NH Medicaid Care Management (MCM) 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.
What You Will Find Here and How You Can Use It
- Reinstatement of Pharmacy Co-Pays for New Hampshire Medicaid and NH Health
Protection Program (NHHPP) begins November 1, 2014
Effective November 1, 2014, pharmacy co-pays will be reinstated for Medicaid and NHHPP
recipients, including those enrolled with Well Sense Health Plan and New Hampshire Healthy Families. Recipients with income over 100% of the Federal Poverty Level will be charged a pharmacy copayment unless the individual is exempt for any of the following reasons:
- Under age 18
- Pregnant or in the 60-day postpartum period
- Approved for Nursing Facility Services
- Approved for Home and Community-Based Care Services
- Approved for Breast and Cervical Cancer Program (BCCP)
There are no pharmacy co-pays for recipients at or below 100% of the Federal Poverty Level. Recipients will receive a letter from DHHS outlining their co-payment responsibilities. Co-payment amounts for recipients who are above 100% of the FPL and not exempt are:
Pharmacy providers with questions should call the appropriate provider relations unit:
- Magellan (Fee-for-Service Medicaid)
- Well Sense Health Plan
1-877-957-1300, option 3
- New Hampshire Healthy Families
- MCM Presentation, 03/12/2015
- Public Forums for MCM Step 2 Program
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