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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
September 19, 2020
What’s next?
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Announcements
All attendees will be muted during the
presentation.
Please use the Q&A box shown at right to
ask a question during the presentation.
Individuals on the phone will be able to ask
questions at the end of the presentation.
A recording of a town hall will be available on
the DHCF website.
A copy of the presentation will be available
on the DHFC website.
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
NEW DHCF LOGO
COMING
OCTOBER 1, 2020
Host:
Melisa Byrd,
Senior Deputy Director/State
Medicaid Director at DHCF
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
DHCF Administers the District’s Public Health
Insurance Programs
Of beneficiaries are enrolled
in Managed Care, known as
DC Healthy Families
Program in FY 2020
DHCF covers more than
280,000 people
4 out of 10 District residents
7 out of 10 District children
On average during FY 2019, more
than 265,000 in Medicaid; among
those not eligible for Medicaid,
15,000 in the DC Healthcare
Alliance and 4,000 in the
Immigrant Children’s Program
75%
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
VISION
All residents in the District of Columbia have the supports and services they need to
be actively engaged in their health and to thrive.
MISSION
The Department of Health Care Finance works to improve health outcomes by
providing access to comprehensive, cost-effective and quality healthcare services for
residents of the District of Columbia.
VALUES
Accountability – Compassion – Empathy – Professionalism – Teamwork
STRATEGIC PRIORITIES
1. Building a health system that provides whole person care
2. Ensuring value and accountability
3. Strengthening internal operational infrastructure
Led by Strategic Priorities, DHCF is
Reforming Medicaid
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Medicaid Reform and You
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community Health Plan
District of Columbia (formerly known as Trusted Health
Plan)
4. Questions & Answers
Presenter:
Lisa Truitt,
Director of Health Care
Delivery Management
Administration at DHCF
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Key Takeaways
• The District is shifting its Medicaid health care delivery
system to improve health outcomes
• New managed care contracts that increase access to providers and
expand value over volume
• Increasing access to care coordination
• Enrollees currently in the DC Healthy Families program will
be assigned an MCO effective October 1.
• In October, approximately 19,000 (FFS) beneficiaries will be
transitioned to the District’s managed care program – DC
Healthy Families. No changes for children under 21.
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Key Takeaways (cont’d)
1. Covered benefits and eligibility requirements are not changing
2. New managed care enrollees transitioning from FFS will
receive care coordination and an Individualized Care Plan
from a designated case manager
3. All managed care enrollees will be assigned to an MCO
effective October 1. Enrollees may change to any MCO for
any reason between October 1 – December 31, 2020
4. All DC hospitals, FQHCs and hospital affiliated physician
groups will be in network for all MCOs
5. Enrollees are ensured that coverage and care will not be
interrupted
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Does this reform impact you?
Yes
Individuals currently in the DC
Healthy Families Program
Individuals aged 21 or older,
and
Receiving Medicaid SSI or SSI-
related Medicaid because of a
disability, or
who previously opted-out of managed
care
No
Individuals who receive both Medicare
and Medicaid (Dual Eligible)
Individuals living in an institution or a
nursing home
Individuals enrolled in a Home and
community-based waiver program
(EPD or IDD Waiver)
Children under 21 not currently enrolled
in the DC Healthy Families Program
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Does this reform impact you?
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community Health Plan District of
Columbia (formerly known as Trusted Health Plan)
4. Questions & Answers
Presenter:
Judy Strother,
Enrollment Broker
Project Manager at
Maximus
How to Enroll with a Health Plan
Judy Strother, Presenter
DC Healthy Families/ DC Health Care Alliance
Enrollment Broker Project Manager
What Is An
Enrollment
Broker?
How Can
They Help?
We are the dedicated Call Center for residents enrolled in the
DC Healthy Families Program (DCHFP) and the DC Health
Care Alliance (Alliance). We are here to assist eligible
beneficiaries with enrollment and transfer needs within the
District of Columbia’s Medicaid Managed Care Organizations
(MCOs).
Once approved for enrollment into the DC Healthy Families
Program and Alliance, enrollees will receive a New Member
Enrollment Packet with instructions on how to enroll into one
of the 3 newly awarded MCOs.
AmeriHealth Caritas DC
CareFirst Community Health Plan DC
(formerly Trusted Health Plan)
MedStar Family Choice DC
Enrollees have four (4) ways to select and enroll into a MCO that meets their
families needs. An Enrollment Broker Customer Service Representative (CSR)
is available to assist with which ever option the enrollee chooses.
