Kentuckians with Medicaid coverage can switch to a different managed-care organization though Dec. 16. Switching is voluntary and coverage with a newly chosen MCO will start Jan. 1.
Kentuckians can apply for Medicaid benefits at any time during the year through the state Department for Community Based Services. Upon initial enrollment, Medicaid participants must choose a MCO, but have a 90-day window to change for any reason.
After the window closes, Kentucky Medicaid members can change to a new MCO only during the yearly open enrollment period, which started Oct. 24 and runs through Dec. 16. Once a person is enrolled in the new MCO, they have a 90-day window to make a change.
There are a few exceptions to this rule, which fall under “disenrollment for cause,” which includes things like poor quality of care, lack of access to services covered under the MCO contract, and lack of specialty providers to deal with the member’s health care needs, to name a few. Members must submit a written or oral request for disenrollment to DCBS or the MCO.
Kentucky has five MCOs to choose from: Aetna Better Health of Kentucky, Anthem Blue Cross and Blue Shield Medicaid, Humana-CareSource, Passport Health Plan and WellCare of Kentucky. Click here for more information on each plan. Click here for Medicaid managed-care updates.
The National Committee for Quality Assurance recently rated Passport Health Plan at 4 on a 5-point scale. WellCare was rated 3.5, Aetna, 3; Humana, 2.5; and Anthem, 2. The annual ratings are based on measures of consumer satisfaction, treatment and prevention. Click here for more details on the ratings.
Eligible members can change MCOs by calling 855-446-1245, Monday through Friday from 8 a.m. to 5 p.m. Eastern Time.