Bayou Health To Include Waiver Recipients

The Department of Health and Hospitals (DHH) has announced a major change to the provision of healthcare services for waiver recipients.  If the change takes place as planned, most people on Medicaid waivers will be required to get their non-waiver services through Bayou Health as of August 1, 2012.  Non-waiver services include doctor and nurse visits, hospitalizations, therapies, equipment and supplies, etc.

The Advocacy Center has informed DHH that, in our opinion, the transition is illegal, since DHH has not changed the regulations that currently make waiver recipients exempt from Bayou Health; but DHH has already started to require waiver recipients to choose among Bayou Health plans.

If this change does move forward, most waiver recipients will have a choice of one of five private health plans.  If they do not choose a plan, DHH will choose a plan for them.

The only waiver recipients who are not required to participate are:

• those under age 19
• those on Medicare
• those on LaHIPP (Medicaid is paying for these recipients' private health insurance premiums)
• those receiving hospice services

The initial letters sent by DHH do not mention that recipients under age 19 can opt out of Bayou Health.  This was a mistake.  DHH is resending corrected letters to waiver recipients.  To opt out, recipients under age 19 must call Maximus at 1-855-BAYOU4U (1-855-229-6848) to state they are choosing not to participate in Bayou Health.  The deadline for making choices is extended to July 20, 2012.

The Advocacy Center has asked DHH to make Bayou Health optional for waiver recipients over age 19 who are not on Medicare or LaHIPP.  Due to their complicated health needs, waiver recipients often have multiple physicians.  This means many will have to change some of their physicians if placed under Bayou Health, particularly under the prepaid plans.  Studies in other states have not yet shown significant savings by placing these recipients under Managed Care.

DHH has not yet responded to this request.

More about Bayou Health plans:

• There are two types of plans: shared savings (CCN-S) and prepaid (CCN-P).  For the two shared savings plans (Community Healthcare Solutions and United Healthcare), only your primary doctor (who gives basic health care and refers you to specialists) needs to be in the plan.  People in these plans can use any Medicaid doctor for the rest of their services.  If you have not been able to find needed specialists who will take Medicaid, this may not be the plan for you.
• For the three prepaid plans (Amerigroup Real Solutions, LA Care, and Louisiana Healthcare), all doctors and hospitals that you use must be in the plan.  If you need a type of specialist the plan does not have, the plan is required to arrange and cover the cost for you.  If you are happy with your current doctors and they are not all in the same plan, this may not be the plan for you.

To learn more about the potential benefits and drawbacks of each type of plan, read the flyer "Bayou Health Basics" at www.advocacyla.org/tl_files/files/BAYOUHEALTHBasics.pdf

As Advocacy Center receives more information about this transition, we will inform you via our website and e-newsletter, Pushing the Envelope.

If you have any problems accessing the medical care you need under Medicaid, contact the Advocacy Center.