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| Decision Assistance Booklet |
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Decision Assistance Booklet Cover and page 1 QExA HAWAI’I QUEST Expanded Access for Healthy Long-Term Living Welcome to QUEST Expanded Access (QExA), a new Medicaid program for seniors, 65 and older, and people of all ages with disabilities. Starting on February 1, 2009, these clients will receive their Medicaid services through a QExA health plan. If you are eligible for QExA, you need to choose a health plan that best meets your needs. If you don’t choose a health plan SOON, the Department of Human Services (DHS) will choose one for you. START NOW! Open this booklet and take an important step toward healthy long-term living Questions: Call the toll-free Helpline at 1-866-928-1959 Open 8 a.m. to 5 p.m. Monday through Friday TTY line toll-free 1-866-928-1958 Visit us on the Internet at www.qexa.org Page 2 Table of Contents: This booklet is available in: Call the toll-free Helpline at 1-866-928-1959 to get a copy sent to you. Page 3. Step 1: Learn About Your Choices. It’s easy to learn about QExA and your health plan choices. To find out more, you can: . Call the toll-free Helpline at 1-866-928-1959 and speak with an Enrollment Counselor. We are here to answer your questions and help you choose your health plan. . Attend a QExA meeting in your area. Enrollment Counselors will provide information on QExA and your health plan choices. You can get all your questions answered and choose your health plan, too. Call us toll-free at 1-866-928-1959 to find a meeting near you. . Meet face-to-face with an Enrollment Counselor. To schedule an appointment, call us toll-free at 1-866-928-1959.. Page 4. Step 2: Choose a Health Plan. With QExA, you will receive your medical services through a health plan. This means you use the doctors, hospitals, pharmacies and care facilities that work with your health plan. . You will choose a doctor, called a Primary Care Provider (PCP), who will make sure your healthcare needs are met. If you don’t have a doctor, your health plan will help you find one. . Time is limited – you need to choose a health plan SOON!. Some questions to ask before you choose a health plan:
Call us toll-free at 1-866-928-1959 to find out which health plans they work with. . Look at your choices and find the health plan that:
There are two QExA health plans: Evercare and `Ohana Health Plan. Both health plans are available on the Big Island, Kauai, Maui and Oahu. Only `Ohana Health Plan is available on Lanai and Moloka‘i.. Page 5. Step 3: Sign Up with a Health Plan. There are three ways to sign up with the health plan you choose:. Call the toll-free Helpline at 1-866-928-1959 and speak with an Enrollment Counselor. We are ready for your call and want to help you choose the health plan that is right for you. TTY users call toll-free 1-866-928-1958. . Send to us the QExA CHOICE Form provided with this booklet. Fill it out and mail it to us at: P.O. Box 135038, Honolulu, HI 96801. Or fax it toll-free to 1-866-535-7620. . Meet with an Enrollment Counselor to help choose your health plan. Call us toll-free at 1-866-928-1959 to find out more. . Page 6 . Evercare QExA. Evercare QExA offers expert service coordination. Evercare has been helping members get care for a long time. With Evercare QExA as your managed care program, you will work with a local service coordinator to make a care plan to fit your specific needs. We will help you with the complex healthcare system. We will work with your doctors and family to help you meet your health goals. With Evercare QExA, you are at the center of your healthcare. We want you to stay healthy and independent. Depending on your care plan, developed by your Service Coordinator, you may be eligible for services such as adult day care, personal help, assisted living, meals and supplies. We can even help with minor home changes so you can get around more easily. We coordinate with Medicare . If you have Medicare, we can help coordinate your Medicare and Medicaid benefits. Benefits to help you stay healthy: Page 7 With Evercare QExA you also get: What if I am already getting care from a doctor? Our goal is to give you a smooth transition to Evercare. We want you to keep getting good care from a provider you like. Call 1-888-980-8728 (toll-free) or for hearing impaired, 1-888-685-8480 to see if your provider is in our group of providers. Or for more information, visit our website at EvercareHealthPlans.com/HI_QExA. What does Evercare QExA cost? Evercare QExA is free! There is no cost to enroll in Evercare QExA. There are no co-payments. How do I enroll in Evercare QExA? To enroll, call the QExA Enrollment Counselor. Why should I choose Evercare QExA? 2008 United Healthcare Services, Inc. Page 8 ALL ABOUT ‘OHANA Why Choose Us? Our people, services and beliefs are all centered on caring for you and your ‘ohana (your family and support group) in a way that best fits your needs. We do this by: If this sounds right for you and your ‘ohana, then come join ‘Ohana! Come