Mail – Complete the enrollment application received in the New Enrollee’s
Enrollment packet and mail to the Enrollment Broker for processing
Online – www.dchealthyfamilies.com to access your account and enroll
Virtual Meeting via Zoom – Contact DC Healthy Families Outreach Team
- Go online at
https://www.dchealthyfamilies.com/Home/Contact.aspx
- Call (202) 639-4030 or 1 (800) 620-7802
Call
Center
Services
By contacting our Call Center, enrollees can speak to a Customer
Service Representative, who will educate them on the following
topics:
Benefits-using the MCO Comparison Chart
Selecting their Primary Care Provider (PCP) – searching for
their current provider, by health plan
Selecting their Primary Dental Provider (PDP) – searching for
their current providers, by health plan
Our CSR’s also have access to Language Line representatives
who assist enrollees, when English is not their primary language.
Once the enrollment is completed, enrollees will receive a
confirmation letter from the Enrollment Broker, listing their
selections:
MCO or Health Plan selected
PCP selected
PDP selected
Call
Center
Services
Open Enrollment begins October 1, 2020 and ends
December 31, 2020. The Enrollment Broker hours of
operations will be as follows:
• Hours of Operations are:
Monday – Friday; 8:00 a.m. – 7:00 p.m.
1
st
Saturday of the month; 10:00 a.m. – 2:00 p.m.
• Phone Numbers:
1 (800) 620-7802 (Main Line)
1 (866) 758-6807 (Dental Line)
1 (800) 788-0342 (Complaint Line)
(202) 639-4041 (TTY/TDD)
(202) 289-6764 (FAX)
Contents of the New Enrollment Packet
Health Plan Selection Form – allows for mail-in selections
How to Choose Your Health Plan
Health Plan Comparison Chart
Health Risk Assessment Form (if over 18)
CAHMI Form (if under 18)
How to use tools and services offered by the Enrollment Broker
Enrollees will receive a How to Choose Your Health Plan in your New Enrollment Packets. It’s designed to be
helpful during the selection process. It can be used whether you’re enrolling online, by mail or by calling
the Call Center.
• Step 1: Think about your family’s health needs
The doctors you want to see
Which hospitals, clinics and pharmacies you want to use
Other services or benefits that you need
• Step 2: Find out what each health plan offers
Use the Health Plan Comparison Chart to learn about the services each health plan offers
Choose a plan that lets you go to the doctors and clinics you want and gives you the services you need
• Step 3: Sign-up or change your plan
Sign-up or change your Health Plan over the phone (202) 639-4030 or 1 (800) 620-7802
Sign-up or change your Health Plan online
www.dchealthyfamilies.com
Fill out the Health Plan Selection form and all of the other forms in the Enrollment Packet. Mail them
back in the enclosed envelope found in the Enrollment Packet.
How to use tools and services offered by the Enrollment Broker
Physician Visits and Check-ups
Emergency Services
Hospital Services
Urgent Care Services
Prescription Drugs
X-Rays and Lab Services
Language Translation and Interpretation
Services
Telehealth and Telemedicine Services
Vision Services
Maternal Services
Health Check Well Child Visits
Immunizations
Non-Emergency Transportation
Dental Services
Care Coordination and Case Management
Services
Family Planning Services
Enrollees will receive a MCO Comparison Chart in their New Enrollment Packet. The MCO
Comparison Chart provides a list of benefits available across all health plans. It can be used
along with the How to Choose a Health Plan to select the health plan. It can also be used
whether the enrollee is enrolling online, by mail or by calling the Call Center.
How to view your assignment online or via phone
Enrollees can use their computer or cell phone to view their health plan and provider
assignments by going to www.dchealthyfamilies.com.
The website includes the following:
• Overview of the DC Health Families and DC HealthCare Alliance programs
• A link to a step by step walk – through to complete the new enrollment or transfer
Enrollee can also:
• Enroll into a health plan
• Reset their PIN number if it does not work or if they have forgotten
• Read more about the enrollment and transfer process
• Look at their account
• Compare Health Plans
• Find a doctor
• Get more enrollee information
How to view your assignment online or via phone
The website includes the following, continued:
• Find informational meetings
• Compare Health Plans
• Request a face to face meeting to review their enrollment options
• Locate information on a Primary Care Physician (PCP)
Where to view your online assignments
How to change your MCO
Enrollees can change their health plan, if they are dissatisfied with their
assigned health, between October 1 – December 31, 2020. They can use
one the options below:
• Online: www.dchealthyfamilies.com
• Mail-In: Complete the Health Plan Selection form and all mail it using the
enclosed returned envelope found
• In the Enrollment Packet
• Call the Enrollment Broker and speak to a Customer Service
Representative
Phone Numbers:
1 (800) 620-7802 (Main Line)
1 (866) 758-6807 (Dental Line)
1 (800) 788-0342 (Complaint Line)
(202) 639-4041 (TTY/TDD)
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Does this reform impact you?
