8071-R15 WBS Show Me Healthy Kids Health Plan User Guide

8071-R15 WBS Show Me Healthy Kids Health Plan

Product Information

Welcome to Show Me Healthy Kids. This guidebook provides basic information on managing your or your child’s healthcare benefits. The Show Me Healthy Kids health plan is a network of doctors, hospitals, and other healthcare providers across Missouri. You will receive healthcare coverage through Show Me Healthy Kids as long as you are eligible. Eligibility groups for Show Me Healthy Kids include

• Children under the age of 19
• Pregnant women
• Parents or caretakers of children
• Former foster care youth under the age of 26

If you or your child does not fall into one of these groups or has Medicare, you will be covered by a general MO HealthNet Managed Care health plan or the MO HealthNet Fee-For-Service program.

Product Usage Instructions

Once enrolled in Show Me Healthy Kids, you will receive two ID cards in the mail

1. A MO HealthNet ID card for prescription medications
2. A Show Me Healthy Kids ID card for use at your doctor’s office

It is important to bring both ID cards to every appointment. Additionally, you will receive a letter with more information about your new health plan and the start date of your services. If you need assistance with opting out of the Show Me Healthy Kids health plan, finding a Primary Care Provider, or have questions about your coverage or any unpaid medical bills, you can contact the following

• MO HealthNet Managed Care Enrollment Helpline : 800-348-6627 (Monday-Friday, 7:00am-6:00pm Central Time)
• Show Me Healthy Kids health plan: 877-236-1020

If you need to report a change in your address or contact information, or request a new MO HealthNet ID Card, please contact your or your child’s Children’s Division case manager or subsidy case manager. For former foster care youth, please email CDMHNQuestions@dss.mo.gov.
If you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, please call Relay Missouri at 800-348-6627 (TTY/TTD: 711) for interpretation services.
All information can be interpreted in any language at no cost.
For more information and resources, you can visit the Show Me Healthy Kids website at www.MyMOHealthPortal.com.

Show Me Healthy Kids Health Plan

Member Guidebook

• Visit us online
• www.MyMOHealthPortal.com
• Call Toll Free: 800-348-6627; TTY/TTD: 711
• Monday-Friday 7:00am-6:00pm Central Time Interpretation Services Available
• Enrollment materials are available in alternative formats
• and communication modes.
• Hay información en español.
• ¡Servicios interpretativos gratis!
• Llame al 800-348-6627 (TTY/TTD: 711).
• Keep this Member Guidebook for future use.
• Revised: 11/2022

Welcome
Welcome to Show Me Healthy Kids. This guide will give you the basic information you need to manage your or your child’s healthcare benefit.

• Visit https://MyMOHealthPortal.com to learn more
• MO HealthNet Managed Care Enrollment Helpline –
• 800-348-6627 Call for help with questions about opting out of the Show Me Healthy Kids health plan or finding a Primary Care Provider. The Enrollment Helpline is open from 7:00 A.M. to 6:00 P.M., Monday through Friday (except holidays).
• Show Me Healthy Kids health plan—877-236-1020
• Call if you need help finding a provider or if you have questions about your coverage or any unpaid medical bills.

Reporting Changes
If you need to report a change in your address or contact information, or to request a new MO HealthNet ID Card, contact your or your child’s Children’s Division case manager or subsidy case manager. If you are a former foster care youth, please email CDMHNQuestions@dss.mo.gov

Hearing or Speech Impaired
If you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Missouri

• 800-735-2466 (Voice)
• 800-735-2966 (Text Phone)

About Show Me Healthy Kids|
The Show Me Healthy Kids health plan began on July 1, 2022. You or your child were automatically enrolled into this health plan on July 1, 2022, or the day you were approved for MO HealthNet benefits. Show Me Healthy Kids has a network of doctors, hospitals, and other providers across.

Missouri that you may see for care.
You or your child will continue to get healthcare coverage through Show Me Healthy Kids as long as you are eligible. Eligibility groups for Show Me Healthy Kids include

• Children in the care and custody of the Missouri Department of Social Services
• Children or youth in alternative care
• Children receiving adoption or legal guardianship subsidy
• Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by MO HealthNet (Missouri Medicaid), and who meet other eligibility criteria
• Former foster care youth under the age of 26, who were in foster care on their 18th birthday and covered by Medicaid from another state, and who are not currently eligible for Medicaid coverage under another program.

If you or your child is not in one of these groups or has Medicare, you cannot be in the Show Me Healthy Kids health plan. You or your child will be covered by a general MO HealthNet Managed Care health plan or the MO HealthNet Fee- For-Service program.

