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Medicaid Care Management (MCM)
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What is the Medicaid Care Management (MCM) program?

Most New Hampshire Medicaid recipients receive their services in managed care. These recipients are in a program known as Medicaid Care Management (MCM).

The MCM program uses two (2) Health Plans. Each Health Plan has its own network of doctors, nurses and other providers who work together to give you the care you need.

You have Medicaid and you get the same benefits as someone on regular Medicaid. Both Health Plans cover the same basic services and programs as regular Medicaid. Each Health Plan may also offer extra services not available under the regular Medicaid program.

The added services you get will depend on the Health Plan you pick. These extras may include wellness and prevention programs that help you stay healthy and meet your health goals.

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What are my Health Plan choices?

You can pick from these three Health Plans:

Health Plan Name Health Plan Contact Information
New Hampshire Healthy Families www.Nhhealthyfamilies.com
Member Services: 1-866-769-3085
Well Sense Health Plan www.WellSense.org
Member Services: 1-877-957-1300

REMEMBER: You have NH Medicaid and get the same services as someone one regular Medicaid. You can keep your current doctor or other health care provider as long as they are in the Health Plan you picked.

Each Health Plan offers different programs to support overall wellness while still covering all of the same services as NH Medicaid. The extra supports you get will depend on which Health Plan you pick. Be sure to choose the one that is right for you! See Meet Your Health Plans Adobe Acrobat Reader Symbol to find out more about each Health Plan.

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Do I have to be in the MCM program?

Most people who get Medicaid services must be part of the Medicaid Care Management (MCM) program. MCM is "mandatory" for these people.

For a limited time, a small number of people will have the option to either pick a Health Plan or stay in regular Medicaid. For these people, MCM is "voluntary". If you are in this group, and you do not want to be a part of MCM, you must "opt-out" of the MCM program. If you "opt-out" of MCM, you will stay in regular Medicaid, just as you are now. Nothing will change.

Coming soon, everyone who is "voluntary" will become "mandatory". At that time, all but exempt people will be in MCM. If your current status is "voluntary", now is a great time to get to know the different Health Plans, and see which one best fits your needs. If you do not want to be part of MCM, but do not opt out, a Health Plan will be chosen for you.

A very small number of people cannot pick a Health Plan. These people are "exempt" from MCM. If you are "exempt", you will continue to get your services through regular Medicaid, just as you do now.

Call the Medicaid Service Center toll free at 1-888-901-4999 to find out if your enrollment in MCM is mandatory, voluntary, or if you are exempt from MCM.

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How will I know if MCM is "mandatory", "voluntary", or if I am "exempt"?

The type of assistance you get determines whether you are mandatory, voluntary or exempt from Medicaid Care Management (MCM). The Health Plan Selection Form, which came with the Enrollment Packet Adobe Acrobat Reader Symbol you got telling you to pick a Health Plan, lists each person in your case who has not already picked a Health Plan, and whether they are "mandatory" or "voluntary".

example

If you did not get a letter, or if your name was not on the list, it is likely that you are "exempt".

If you need help finding out if MCM is mandatory, voluntary, or exempt for you or someone in your case, call the Medicaid Service Center toll free at 1-888-901-4999.

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Will my benefits change under MCM?

You have NH Medicaid and get the same services as someone on regular Medicaid. Your benefits are the same. Additional benefits will depend on the Health Plan you pick.

Each Health Plan must cover all the same services as regular Medicaid. However, NH Medicaid uses a Care Management program for your services. You may get extra services and programs not offered by regular Medicaid. For example, if you have a chronic health need, your Health Plan may offer a care manager who will help you manage your illness.

Some of your services will stay under regular Medicaid. These include children's dental care, nursing home, and home and community based care (HCBC) waiver services.

Don't throw away your Medicaid Card. You still need it. Show both your NH Medicaid Card and your MCM Health Plan card to your doctor or pharmacist at each visit.

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How do I "opt-out" of MCM?

The type of assistance you get determines whether you must choose a Health Plan, can opt-out or cannot be in Medicaid Care Management (MCM).

For a limited time, a small number of people will have the option to either pick a Health Plan, or stay in regular Medicaid. For these people, MCM is "voluntary". If you are in this "voluntary" group, and you do not wish to pick a Health Plan or be in MCM, you must "opt-out" of MCM. If you "opt-out" of MCM, you will stay in regular Medicaid.

If you choose to "opt-out", you must let the Department know, by:

  • Calling the Medicaid Service Center toll free at 1-888-901-4999; OR
  • Making this selection in your NH EASY account; OR
  • Selecting this option when you complete and return your "Health Plan Enrollment Form" (see below):

example

Coming soon, all "voluntary" groups will become "mandatory". At that time, everyone except those that are "exempt" will be in MCM. If your status is "voluntary", now is a great time to give managed care a try, get to know the Health Plans, and see which one best fits your needs.

REMEMBER: You have NH Medicaid and get the same services as someone on regular Medicaid. You can keep your current doctors as long as they work with the Health Plan you pick. Any extra services you get will depend on the Health Plan you pick.

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If MCM is "voluntary" for me, why should I switch to MCM?

Coming soon, everyone who is "voluntary" will become "mandatory". At that time, all but exempt people will be in MCM. If your current status is "voluntary", now is a great time to get to know the different Health Plans, and see which one best fits your needs.

REMEMBER: You have NH Medicaid and get the same services as someone on regular Medicaid. You can keep your current doctors as long as they work with the Health Plan you pick. Any extra services you get will depend on the Health Plan you pick.

Each Health Plan offers different programs to support overall wellness while still covering all of the same services as NH Medicaid. The extra supports you get will depend on which Health Plan you pick. Be sure to choose the one that is right for you! See Meet Your Health Plans Adobe Acrobat Reader Symbol to find out more about each Health Plan.

Being in Medicaid Care Management (MCM) and picking a Health Plan does not affect your ability to get other services including cash assistance, child care, Long Term Care (LTC), Home and Community Based Care (HCBC), or Food Stamps.

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