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community Health Plan District of
Columbia (formerly known as Trusted Health Plan)
4. Questions & Answers
Presenter:
Stephanie Hafiz, Director
of Member Engagement
AmeriHealth Caritas District of Columbia
Overview of Benefits, Services and Key Telephone Numbers
September 2020
AmeriHealth Caritas District of Columbia
Overview
• AmeriHealth Caritas District of Columbia has proudly served the District of Columbia since 2013
o Since becoming part of the DC Community, we have consistently championed health equity for the
most vulnerable communities and provided health care benefits and services for over 100,000
enrollees annually.
• Key Benefit and Services
o Medical, behavioral health, vision, dental, pharmacy,
emergency care, urgent care and transportation
o Bright Start Maternal Health Program
o Care Manager and Community Health Worker care coordination
o Health coaching and counseling
o Help with scheduling appointments
o Support and guidance to resources for things like housing , food, employment assistance and legal aid
Access to all District-based acute care hospitals and related physician groups
• Add Value Benefits and Services
o Free Gym Membership Program
o Free Daily Live Workout Classes
o Free Fitness Videos
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o Free Access to the Weight Watchers (WW) Program
o Enrollee Wellness Center
o Incentive Gift Cards (Maternal Health and Teen Rewards)
AmeriHealth Caritas District of Columbia
Key Services and Telephone Numbers
• Enrollee Services (202.408.4720 or 800.408.7511)
o Customer Service Available 24/7
o New ID Cards
o Help with finding a new primary doctor (PCP) or dentist (PDP)
o Questions about your benefits and services
• Non-Emergency Transportation (800.315.3485)
o Available 24/7 (includes transportation to urgent care)
o Free Transportation to Network Doctors and Dentists
• Care Management / Care Coordination / Community Resources
o Rapid Response (877.759.6224)
o Community Outreach Solution Team (202.216.2318)
• Nurse Advice Line (877.759.6279)
o 24/7 access to experienced nurses
• Telemedicine (855.879.4332)
o 24/7 access to doctors by phone or web-based video conference
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Does this reform impact you?
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community Health Plan District of
Columbia (formerly known as Trusted Health Plan)
4. Questions & Answers
Presenters:
– Leslie Lyles Smith,
Executive Director
– Sharon Henry, Director
of Clinical Operations
Hospital name or service line (optional) 28
MedStar Family Choice
DHCF Town Hall
This program is funded in part by the
Government of the District of Columbia
Department of Health Care Finance.
Hospital name or service line (optional) 29
Who We Are
• Previously served as a District of Columbia MCO
• Parent Company, MedStar Health, rich history
serving DC residents
• Integrated Healthcare Delivery System
Hospital name or service line (optional) 30
Key Aspects
• Provide full benefits and services for DC Healthy
Families and DC Healthcare Alliance
• Rebuild Provider Network to include DC based
hospitals and affiliated providers
• Support Your Continuity of Care
Hospital name or service line (optional) 31
Support Services
• Care Managers – Nurses and
Social Workers to assist you with
your clinical care needs, in
partnership with other
departments and community
agencies
• Community Outreach and
Community Health Workers –
help to navigate your health care
needs
• Health Education Programs to
help you learn more about your
health and promote self-
management
• We strive to deliver the best to
every Enrollee every day. The
Enrollee is the first priority in
everything we do
Hospital name or service line (optional) 32
Service Delivery Partners
Dental and Vision
Avēsis
Behavioral and Mental
Health
Magellan
Transportation
Access2Care
Pharmacy
CVS Caremark
Nurse Advice Line
Carenet Health
Hospital name or service line (optional) 33
What To Expect
Welcome Packet
Enrollee ID Card
Enrollee Handbook & welcome
information
Welcome Calls
Hospital name or service line (optional) 34
MFC Contact Information
Enrollee Services
(888) 404-3549
Website
www.MedStarFamilyChoice.com
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Does this reform impact you?
