Effective May 1, 2017, the MO HealthNet Managed Care program is offered statewide to all 114 counties and the City of St. Louis. Approximately 240,000 participants, who previously were enrolled in the MO HealthNet Fee-For-Service (FFS) program, are transitioned to a Managed Care health plan. These new Managed Care participants join about 500,000 existing Managed Care participants, amounting to an estimated 740,000 Missourians in the Managed Care program. Participants have received welcome packages from their health plans and will receive services through their health plan’s network of providers.
Missourians who are aged, blind or disabled will remain in the MO HealthNet FFS program. MO HealthNet FFS and Managed Care program participants will not lose eligibility or coverage as a result of the transition to statewide Managed Care; health care benefits will remain the same.
Providers currently enrolled with MO HealthNet’s FFS program in the counties impacted by the Managed Care geographic extension are encouraged to contract with the three newly awarded MO HealthNet Managed Care health plans and to maintain their enrollment with MO HealthNet. To contract with the MO HealthNet Managed Care health plans, contact them directly.
Open enrollment for participants to choose a Managed Care health plan ended April 3, 2017. Participants who did not enroll by April 3, 2017, have been auto-assigned to a health plan. Participants have 90 days from the date coverage starts to change health plans for any reason. For example, a participant may change health plans if their provider is not contracted with the same health plan. After the 90 day period has passed, participants may change health plans if they have “just cause.” For more information, refer to the Participant Resource on “just cause” http://dss.mo.gov/mhd/participants/mc/files/changing-managed-care-health-plans.pdf.
Please note: While the Managed Care program is based on the MO HealthNet FFS program, the two programs have differences. The Managed Care health plans are not required to follow the FFS program’s prior authorization or timely filing rules; in certain circumstances, the Managed Care health plans may establish rates of reimbursement different than the FFS program. Providers are encouraged to work with the Managed Care contracting teams to define and understand those differences and negotiate a mutually satisfactory agreement.