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.
What You Will Find Here and How You Can Use It
- 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
- More about Medicaid Care Management …
- Learn more about MCM Step 2 …
- MCM Commission Meetings
- Meeting Minutes and Materials can be found on the Governor's Commission on Medicaid Care Management website
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