Managed Care Plan Participants Frequently Asked Questions

You will receive a letter in the mail about your MO HealthNet Managed Care health plan and the date your services began. You will also receive a welcome packet with important information about your coverage from the MO HealthNet Managed Care health plan. Your health plan may also call you to ask you questions. We recommend you connect with your health plan directly once you have been enrolled with a plan. They can help you with any special medical needs or answer any specific questions you may have.

You will continue to get healthcare coverage through Managed Care as long as you are eligible. Each year you will be required to:

1. Complete an annual review – This review will make sure you are still eligible for healthcare coverage. If your eligibility changes at any time, your coverage may end.
2. Review your enrollment – You will get an annual open enrollment packet where you will have a chance to change your health plan, you do not have to change anything. If you do not change anything you will stay in your current health plan.

After you are enrolled with a MO HealthNet Managed Care health plan, they will send you a welcome kit that tells you about your MO HealthNet Managed Care benefits. All MO HealthNet Managed Care health plans are required to offer the same services. Some of the services include:

• Doctor visits (i.e., well checks, mammograms, cancer screenings)
• Hospital stays and emergency care (inpatient/outpatient services)
• Approved specialists care (with your provider’s referral)
• Behavioral health and substance abuse services
• Coaching and services to help you quit smoking
• Other services, such as dental, eye care, medical equipment, and family planning

Services may be limited based on your eligibility group or age, and some services may require prior approval. It is important to work with your health care provider to find out if a service you need is covered. For more information about the MO HealthNet Managed Care Program and the services available, review your health plan’s member handbook:

• Healthy Blue
• United HealthCare
• Home State Health
• Show Me Healthy Kids (managed by Home State Health)

After you are approved and enrolled in a MO HealthNet Managed Care health plan, you will get a welcome kit in the mail about the health plan you were assigned to and the date your services began. You can start getting care once you receive your welcome kit.

Your new health plan will also send you a Managed Care health plan card. You will also get a MO HealthNet ID Card from the MO HealthNet Division (MHD). You should always carry both cards with you and show them each time you receive care. Call the phone number on your health plan card if you have any questions about your services.

If you need health care services, call your Primary Care Provider (PCP – your doctor) and they should refer you to specialists and other health services you may need.

Based on your family’s income and family size, your family may need to pay a monthly premium. The letter you received from the Family Support Division about your eligibility should have told you if you need to pay a premium. If you have questions about premiums, call MO HealthNet Participant Services at 1-800-392-2161. This does not apply for Show Me Healthy Kids members.

If your child is a member of a federally recognized American Indian or Native Alaskan Tribe, you do not have to pay a premium for your child’s health services.

If you are enrolled with a MO HealthNet Managed Care health plan, you can find a doctor by using the provider search on the health plan’s website or by calling your health plan directly.

You may change your Primary Care Provider by contacting your MO HealthNet Managed Care health plan.

You should check with your Primary Care Provider (PCP – your doctor) or your MO HealthNet Managed Care health plan to determine if you need a referral to see a specialist.

Contact the member services number on your MO HealthNet Managed Care health plan ID card to determine if you are able to receive assistance for non-emergency medical transportation. Some MO HealthNet Managed Care health plans have the phone number for transportation on their Managed Care health plan card.

Emergency:

If you need healthcare for an emergency when you are out of town, you do not need to call your PCP or health plan first. You should:

• Go to the nearest emergency room or call 911
• Call your PCP after an emergency room visit
• Get your follow-up care from your PCP Once you return home, you must receive all routine health care services from your PCP. All services outside the United States and its Territories are not covered.

Non-Emergency:

If you need urgent health care when you are away from home, call your Primary Care Provider (PCP – your doctor) or your MO HealthNet Managed Care health plan for assistance. The care must be approved by your PCP prior to you receiving the services. Your PCP will need to contact your MO HealthNet Managed Care health plan for prior authorization. Non-Emergency out of state service is defined as “not within the physical boundaries of Missouri or any of the states that border Missouri.”

Contact your MO HealthNet Managed Care health plan at the telephone number on the back of your Managed Care health plan ID card.

Contact your MO HealthNet Managed Care health plan at the telephone number on the back of your Managed Care health plan ID card.

