determined by the eligibility verification system, which will be maintained for providers by Molina.
Providers do not directly link patients to a Health Plan. Medicaid and LaCHIP enrollees select their Health Plans and indicate their preferred provider or, if no choice is made, they are assigned to a Plan. During the first 90 days of enrollment, enrollees can change Plans for any reason. After the initial 90 days, the patients are locked into that Health Plan until the next open enrollment, unless they have good cause to change Plans. Patients wishing to change Health Plans should be referred to the Enrollment Center’s toll-free number, 1-855-BAYOU-4U. Patients wishing to change doctors should be referred to their Health Plan’s Member Services toll free number.
Medicare Dual eligibles are excluded from Health Plan enrollment. For members with commercial insurance as the primary payer, Medicaid via the Bayou Health Plan will be the payer of last resort. Those members enrolled in LaHIPP (DHH is paying the employee’s share of the premium for employer sponsored insurance) are excluded.
Yes. Each patient has both a Medicaid card to obtain carved out services and a second member ID card issued by the Health Plan. The contract requires that the Health Plan issued ID card include the name of the PCP, the PCP’s address and phone number, and numbers for the Plans Member services.
Each Health Plan is contractually required to provide members with health management for three specific chronic health conditions (diabetes, asthma and congestive heart failure) as well as care management for pregnant women to improve birth outcomes. In addition, some of the Plans are also offering programs for hypertension, COPD, sickle cell, or HIV. Prepaid Plans can offer Expanded Benefits, which are services beyond what is covered under the Louisiana Medicaid State Plan. Examples are hypoallergenic bedding for members with asthma, and vision screenings and dental cleanings for adults over the age of 21.
All five Plans can offer members incentives for healthy behaviors. Examples of actual programs are a $20 gift card for getting a health assessment within 90 days of enrollment, up to $65 in gift cards for keeping prenatal visits and post partum visits.
More information can be found on the Health Plan Comparison Chart, each Plan's brochure, and directly from the Plan.
As improving quality is a key objective, DHH is requiring that Health Plans work with their network PCPs to attain formal recognition as a primary care medical home (PCMH), with the percentage increasing each year. The alternative to urgent care clinics in DHH's experience is often the hospital emergency room. To the extent that a Health Plan utilizes urgent care clinics, DHH's expectation would be that the care is coordinated with the PCP (e.g., payment to the urgent care facility contingent on their providing the clinical records of the visit to the PCP and or the Health Plan).
Members contacting the Enrollment Center (or subsequently the Health Plan) to indicate preferred PCP are not restricted to only PCPs who practice in the GSA in which they reside. If their preferred PCP is in the Health Plan's Directory, they can request linkage to the PCP.
DHH's Contract with the Health Plans includes language that Health Plans can allow members to have a specialist as their PCP if the specialist is willing to perform the responsibilities of a PCP.
The member should contact member services for the Health Plan in which they are enrolled to request a specialist be assigned as their PCP, as this preference is not an option when enrolling through the Enrollment Center.
The populations that are excluded and will be in fee-for-service are
Medicare Dual Eligibles (people who have both Medicare and Medicaid)
Recipients who resident in a nursing facility, development center, or group home
Recipients enrolled in a Medicaid Home and Community Based Waiver (NOW, Children's Choice, Supports, Adult Day Health Care, Residential Options, Elderly & Disabled Adult (new name Community) or PACE
Recipients with limited eligibility periods of 3 months or less (Spend-down Medically Needy)
Recipients receiving a single service (family planning, for example)
New Medicaid and LaCHIP enrollees will be excluded for any retroactive period, the month they are added to the eligibility file, and up to two months following, until they are enrolled in a Bayou Health Plan (which will always be the first day of a month, except for newborns).
Providers are allowed to tell their patients which Health Plans they have enrolled with, so their patients can choose a Health Plan with that provider in it, if they wish. But, providers must disclose all Health Plans of which they are a member, and providers cannot steer patients toward any particular Health Plan. Also, any signage or other forms of marketing in a provider’s office must be equal. If a provider has a large sign for one Health Plan, he or she must have signs of the same size for the other plans in which he or she participates.
A Medicaid number cannot be assigned to a baby until after birth. The baby will be automatically assigned to the mother's health plan. The mother will have an opportunity to change the baby's plan, if she wishes.
Mailing Address: Department of Health & Hospitals | P. O. Box 629 | Baton Rouge, LA 70821-0629 Physical Address: 628 N. 4th Street | Baton Rouge, LA 70802 | PHONE: 225.342.9500 | FAX: 225.342.5568 | DisclaimerCustodian of Records For Bayou Health1-855-BAYOU4U (1-855-229-6848 )