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How will I get my medical care if I opt-out of MCM?

If you are "voluntary" and "opt-out" of Medicaid Care Management (MCM), nothing will change for you. You will still get regular Medicaid.

You are "voluntary" if you are:

  • A child in Foster Care
  • Get Home Care for Children with Severe Disabilities, also known as the "Katie Beckett"
  • Are a child with Supplemental Security Income (SSI)
  • Are dually eligible for Medicare and Medicaid
  • Are enrolled with Special Medical Services or Partners In Health

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 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.

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How will I get my medical care if I am "exempt" from MCM?

If you are "exempt", nothing will change. You will continue to get your care through the regular NH Medicaid program.

You are "exempt" if you:

  • Get benefits from the Veterans Administration
  • Get "In-and-out" Medicaid assistance, also known as "Spend Down"
  • Are a Qualified Medicare Beneficiary (QMB) only or a Special Low Income Medicare Beneficiary (SLMB) recipient, and have no other kind of Medicaid coverage at all
  • Are a Qualified Disability Working Individual (QDWI) recipient, and have no other kind of Medicaid coverage at all

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Will I still get other services?

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.

The New Hampshire Department of Health and Human Services (DHHS) will continue to contact you about your case. You must still complete the required forms, or see your case worker when needed. As always, if you do not send in your paperwork, or do the other things required of you, your Medicaid and other services could end.

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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What happens if I don't choose a Health Plan?

If you do not act by the due date that is on your letter, a Health Plan will be chosen for you.

If MCM is "voluntary" for you and you do not pick a Health Plan or tell us that you do not want to pick a Health Plan by the due date, one will be chosen for you.

If MCM is "mandatory" for you, a Health Plan will be chosen for you.

You will be told which Health Plan has been "auto-assigned" to you.

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Will my benefits change under MCM

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

Each Health Plan must cover all the same services as regular Medicaid. However, you will get your services in a managed care program. 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.

Show both your NH Medicaid Card and your MCM Health Plan card to your doctor or pharmacist at each visit.

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Will I still be able to see my current doctor?

If you want to keep your same doctor, you must pick a Health Plan that your doctor works with.

If your doctor is in one of the Health Plans, you may want to choose that Health Plan. If your doctor works with more than one Health Plan, pick the one with the services and programs you like best

If you have a number of doctors and health care providers in different Health Plans, pick the Health Plan that works with the doctors you most want to keep.

If your doctor does not work with any of the Health Plans, we can help you pick a plan, and then your Health Plan can help you find a new doctor that will give you the care that is right for you.

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What do I do with my Medicaid Card?

You may still need to use your Medicaid card for some services, so show both cards to your doctor at each visit.

Services still covered by regular Medicaid include children's dental care, Long Term Care (LTC), and waiver services.

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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New Hampshire Department of Health and Human Services
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