Care Coordination for HealthChoice/Medicaid Recipients
What is HealthChoice?
HealthChoice is Maryland's Medicaid managed care program. Most people who qualify for Medicaid are required to enroll in a Managed Care Organization (MCO).
It is best to select an MCO that your doctor participates with. If your doctor does not participate in the MCO you select or are assigned to, you will need to choose another primary care doctor (PCP) to oversee your medical care.
What is a HealthChoice MCO?
An MCO is a group of doctors, clinics, and other health care providers who work together to take care of HealthChoice members' health care needs.
MCO’s are responsible for providing or arranging for most of your health care services including most pharmacy services. Some services, such as mental health and substance use disorder services, and certain drugs are covered by the State and not your MCO.
The Administrative Care Coordination Unit (ACCU) serves as a local resource for all HealthChoice members. The ACCU can help with the following:
- Understanding your Health Choice benefits and how to access services.
- Explain your MCO choices and how to change MCO's.
- Help you find a primary care physician or specialist in your MCO's network. (You can change PCPs at any time.)
- Help you find a dentist.
- Help link you to Medicaid transportation services.
- Help to get your prescriptions filled.
- Help to renew your Medicaid benefits through the Maryland Health Connection.
- Help keeping your information updated and getting a new Medicaid card if your card is lost or stolen.
- Help resolving billing issues.
- Explain your appeal and grievance rights.
Ombudsman
The ACCU Unit also has an Ombudsman. The local Ombudsman acts as an advocate for your health care needs. An Ombudsman may contact you when there are complex medical issues involving care coordination with the MCO. The HealthChoice Program may also request that an Ombudsman contact you to ensure that any complaints that you have about your health care or MCO have been resolved.
Maryland Medicaid HealthChoice Program ACCU/Ombudsman Services Brochure
For more information, call (301) 759-5094 Monday through Friday, 8:00 a.m. to 4:30 p.m.
