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NH Medicaid Care Management (MCM) Program

NH Medicaid Care Management Program

Care Management helps NH Medicaid recipients to coordinate their health care. It will also help those Medicaid recipients with chronic diseases like diabetes, asthma, obesity, and mental illness. Through this program, Medicaid recipients have wellness and prevention programs as a part of their Medicaid benefit.

Most Medicaid recipients will pick a Health Plan and a primary care provider (PCP) from the Health Plan's list of providers. The Health Plan will pay doctors, nurses, hospitals, and other providers.

NH Medicaid Recipients NH Medicaid Providers

What You Will Find Here and How You Can Use It

This webpage will have information about MCM for Medicaid recipients, providers, and for the public.

What's New!

  • Transition of Preferred Drug List (PDL) to NH Medicaid's MCOs
    Effective October 1, 2015, New Hampshire Medicaid's two managed care organizations (MCOs) will use their own Preferred Drug List (PDL). The NH Department of Health and Human Services has approved each MCO's PDL, policies and prior authorization requirements.

    There are no changes in prescription co-pays.

    For new prescriptions, beginning on 10/1/15, prescribers should use each respective MCOs Preferred Drug List for their health plan members. For ongoing prescriptions, starting on 10/1/15, the MCOs will provide continuity of coverage for up to 6 months, or until a medical necessity review is completed or the prior authorization expires.

    If a health plan member is currently taking a prescription drug which may be switched to a covered formulary alternative that is clinically appropriate for the condition being treated, the member and prescriber will be notified in writing of the pending drug change.

    For assistance with the MCOs' drug benefits, please contact:

    • New Hampshire Healthy Families Health Plan: 1-866-769-3085
    • Well Sense Health Plan: 1-877-957-1300
  • Step 2-Client and Provider Information Session Slide Decks
    The Department of Health and Human Services (DHHS), in conjunction with New Hampshire Healthy Families and the Well Sense Health Plan, held public information sessions for Medicaid recipients and providers to inform them about mandatory enrollment into Medicaid Care Management for medical
    services. The presentations are available below.
  • Step 2 – Meetings for CFI Providers to Learn about Contracting with Health Plans
    The Department of Health and Human Services (DHHS) is hosting two meetings in August for Choices for Independence (CFI) waiver providers to learn about contracting with the two health plans: New Hampshire Healthy Families and the Well Sense Health Plan. The first session on August 11, 2015, will be targeted to CFI's Residential Care Providers. The second session, on August 21, 2015, will be targeted to CFI's In-Home Service Providers. Please click on the below link for information on the two sessions.
  • More about Medicaid Care Management …
  • Learn more about MCM Step 2 …
  • MCM Commission Meetings

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

copyright 2010. State of New Hampshire