How it Works
Once you are enrolled in Show Me Healthy Kids, you will get two cards in the mail : a MO HealthNet ID card (used for your prescription medications) and a Show Me Healthy Kids ID card (used at your doctor’s office). You will need to bring both ID cards to every appointment. You will also get a letter that gives you more information about your new health plan and the date your services began.

Health Risk Assessment
The Health Risk Assessment form helps the health plan understand you or your child’s health care needs. You need to fill out the Health Risk Assessment form for each person in your household enrolled in the Show Me Healthy Kids health plan and return it in the pre-paid envelope provided in your enrollment packet.

Choosing a Primary Care Provider

What is a Primary Care Provider?
Your primary care provider is the doctor, nurse practitioner, or clinic you call when you need health care services, unless it is an emergency.

Choosing a Primary Care Provider
You must choose a primary care provider that is with the Show Me Healthy Kids health plan. If they are not, you will need to contact your health plan and choose a new provider. If you do not choose a provider, the health plan will choose one for you.

What type of Primary Care Provider do I need?
If you or your child have a chronic illness, special needs, or if you are pregnant, your primary care provider may be a specialist. You can also choose a Federally Qualified Health Center (FQHC) as your primary care provider. FQHCs provide primary care and other core services, such as health care, preventive (wellness), behavioral health, immunizations (shots), home nurse visits, and other services.

Frequently Asked Questions

Do I have to be in Show Me Healthy Kids?
Members of the Show Me Healthy Kids health plan are not able to change health plans, but you do have the option to opt out if you or your child meets one of the following

• Eligible for Supplemental Security Income (SSI) benefits
• Children who are enrolled in the Special Health Care Needs program

For help with opting out of Show Me Healthy Kids, call 800-348- 6627.
What happens if I lose eligibility for Show Me Healthy Kids?If you or your child’s Show Me Healthy Kids eligibility changes, it may cause you to be moved to one of the general Managed Care health plans as long as you are eligible for MO HealthNet

Managed Care services. Examples of why you or your child could lose eligibility for the Show Me Healthy Kids include

• Leaving the care and custody of the state
• No longer receiving adoption or legal guardianship subsidy
• Former foster care youth turning 26 years of age
• Moving out of Missouri

If I become pregnant and have a baby, will my baby be placed in the same health plan?
Yes, as long as the baby is eligible for MO HealthNet (Medicaid).

If I move, will I have to change health plans?
No. Your health plan is statewide and will not change if you move within Missouri. You will need to contact the Children’s Division per case type below to report your change of address

• For resource and kinship families, contact your CD case manager
• For subsidy cases, contact your subsidy case manager
• For former foster care cases, email CDMHNQuestions@dss.mo.gov

How do I get enrollment materials if I do not have the internet?All materials are mailed to you. If you lost your enrollment packet, contact the MO HealthNet Enrollment Helpline at 800-348-6627 and ask for a new packet to be mailed to you.

Covered Services
The services below are covered by all Managed Care health plans. Some services are limited based on your age or eligibility group and other services may be available depending on your needs. Work with your provider to see if the service you need is covered.

Healthy Children and Youth (HCY) services. Examples include

• Physical exams
• Immunizations (shots)
• Testing lead levels in blood

| Covered
Hearing aids and related services| Covered
Home health services| Covered
Hospice (if you are in the last 6 months of life)| Covered*
Inpatient/outpatient services| Covered
Laboratory tests and x-rays| Covered
Maternity services| Covered
Personal care| Covered
Pharmacy| Covered through MO HealthNet Fee-For-Service
Preventative care, including

• Well checks
• Mammograms
• Cancer screenings

| Covered
Podiatry (medical services for your feet)| Covered
Service| Coverage
---|---
Primary care provider services| Covered
Specialist care (with your provider’s referral)| Covered
Therapy services (physical, occupational, and speech)| Covered
Tobacco cessation counseling| Covered
Transplant related services| Covered
Transportation to medical appointments| Covered*
Treat No Transport services| Covered
Local health department services, including

• Immunizations (shots)
• Screening, diagnosis and treatment of sexually transmitted diseases, HIV, tuberculosis and lead poisoning

| Covered
Vision| Covered*

• Limited Coverage Benefit. Refer to health plan handbook for more information.

