Washington State Health Care Authority
Service areas adjusted for 2015 Apple Health managed care plans.
February 5, 2015
Nearly 1.4 million Washington residents are enrolled in an Apple Health managed care plan. Managed care is a prepaid, comprehensive system of medical and health care services provided by plans under contract with the Washington State Health Care Authority (HCA). In 2015, Apple Health managed care plans in Washington include:
- Columbia United Providers
- Community Health Plan of Washington
- Coordinated Care
- Molina Healthcare
- UnitedHealthcare Community Plan
The Washington State Health Care Authority (HCA) has signed contracts with six Apple Health (Medicaid) managed care plans for 2015, including one new contractor: Columbia United Providers (CUP) in Clark County. Although CUP was not contracted directly with HCA in 2014, it was contracted with Community Health Plan of Washington (CHPW).
Enrollment changes in Clark County:
- Apple Health clients who were enrolled with CHPW in 2014 and served exclusively by CUP-contracted providers have been moved to CUP, with the option of choosing another plan. This ensures patients can continue their relationship with their providers.
- If CHPW did not contract with an Apple Health enrollee’s current provider but Molina Healthcare did, the enrollee was assigned to Molina, but may still choose another plan.
- CHPW remains in Clark County and will continue to serve other Apple Health enrollees whose providers retained their contract with CHPW.
- Family members must all be enrolled in the same health plan. In some cases, some family members were reassigned so the entire family was enrolled in the same plan. Families may choose a different health plan, available in their service area if they wish.
- Coordinated Care and UnitedHealthcare no longer serve Apple Health enrollees in Clark County. These enrollees have been assigned to Molina, with the option of choosing another plan.
Enrollees living in Clark County may contact HCA to change their health plan:
- Toll-free at 1-800-562-3022 or
- 1-800-848-5429 TTY/TDD or 711 (for people with hearing or speech equipment).
In addition to changes in Clark County, about 5,000 Apple Health (Medicaid) enrollees statewide needed to choose a new plan in 2015 because their current plan is no longer available in their county. They received a letter telling them that their old plan is no longer available, and that HCA chose a new plan for them. Enrollees may remain with the plan HCA chose for them, or they may choose another plan.
Enrollment in Apple Health (Medicaid) is available year-round on the state’s Health Benefit Exchange: www.wahealthplanfinder.org.
New benefits covered under Apple Health Managed Care in 2015 (previously covered on a fee-for-service basis) include:
- Bariatric surgery for those who have diabetes or need total joint replacements.
- TDAP vaccines for pregnant or postpartum enrollees given in any setting (provider, pharmacy, whether or not ordered by the primary care provider).
- Pediatric palliative and concurrent care for children with a life-limiting condition.
- Hearing aids and supplies for children age 20 and younger.
- Additional assistance provided by health plans offered to enrollees needing mental health services.
In 36 of 39 counties, enrollees will receive services through a managed care plan. Three counties are voluntary: Clallam, Skamania and Klickitat. “Voluntary” means eligible individuals are not required to be enrolled in a managed care plan and may instead receive the same services through the fee-for-service delivery system. Individuals will be assigned to the available plan but may opt out of managed care and receive services under fee-for-service.
Starting February 1, 2015, enrollees in Clallam County will not be automatically enrolled in Molina Healthcare, but may request to be enrolled. Current Molina enrollees will remain with that plan unless they request to opt out and receive services through fee-for-service.