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Member Transition from PAP to MCM

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On January 1, 2019, the New Hampshire Health Protection Program (NHHPP)/Premium Assistance Program (PAP) becomes the Granite Advantage Health Care Program. Through Granite Advantage, thousands of Granite Staters are eligible to receive coverage at little or no cost to them.

Coverage under the Qualified Health Plans (QHP); Ambetter, Anthem Blue Cross Blue Shield, and Harvard Pilgrim Health Care of New England, will end on December 31, 2018.

Current Premium Assistance Program (PAP) members must select a Medicaid Care Management (MCM) plan during open enrollment or be auto-assigned.

Open Enrollment is available from November 1, 2018 through December 28, 2018.

Member Transition graphic*All PAP members who do not actively select by December 3, 2018 will be auto-enrolled in an MCM plan. Ambetter members who do not actively select will be auto-enrolled into New Hampshire Healthy Families effective January 1, 2019. Members will still be able to switch until open enrollment ends on December 28, 2018.

The effective date of coverage under the MCM is January 1, 2019.

Before PAP members enroll in a MCM plan, they should check the managed care organizations' websites to make sure:

  • Their current providers are in the MCM network;
  • They review plan rules in member handbooks; and
  • Their prescription drugs are covered by the MCM plan.

Do QHP prior authorizations carry over to the MCOs?
The Department will work with the QHPs and MCOs to transfer prior authorization information. If at all possible, PAP members should refill current medication prescriptions before December 31. Members may also get a 72-hour supply from their pharmacy, if a pharmacy approval is pending with the MCO. Please check with your MCO for any surgery or MRI (any high tech radiology) procedures scheduled in January 2019.

Will my co-pays change under the MCM plans?
Yes. The only co-pays that will remain are pharmacy. These copays will be $1.00 for preferred drugs and $2.00 for non-preferred drugs. There are also co-pay exemptions, such as for family planning products. Check with the MCM plan for further details.

How will my benefits change under the MCM plans?
You have NH Medicaid and get the same services as someone on regular Medicaid.

Each Health Plan must cover all the same services as regular Medicaid, including non-emergency medical transportation, EPSDT services for 19 & 20 year olds, family planning services, and eyeglasses. However, you will get your services in a managed care program. Managed care plans may offer 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.

Nursing home and home and community based care (HCBC) waiver services are covered under Fee-For-Service. If you need skilled nursing facility care, you have to apply for Medicaid Medical Eligibility for Long-term Care.

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

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