Join ‘Ohana... World-Class HealthCare Right Here at Home! 1-888-846-4262 (TTY/TDD : 1-877-247-6272) www.ohanahealthplan.com Page 9 The ‘Ohana Service Coordinator Your local, on-island ‘Ohana service coordinator is a trained healthcare professional and is your advocate within the plan, in the community and across the different healthcare services. Your coordinator will help explain the services that we offer and help you access care when needed. Treating the Whole Person We understand that you and your family may have more than medical needs. Our service coordinators are trained to create care plans that address the needs of the whole person. Person and ‘Ohana-Centered Care We understand that each member has different needs. Your goals and outcomes are the focus of the care planning and management process. Local People, Local Presence When you call ‘Ohana Health Plan, you will talk to an ‘Ohana employee right here in Hawai‘i. When you attend an ‘Ohana event, you will meet with ‘Ohana associates who live and work in your neighborhood. HealthConnections Staying healthy is important at every stage in life. HealthConnections are specific programs that help you and your family take steps to maintain a healthy lifestyle. We have programs to help you connect with local community-based groups when you need additional support. ‘Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. Page 10 QExA Covered Services Medicaid services provided through your QExA health plan include:
Long-Term Care Services, including:
Page 11 Behavioral Health Services, including:
Medicaid services coordinated by QExA include:
For more information about QExA covered services, call us toll-free at 1-866-928-1959. Page 12 Q and A What is QExA? QExA is a new Medicaid program for seniors, 65 and older, and people of all ages with disabilities who currently receive treatment through a Fee-For-Service system. With QExA, these clients will benefit, for the first time, from comprehensive and coordinated care. They will be assisted by a team of healthcare professionals, including Service Coordinators. Starting February 1, 2009, clients will receive medical treatment through the QExA health plan of their choice. Clients will choose a doctor, called a Primary Care Provider (PCP), who works with their health plan. They will see this doctor for regular checkups or when they are sick. When clients need a specialist or other medical services, the PCP arranges care. All QExA members will have a Service Coordinator through their health plan. Service Coordinators make sure the health needs of clients are met. For a list of QExA covered services, see pages 10-11. Page 13 Is everyone in QExA? QExA is designed for seniors, 65 and older, and people of all ages with disabilities who receive Medicaid. Participants in the State of Hawaii Organ and Tissue Transplant (SHOTT) program and Maui PACE are not eligible for QExA. For more information about QExA eligibility, call us toll-free at 1-866-928-1959. What doctors can I see? You need to choose a Primary Care Provider who participates in your QExA health plan. That physician will coordinate your care and make sure you have access to medical specialists and other services. It is easy to find out which doctors participate in the QExA health plans. You can:
Page 12 Q and A continued How do I find out which health plan my doctor is in?
One website is www.evercarehealthplans.com/HI_QExA. The other website is www.ohanahealthplan.com. What are my health plan choices? There are two health plans that provide Medicaid services through QExA: Evercare and `Ohana Health Plan. For more information on each plan, see pages 6-9. For a list of covered services, see pages 10-11. If you live on Lanai or Molokai, you will receive QExA services through `Ohana Health Plan. See pages 8-9 for more information on `Ohana Health Plan. Call the toll-free Helpline at 1-866-928-1959 to find out more about the doctors and facilities available to QExA clients on Lanai and Molokai. Page 15 What happens if I don’t choose a health plan? If you do not choose a health plan between October 1 and December 1, 2008, DHS will choose one for you. Don’t wait; call the toll-free Helpline at 1-866-928-1959 to find out more about your choices. An Enrollment Counselor is ready to answer your questions and help find the health plan that is right for you. Can I change health plans? Yes, you have 90-days to change health plan, for any reason. After this 90-day grace period ends, you can only change health plans:
Back cover and page 16 What Happens Next? After you choose your health plan, we will send you a letter with the:
Your health plan will send you a:
Remember … If you have any questions, help is just a phone call away. Call the toll-free Helpline at 1-866-928-1959 Open 8 a.m. to 5 p.m. ,Monday through Friday TTY line toll-free 1-866-928-1958 Visit us on the Internet at www.qexa.org QExA HAWAI`I QUEST Expanded Access for Healthy Long-Term Living Sponsored by the State of Hawaii Department of Human Services Med-QUEST Division |
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