Members Rights & Responsibilities
Show Me Healthy Kids members have rights that protect the quality of care received from the health plan. You or your child have the right to:

• Be treated with respect and dignity
• Receive needed medical services
• Privacy and confidentiality (including minors) subject to state and federal laws
• Select your own primary care provider
• Refuse treatment
• Receive information about your health care and treatment options
• Participate in decision-making about your health care
• Have access to your medical records and to request changes
• Have someone act on your behalf if you are unable to do so
• Be free of restraint or seclusion from a provider who wants to
  • Make you do something you should not do
  • Punish you or get back at you
  • Make things easier for them
• Be free to exercise these rights without retaliation
• Receive one copy of your medical records once a year at no cost

Show Me Healthy Kids members also have certain responsibilities

• Be knowledgeable about your medical coverage
• Get routine and ongoing care from your providers
• Contact your primary care provider first when needing care
• Only use the emergency room in an emergency
• Make and keep appointments or call ahead to cancel
• Carry your MO HealthNet card and Show Me Healthy Kids card at all times and show them at your appointments

Helpful Information

• Access to Care – The health plan must enroll providers that are available and close to where you live. The health plan must provide urgent care for physical or behavioral health within 24 hours, regular care if you have symptoms within five business days, and regular check-ups within 30 calendar days. There are special requirements for maternity care.
• Grievance or Appeal – To make a grievance or appeal, call or write to the Show Me Healthy Kids health plan.
• Identification (ID) Cards – You or your child will receive a MO HealthNet ID card and a Show Me Healthy Kids ID card once you are approved. Always carry both cards and show them every time you get care. If you lose your MO HealthNet card, contact your Children’s Division case manager or subsidy case manager. For former foster care youth, email: CDMHNQuestions@dss.mo.gov. If you lose your Show Me Healthy Kids card, call the health plan.
• Release for Moral or Religious Reasons – The health plan may not cover services you or your child needs because of moral or religious reasons. If this happens, your health plan will let you know how and where else to get the service.
• General Sickness – If you or your child gets sick, you should call your primary care provider first unless it is an emergency. If it is an emergency, call 911 or go to the nearest emergency room, even if it is not in your health plan network.
• Specialist – If you need a specialist, your primary care provider should refer you.

Advocates for Family Health
Advocates for Family Health is an ombudsman service. An ombudsman is a problem solver who can advise and help you.

They can help if you

• Need help understanding your rights and benefits
• Feel your rights to health care are being denied
• Are not able to solve the problem by talking to a nurse, primary care provider, or your health plan
• Need to talk to someone outside of your health plan
• Are not sure how to make a grievance (complaint)
• Need help when appealing a decision by your health plan
• Need help requesting a State Fair Hearing

Call the Advocates for Family Health office for your county for help.

Legal Aid of Western MO

• 4001 Dr. Martin Luther King, Jr. Blvd.
• Suite 300
• Kansas City, MO 64130
• Phone: 816-474-6750
• Fax: 816-474-9751

Mid-MO Legal Service

• 117 North Garth
• Columbia, MO 65203
• Phone: 573-442-0116
• Fax: 573-875-0173

Legal Services of Southern MO

• 809 North Campbell
• Springfield, MO 65802
• Phone: 417-881-1397
• Toll free : 800-444-4863
• Fax: 417-881-2159

Legal Services of Eastern MO

• 4232 Forest Park Avenue
• St. Louis, MO 63108
• Phone: 314-534-4200
• Toll free : 800-444-0514 ext. 1251
• Fax: 314-534-1028

Non-Discrimination Notice
The MO HealthNet Division complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. The MO HealthNet Division does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

The MO HealthNet Division

• Provides aids and services to people with disabilities at no cost to communicate effectively with us, such as
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides language services at no cost, to people whose primary language is not English, such as
  • Qualified interpreters
  • Information written in other languages

If you need a qualified interpreter, written information in other formats, translation or other services, call the MO HealthNet managed care enrollment helpline at 800-348-6627.
If you believe the MO HealthNet Division has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with the Missouri Department of Social Services, Office for Civil Rights at 800-776-8014; or 866-735-2460 (Voice); 800-735-2966 (Text). Complaints may also be filed by writing to: Missouri DSS Office for Civil Rights, P.O. Box 1527, Jefferson City, MO 65102-1527.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at

• ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or
• phone at : U.S. Department of Health and Human Services,
• 200 Independence Avenue, SW Room 509F, HHH Building,
• Washington, D.C. 20201, 800-368-1019, or TDD at 800-537-7697.

Complaint forms are available at

• www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html
• Multi-language Interpreter Services

ATTENTION: If you speak English, language assistance services, at no cost, are available to you. Call 800-348-6627.
.

All information can be interpreted in any language at no cost.
800-348-6627 TTY/TTD: 711

References

• MO.gov
• Complaint Process | HHS.gov
• MO Health Net - Home
• MO Health Net - Home
• U.S. Department of Health & Human Services - Office for Civil Rights
• Complaint Process | HHS.gov
• MO Health Net - Home

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