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community
Health Plan District of Columbia (formerly
known as Trusted Health Plan)
4. Questions & Answers
Presenters:
– George Aloth,
President/CEO
– Timothy Sullivan, Chief
Operating Officer
– Karyn Wills, Chief
Medical Officer
CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. which are independent licensees of the Blue Cross and Blue Shield Association.
® Registered trademark of the Blue Cross and Blue Shield Association.
Proprietary and Confidential
DHCF Town Hall: DC Medicaid and You
September 2020
CareFirst Community Health Plan District of Columbia
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9/21/2020
Proprietary and Confidential
Welcome & Introductions
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Hello
George Aloth
President & CEO
George.Aloth@carefirstchpdc.com
Dr. Karyn Wills
CMO
Tim Sullivan
COO
Tim.[email protected]om
Dr. Djinge Lindsay
Medical Director
Djinge.lindsay@carefirstchpdc.com
Kenny Green
VP of Provider Relations
Kenny.green@carefirstchpdc.com
Lukeshia Walker
Sr. Dir. Marketing, Outreach and
Health Promotion
Lukeshia.walker@carefirstchpdc.com
Our team is completely local, based in the community and is focused on providing the best possible experience
for our enrollees and our provider partners - please contact any of us if you have any questions
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9/21/2020
Proprietary and Confidential
Key Aspects of the MCO
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Local, in-person support through 2 wellness centers and 1 resource center
Relentless focus on continuity of care to ensure a smooth, seamless
enrollee experience
Enrollee resource navigation including assistance with understanding your benefits and
connecting you to Healthcare Providers and Services carefully selected to give you the best
care
Dedicated programs for Enrollees with Special Health Care Needs
including a team devoted to specialized care
Extensive network of over 5000 providers and District hospitals to serve our
enrollees
Community-based programs including financial assistance, income tax services,
transportation and meal programs
Our top priorities are our enrollees and provider partners – we work within our collective community to
support you and all your healthcare needs
Improve quality of care and population health for our enrollees though
innovation
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9/21/2020
Proprietary and Confidential
Services & Supports for our Enrollees
Non-Emergency
Transportation
Job Training &
Workforce
Development
Searchable Online
Community
Resources
Fitness & Exercise
Program
Financial Capabilities
& Credit Counseling
CareFirst CPHDC
Mobile App
Our team is looking forward to engaging with you and providing you with a great experience as you
seek care within our community – we are here to support you and go beyond just healthcare
Pest Control
GED Preparation &
Testing Assistance
Health, ESL & Digital
Literacy
Allergy Free Bedding
Free Income Tax
Services
Enrollee Portal
Healthy Beginnings
Maternity Program
Wellness & Resource
Centers
Nutrition Education
Programs
Pacify Maternity
Education App
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Agenda
1. Welcome & Introduction
• Key Takeaways
• Does this reform impact you?
2. Enrollment Broker
• What is an enrollment broker?
• How can an enrollment broker help you?
• How to find your MCO assignment
• How to choose a different MCO
3. DC’s Managed Care Organizations (MCO)
• AmeriHealth Caritas District of Columbia, Inc
• MedStar Family Choice
• CareFirst BlueCross BlueShield Community Health Plan
District of Columbia (formerly known as Trusted Health
Plan)
4. Questions & Answers
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Summary
• New health plans start October 1, 2020
• AmeriHealth Caritas DC
• MedStar Family Choice
• CareFirst Community Health Plan
• Assignment letters were mailed last week
• Contact DC Healthy Families to learn about or change your assigned
health plan.
• Children enrolled with HSCSN will not change health plans
• Individuals with Medicare and Medicaid will not be assigned a health
plan
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Key Phone Numbers
DC Healthy Families
Enrollment Broker
www.dchealthyfamilies.com
(800) 620 - 7802
Office of Health Care
Ombudsman
(202) 724 - 7491
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AmeriHealth Caritas
(800) 408 - 7511
MedStar Family Choice
(888) 404 - 3549
CareFirst Community Health
Plan
(202) 821 - 1100
Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
What’s Next?
For more information
• visit www.dhcf.dc.gov/page/medicaid-reform
• call (202) 724-7491
After the presentation you will be redirected to the enrollment broker webpage.
Please complete the short survey after the presentation.
Future text messages keeping you informed of the changes.
Questions?
• Please type your question in the chat.
• If your question did not get answered please send an email to
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Government of the District of Columbia Department of Health Care Finance
For Official Government Use Only
Reminder
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