Enrollment Consultation
The federal government requires that people who enroll in
Medicaid managed care programs such as Family Care must receive
information about the different service options available to them, and
that this information must be provided by someone who does not work for
the same organization or county that operates the care management
organization (CMO). For eligible people who want to enroll in Family Care,
this information is provided by an enrollment consultant who speaks with
the person by phone or in person to make sure he or she fully understands
what it means to receive health and long-term care services from a managed
care program.
Enrollment consultation provides potential enrollees with
complete, accurate and unbiased information that is tailored to their
individual situations, including how much they already know about Family
Care, and how they communicate most effectively. Information provided
includes:
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The full range of services available should the person
choose not to enroll in Family Care, including home care, community
services, case management, and nursing home and other residential
services.
-
All available publicly-funded long-term care programs,
including Medicaid state plan services and Family Care services (and
in Milwaukee County, PACE and the Wisconsin Partnership Program) and
the advantages and disadvantages of each.
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Factors to consider when choosing different programs
or services, including cost, quality, outcomes, estate recovery,
compatibility with the person’s preferred lifestyle and residential
setting, and available resources.
-
Consumer rights and responsibilities, including
complaint, grievance and fair hearing procedures.
In counties where there is more than one managed long-term
care program to choose from (currently only in Milwaukee County), the
enrollment consultant provides information that compares the different
choices, including what services each program offers and what services it
does not, any limits or restrictions on receiving certain services, and
any available information about the quality of services in the different
programs.
Finally, if the person decides to enroll in a managed care
program, the enrollment consultant reviews information about that specific
program, including summarizing information the member will find in the
program’s member handbook, and helps the person complete the enrollment
process so he or she can start receiving services.
The Department of Health and Family Services (DHFS)
contracted with the Southeastern
Wisconsin Area Agency on Aging (SEWAAA), a private non-profit
organization, to provide enrollment consulting in the five counties where
CMOs are operating.
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Last Revised: December 02, 2004
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