Q: We just switched my mom’s Advantage Plan a month ago, and now she’s received a letter telling her she has to call a number to keep from being enrolled in something else! What’s going on?
A: Your mom likely has Medicare and Medicaid, which is known as being dually eligible, or “fully dual.”
Being fully dual, in Southwest Michigan, she’s eligible for a program known as MI Health Link. This is a managed-care program that’s offered here through Aetna Better Health or MeridianComplete.
It’s also a form of Advantage Plan, which might work well for some fully dual individuals. It offers all the benefits from Medicaid and Medicare, as well as other benefits, including: one health plan providing Medicare and Medicaid services; $0 copays or deductibles for in-network services or medications; care coordination; dental care; and transportation for covered medical services.
MI Health Link began in 2015, and since then eligible people have been passively enrolled into the program. In other words, unless someone states they don’t want to be enrolled, they will be enrolled.
Individuals are sent a notification letter about eligibility to the program, and a deadline (usually 90 days from the date of the letter) for “opting out” along with the phone number to call to do so. It’s best to respond as quickly as possible.
If the state hears nothing, another letter is sent 60 days before the enrollment effective date, and then again 30 days before the enrollment effective date. If there is no “opt out” response given by the person, they’ll be enrolled in MeridianComplete or Aetna Better Health, and will receive the information about their new plan.
The number to call to opt-out is Michigan ENROLLS at 800-975-7630.
Those already enrolled in MI Health Link, MI Choice Medicaid Waiver or PACE shouldn’t receive this letter or have to opt out of MI Health Link.
Additionally, if you have opted out of MI Health Link in the past 12 months, you should not receive this letter and have to opt out again.
However, if you have opted out of MI Health Link anytime between 2015 and January 2021, you likely will have to do so again.
If you have additional questions or concerns about this process, or about your health benefit options in general, you can speak with an unbiased, highly trained counselor by contacting the Michigan Medicare/Medicaid Assistance Program (MMAP) at 800-803-7174.
Q: I’m in a Medicaid program where I’m supposed to have a care management team. The problem is, I can never get a timely return call from anyone. Is there an oversight agency I can contact?
A: The Michigan Elder Justice Initiative administers the MICPOP (MI Choice Waiver, Community Transition Services, and PACE Ombudsman Program) and the MI Health Link Ombudsman Program to ensure participants receive the home and community-based services (HCBS) they are entitled to under these programs as well as to protect a participant’s rights.
The phone number to call is 888-746-6456.
MICPOP/MI Health Link advocates work directly with participants via in-person meetings, telephone and/or video teleconferencing to properly understand the issues facing the participant and to assist in resolving their problems. In addition, MICPOP/MI Health Link advocates use their knowledge and experience to educate policy makers and promote improvements within the HCBS system.
These ombudsman programs serve the entire state. There are no fees or costs to applicants, participants or families for utilizing MICPOP/MI Health Link Ombudsman services.