It is very important to report any changes in your circumstances as they may affect your eligibility. It is also important to report any changes to your contact information to ensure you receive important notices about your eligibility and services.

If you have a change in circumstances or your address or phone number changes, you can report the change online or you can call the Family Support Division Information Center at 1-855-373-4636. Help is available through the Family Support Division Information Center from 7:30 a.m. to 5:30 p.m., Monday through Friday.

If your child is in Show Me Healthy Kids and you need to report a change in your address or contact information, contact their Children’s Division case manager or subsidy case manager. If you are a former foster care youth, email CDMHNQuestions@dss.mo.gov.

Your coverage in your MO HealthNet Managed Care health plan will end if your eligibility for MO HealthNet changes in one of the following ways:

• You are no longer in one of the eligibility groups that needs to receive services through a MO HealthNet Managed Care plan:
  • MO HealthNet for Families
  • Children’s Health Insurance Program (CHIP)
  • MO HealthNet for Kids
  • MO HealthNet for Pregnant Women
  • Show Me Healthy Babies
  • Adults Age 19 to 64 Without Disabilities
• You are approved for Medicare coverage
• You enter the Aids Waiver Program while you are in a MO HealthNet Managed Care plan

If your coverage through a Managed Care health plan ends, you may have services through the MO HealthNet Fee-For-Service Program. Call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 for more information or if you have questions regarding your health care options.

If you lose your MO HealthNet ID card, call the Family Support Division Information Center at 1-855-373-4636. Help is available through the Family Support Division Information Center from 7:30 a.m. to 5:30 p.m., Monday through Friday.

When you are approved for MO Healthnet Managed Care, you will be assigned a Managed Care health plan. You have the right to change this health plan if:

• It has been less than 90 days since you were assigned a health plan
• It is your annual open enrollment period and you do not want to stay with the same health plan
• You have “just cause” and the state approves your request

If you would like to change health plans, you will need to submit the request for each family member’s health plan you would like to change. If you are enrolled in Show Me Healthy Kids you are not able to change health plans.

Three ways to change your health plan:

If you have a special health care need, call your MO HealthNet Managed Care health plan. They will work with you to make sure you get the care you need.

If you have a chronic illness and are seeing a specialist for your medical care, you may ask your MO HealthNet Managed Care health plan for a specialist as your Primary Care Provider.

If you are happy with your current health plan and Primary Care Provider (doctor), you do not have to do anything during the annual open enrollment. If you are not happy with your current health plan or Primary Care Provider, you can choose a new one.

If your current health plan is no longer available, you will need to choose a new health plan.

If you would like to choose a new Primary Care Provider, you can search for one online or call the Enrollment Helpline at 1-800-348-6627.

If you are in Show Me Healthy Kids (SMHK), you will not be able to change health plans. You can change your Primary Care Provider, to another one enrolled with SMHK, with or without cause at any time. To do this, call SMHK at 1-877-236-1020.

You should receive a packet in the mail with your enrollment dates. You may also call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 for more information.

You will need to change health plans by the deadline found in your packet. For example, if you are new to Managed Care, you will have 90 days to change your new health plan if you would like to. If you are happy with the health plan you were assigned, you do not need to do anything.

If you choose to mail your change request, we must receive it by the due date in your packet. You may call the MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 to change your health plan by phone.

If you are in Show Me Healthy Kids, you cannot change your health plan.

Visit https://dss.mo.gov/mhd/healthcare-benefit.htm or contact:

MO HealthNet Managed Care Enrollment Helpline: 1-800-348-6627
Call for help with changing a health plan or finding a primary care provider. The Enrollment Helpline is open from 7:00 a.m. to 6:00 p.m., Monday through Friday (except holidays).

MO HealthNet Participant Services Unit: 1-800-392-2161
Call for questions about eligibility, pharmacy or premium payments.

MO HealthNet Health Plans: Call if you need help finding a provider or if you have questions about your coverage or any unpaid medical bills.

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If you are deaf, hard-of-hearing, deaf-blind or have difficulty speaking, call Relay Missouri:
1-800-735-2466 (Voice) 1-800-735-2966 (Text Phone)