Letter to Parents – Medicaid and Medipass Changes – March 2014

Carol Tietz, OTR/L, PA

OT KID WORKS

Mill Pond Professional Center ~  7657 Cita Lane  ~ New Port Richey, Florida ~ 34653

(727) 376-1111 ~ (727) 845-1811 Fax

11099 Hearth Rd. ~ Spring Hill, Florida ~ 34608

(352) 683-7117 ~ (727) 845-1811

 March 4, 2014

Dear MediPass and Medicaid Clients,

You will likely be receiving a letter in the mail from AHCA informing you of Medicaid and MediPass services changes across the state of Florida. The Florida legislature has chosen to move Medicaid and MediPass to a managed care model called “Statewide Medicaid Managed Care” which will change how some individuals receive health care from the Florida Medicaid Program.

At this time, complete details of the new program have not been released. However, OT Kid Works would like to work proactively with you to help minimize the effects of this change on the Occupational Therapy services we provide to your family.  Please keep in mind, full details of the changes have not yet been confirmed.

Based on information I have received the managed care plan will be going into effect May 1, 2014 for children residing in Hernando County and June 1, 2014 for children residing in Pasco and Pinellas counties.  It is my understanding AHCA will be sending an enrollment packet and you will be asked to choose a managed care plan from a list they have chosen. To that end, I wanted to notify you of the plans OT Kid Works currently accepts and plans we will accept in the near future in order to help you make an informed decision.

We are currently network providers for the following companies:

  • United Health Care
  • Freedom Health, Inc.
  • Molina Healthcare
  • Tricare (regular not Prime)
  • Children’s Medical Services (CMS)/ Ped-I-Care
  • Medicaid/Medipass/Straight Medicaid

In addition to the companies listed above, when the managed care program takes effect, we plan to be network providers for the following companies in addition to those listed above:

For children who reside in Hernando County (as of May 1, 2014):

  • Prestige
  • Sunshine State Health Plan (please note, we will only be able to accept Sunshine for those residing in Hernando County)
  • Simply Healthcare Plans

For children who reside in for Pasco/Pinellas Counties (as of June 1, 2014):

  • Prestige
  • Magellan Complete Care
  • Simply Healthcare Plans

I have carefully reviewed and considered the other companies Medicaid has awarded contracts to provide therapy services in Pasco and Pinellas counties including:  Staywell, Sunshine (in Pasco Co. only) and Amerigroup. These plans indicate they will be authorizing therapy services and payment substantially below the current Medicaid/Medipass standard. I have made the decision that we would be unable to offer our clients the best services possible under these plans so therefore I am rejecting their offer to become a provider with these plans. This is very difficult for both parents and providers as we will no longer enjoy the freedoms you had to choose any willing provider for your child under the current Medicaid/Medipass system.

Additionally, I urge you to apply for Children’s Medical Services (CMS) which is a collection of programs for children with special needs. If your child is eligible for CMS, there will be more choices for occupational therapy services outside of the new upcoming managed care program. To apply for CMS, please visit the following websites as soon as possible. For those in Pasco/Pinellas Co. you can also call 727-217-7800 and ask to speak to member services.

http://www.floridahealth.gov/AlternateSites/CMS-Kids/ 

www.healthykids.org.

 

I also recommend applying for Medicaid Waiver for your child if he/she has one of the following diagnoses: Spina Bifida, Cerebral Palsy, Down’s Syndrome, Autism, intellectual disabilities or Prader-

Willi Syndrome. According to Medicaid, beginning at age 3, children who are either on the waiver already or on the waitlist for the waiver are not required to enroll in a Medicaid Managed Care program (MMA).

Please see the attached letter.

If you have any questions or if I can be of help in any way, please don’t hesitate to call or e-mail me at ctietz[at]otkidworks.com. I would also encourage you to call Medicaid with your questions and consider contacting members of the Florida Legislature regarding your concerns. It will be your voices, as parents, that they will respond to, not providers! I am providing you with a list of their e-mail addresses and phone numbers.

Sincerely,

Carol Tietz, OTR/L & The OT Kid Works Staff

Leave a Reply