GHI HMO and GHI PPO Will Withdraw From the Medicaid, FHPlus and CHPlus Programs in Selected Counties, Effective 01/01/2010
Read an article related to this change.
As of January 1, 2010, GHI HMO Select, Inc. (GHI HMO) and GHI PPO will no longer participate in the Medicaid, Family Health Plus or Child Health Plus programs as applicable in the following counties:
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Because enrollment in a Medicaid Managed Care plan is mandatory for GHI HMO Medicaid members living in Albany, Broome, Columbia, Dutchess, Greene, Orange, Putnam, Rensselaer, Rockland, Schenectady, Sullivan and Ulster counties, GHI HMO Medicaid members that live in these counties must choose a new health plan by December 11, 2009, or be automatically assigned to one as of January 1, 2010.
Family Health Plus HMO and PPO Counties
Since Family Health Plus members must receive services from a managed care health plan, members that reside in counties where more than one plan participates in the Family Health Plus program (Albany, Broome, Columbia, Dutchess, Greene, Montgomery, Orange, Otsego, Rensselaer, Rockland, Saratoga, Schenectady, Sullivan, Tompkins, Ulster and Washington counties) must chose a new health plan by December 11, 2009 or be automatically assigned to one as of January 1, 2010.
Members that live in counties where there is only one other Family Health Plus plan (Putnam, Warren, Chemung, St. Lawrence and Schuyler) will be assigned to that plan as of January 1, 2010.
Child Health Plus Counties
Child Health Plus members in all counties must choose a new health plan by December 15, 2009.
Continuity of Care
Former GHI HMO members may be able to continue receiving covered care from you if you are not in their new health plan's network, under the following conditions:
- For up to 60 days from January 1, 2010, in their new health plan, if the patient has a serious condition and is receiving ongoing associated care.
- For up to 60 days after delivery, if the member is three or more months pregnant as of December 31, 2009.
The provider must agree to follow the new health plan's policies and accept the new health plan's reimbursement rates. To obtain prior approval to treat members during this transitional period, please contact the new health plan.
Notices to Your Patients
GHI HMO and GHI FHPlus PPO members residing in these counties are being notified that their health plan will no longer be participating in the Medicaid, FHPlus and CHPlus programs as described above. The notices advise them of their coverage options and the following:
- Medicaid and/or FHPlus members residing in Dutchess, Montgomery, Orange, Otsego, Putnam, Schenectady, Sullivan, Ulster and Washington must call New York Medicaid CHOICE at 1-800-505-5678 by December 11, 2009 to switch to the health plan of their choice.
- FHPlus members residing in Putnam and Warren counties are being advised that they will be assigned to Fidelis because, at this time, that is the only other Family Health Plus plan available in these counties, and that they can contact Fidelis at 1-888-343-3547.
- FHPlus members residing in Chemung, St. Lawrence, and Schuyler counties are being advised that they will be assigned to Excellus because, at this time, that is the only other Family Health Plus plan available in these counties, and that they can contact Excellus at 1-800-722-7884.
- Medicaid and/or FHPlus members residing in Albany, Broome, Columbia, Greene, Rensselaer, Rockland, Saratoga, and Tompkins counties are being advised to contact their Local Department of Social Services Managed Care Unit by December 11, 2009 to switch to the health plan of their choice.
- Child Health Plus members in all counties in the GHI service area are being advised to call the Child Health Plus hotline at 1-800-698-4543 to find out about other health plans in their county and for application assistance.
More Information
For any questions regarding this change, please call Customer Service at 1-877-244-4466, Monday through Friday, from 8 am to 6 pm. TTY/TDD users may call 1-877-208-7920.
Related Article
GHI HMO Medicaid, FHPlus and CHPlus Plans Withdrawing From Westchester and New York City
