Most people that qualify for Medicaid are eligible for HealthChoice and must enroll in a Managed Care Organization (MCO).
How do I enroll in an MCO?
If you applied for Medicaid through Maryland Health Connection (MHC), once your application is complete and verified, you will choose an MCO and primary care provider (PCP) for your health care. Each eligible member of the household may enroll in a different MCO.
If you do not choose an MCO when you apply, you will be automatically assigned to one.
Ask your doctors which MCOs they accept, or use the MCO provider search tool to find doctors by name, specialty, location or MCO.
If you choose a PCP when you select your MCO, the MCO is advised of this choice.
If you are new to the Medicaid program, you will be issued a red-and-white Medical Assistance card to use until you are enrolled in the MCO. Once enrolled in an MCO, you will also receive your HealthChoice card with a new member enrollment packet.
If you applied for Medicaid through the Department of Human Services (DHS), you can choose an MCO and PCP in one of these ways:
What is the Health Service Needs Information (HSNI) Form?
The HSNI formally known as the Health Risk Assessment is a series of questions which is used as part of the HealthChoice enrollment process to identify consumers who may need immediate care because of health problems. The form is completed at the time of MCO selection. The information is sent to the MCO. The MCO is responsible for ensuring you get the services needed in a timely manner. You can complete the HSNI form on the MarylandHealthConnection.gov if you have an account, by calling the MHC or you can complete the form received in the enrollment packet.
Can I change my MCO or be disenrolled?
You can change MCOs for any reason within 90 days of your initial enrollment into HealthChoice. Once your 90-day period ends, you must remain with your MCO for 12 continuous months before you will be allowed to change MCOs.
You also may change MCOs in select circumstances, such as:
When you move to a county that your current MCO doesn’t participate in;
To maintain the family unit;
When special provisions involving children in State supervised care or children in foster care need to be made or;
To maintain continuity of care with PCP when the PCP’s contract with your MCO is terminated for reasons specified in COMAR 10.09.63.
Disenrollment from an MCO occurs when a consumer:
Loses Medicaid eligibility;
Becomes institutionalized for more than 90 successive days in a long term care facility;
Becomes institutionalized for more than 30 successive days in an Institute for Mental Disease (IMD) facility;
Becomes institutionalized for more than a total of 60 days in a calendar year in an IMD;
Is admitted to an Intermediate Care Facility/Mental Retardation (ICF-MR) or;
Is determined eligible for the REM program