April 1 brings major improvements for Apple Health (Medicaid) program

OLYMPIA – On April 1, the Health Care Authority will launch several changes to the state’s Apple Health (Medicaid) program, which covers nearly 2 million Washington residents.

“Tomorrow marks the launch of a new and improved approach to provide services to our Apple Health clients,” said HCA State Medicaid Director MaryAnne Lindeblad. “We are moving in a new direction, one that assures our clients have access to health care that focuses on the whole person, integrated care, and a system that better supports the health and well-being of our clients.”

The improvements include:

Physical and behavioral health services integrated in Clark and Skamania counties, our “early adopter” region. Apple Health clients in Clark and Skamania counties will choose one plan that can meet all of their physical and behavioral health needs. All other areas of the state will be required to fully integrate by 2020, using the Regional Service Areas created for Medicaid purchasing.

Currently, Apple Health clients with mental health and substance abuse needs must navigate three separate systems to access the services they need to get and stay healthy. The physical health, mental health, and substance use disorder delivery systems cannot easily communicate with each other about shared clients’ care, which leads to duplication of services, gaps in care, and, at times, a frustrating experience for both clients and the providers who serve them.

Whole-person care will be delivered through managed care plans responsible for ensuring physical and behavioral health services are well-coordinated. By combining the funding sources for all services and holding one organization (the managed care plan) accountable for delivering high-quality, whole-person care, incentives are better aligned to ensure effective delivery of services, improved quality of care, and interdisciplinary care teams that can more easily support clients in getting the care they need.

Children in foster care and adoption support moving to managed care. Apple Health foster care clients will move into a managed care plan that will provide more seamless care coordination. Implemented as a result of House Bill 1879, HCA will be auto-enrolling children and youth in foster care into a managed health care plan.

The new plan will be administered under contract with Coordinated Care of Washington. The following individuals will be automatically enrolled:

o Children and youth in foster care.
o Children and youth in adoption support.
o Young adults in extended foster care (18- to 21-year-olds).
o Young adults ages 18 to 26 who aged out of foster care on or after their 18th
birthday.

Moving to managed care will provide a more collaborative approach to care for these children, youth, and young adults. Contracted providers will have the technology to securely access and share the client’s medical information, avoiding duplication of services. And clients can look forward to smoother health care transitions as children and youth move from home to foster care, and between placements, or other institutional settings.

Same-day enrollment. Apple Health clients will be enrolled in a managed care plan the same month that they are determined eligible as a new or renewing client. This means clients no longer have to be placed temporarily in a fee-for-service system while they are waiting to be enrolled or reconnected to a managed care plan.

For more information:

• Learn more about Apple Health.
• Learn more about physical and behavioral health integration.