What is Medicaid Select?

Medicaid  Select is  a new managed care program for the aged, blind and disabled. Members will select a doctor to serve as their Primary  Medical  Provider (PMP).   The PMP will  be responsible to provide or coordinate most of the member’s care.                             

Who is eligible for this program?

The  following  individuals will be required  to enroll  in  Medicaid Select:    aged, blind, the physically and mentally  disabled, children  receiving   adoptive  services,   Medicare/Medicaid  dual eligibles, MedWorks  participants   and   individuals   receiving Room and Board Assistance.

Who will not be included in the program?

The following individuals are excluded from enrollment in Medicaid Select: breast and cervical cancer group, wards, foster children, persons in nursing homes, ICF/MRs and state operated facilities, persons on waivers, persons receiving hospice services and individuals for whom Medicaid pays only the Medicare premiums.

Who is eligible to be a Primary Medical Provider (PMP) for this program?

Medicaid Select will have five standard PMP categories – Family Practice, General Practice, Internist, Pediatrician and OB/GYN. In addition, any physician specialist such as a Cardiologist, Psychiatrist, Urologist, etc. may serve as a PMP.

Will I need to complete another application or contract?

To serve as a PMP for Medicaid Select members, you must first be enrolled as an Indiana Health Coverage Programs (IHCP) provider. You will be required to sign a Medicaid Provider Agreement Addendum to provide services to Medicaid Select members and complete the appropriate paperwork to provide information about you and your location.

What panel size is allowed?

 PMPs may designate a panel size of 50 - 1,000 Medicaid Select members. The Office of Medicaid Policy and Planning (OMPP) must approve a panel size smaller than 50 or larger than 1,000.

Can this panel be combined with my Hoosier Healthwise Panel?

No, the panels will be maintained separately.

Will there be any payment to serve as a PMP?

There will be an administrative fee payment of $4.00 per member/per month.
 

How will I be reimbursed?

In addition to the administrative fee, PMPs will be reimbursed, as usual, based on the fee-for-service schedule. Claims will be submitted to the state’s fiscal agent, EDS, for processing and payment.

What networks will be available?

The program will start with only a Primary Care Case Management (PCCM) system. OMPP intends to procure risk-based managed care organizations in the future.
 

Will members be auto-assigned?

Yes, auto-assignment is a requirement for Medicaid managed care. However, members will have 60 days to select a PMP before they are auto-assigned. Members will only be auto-assigned to the five traditional PMP types or to a non-traditional PMP type (specialist) if they have previously been linked to that physician in the Medicaid Select program. Members may also be linked to a non-traditional PMP type (specialist) on a self-selection basis. Members will be able to change their PMP if they are auto-assigned or choose to see a different doctor than originally selected.

May I continue to see members that I already see?

Only if you enroll as a PMP and the member selects you as their PMP or you receive a referral from the assigned PMP.

What services are available to members?

 Covered services will not change under Medicaid Select program.