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Children’s Community Health Plan A member of Children’s Hospital and Health System.

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Presentation on theme: "Children’s Community Health Plan A member of Children’s Hospital and Health System."— Presentation transcript:

1 Children’s Community Health Plan A member of Children’s Hospital and Health System

2 What is CCHP? an HMO for Medicaid and BadgerCare eligible children and adults Milwaukee, Waukesha, Racine and Kenosha Counties. CCHP does not participate in SSI

3 What benefits does CCHP offer? Doctor Visits Hospital Services Dental Services Vision Services Behavioral Health Medical Equipment Emergency Care Prescription Drugs Transportation for Milwaukee County Residents

4 Why has Children’s entered the Medicaid HMO market? Children ’ s entered the Medicaid HMO market for many reasons To maintain local ownership and management To increase member access to needed services (especially dental and mental health) To integrate delivery and management of care

5 Why has Children’s entered the Medicaid HMO market? (cont’d.) CCHP has the ability to integrate health care and social services (Children ’ s Service Society of Wisconsin) CCHP is committed to re-distributing funds back to providers and into the community

6 Who is in our Provider Network? Aurora Health Care (special rules apply) Children ’ s Hospital & Children ’ s Medical Group Columbia / St. Mary ’ s Wheaton Franciscan HealthCare Medical Associates Froedtert & Community Health Medical College of Wisconsin United Hospitals System Waukesha Elmbrook Health Care Waukesha Memorial and Oconomowoc Memorial Hospitals

7 Who is in our Provider Network? (cont’d) Dental services coordinated by SEDA Vision services coordinated by Herslof

8 Medicaid & BadgerCare Statistics as of February 2007 Wisconsin 487,465 pregnant women, children and their caretakers in Family Medicaid Of this number, 97,294 are enrolled in BadgerCare

9 Medicaid & BadgerCare Statistics as of February 2007 Milwaukee County 144,432 pregnant women, children and their caretakers in Family Medicaid (approx. 30% of the state ’ s total) Of this number, 18,570 are enrolled in BadgerCare

10 CCHP Enrollment As of 4/1/07MilwWaukRacineKenoshaTotal2/1/06 Change CCHP/Dean SE4, ,7771,495 8, ,223 United/AC63,7005,650 8,566 5,85583,771 69,362 14,409 MHS/NHP63,3132,984 5,035 7,71179,043100,661(21,618) Abri 5, , ,637 6,444 1,193 Other (9) _______________________________________________________________________________ 136,436 9,462 17,492 15, , ,517 2,198

11 Dean Health Plan Southeast Dean Health Plan has subcontracted with CCHP to expand their Medicaid service area to Milwaukee, Racine, Kenosha and Waukesha counties. Through the subcontract with CCHP, Dean Health Plan members will access the CCHP provider network and follow all CCHP policies and procedures.

12 How will Dean Health Plan impact you as a provider? Dean Health Plan Medicaid members, living in Southeastern Wisconsin will access the CCHP provider network. From an operational perspective, this addition will be seamless to CCHP providers.

13 How will Dean Health Plan impact you as a provider? (Cont’d) Members that select or are auto assigned to Dean Health Plan in Milwaukee, Kenosha, Racine and Waukesha counties will have the Forward Card. When a provider office swipes the Forward Card or calls EDS eligibility, the HMO identifier of Dean Health Plan Southeast will appear – HMO #18. As a result, members will be able to access services at your clinic. If you are a provider for CCHP, you will also be a provider for Dean Health Plan Medicaid in Southeastern Wisconsin.

14 Contact Information Mark Rakowski, Executive Director Teri Frederickson, Dir. Of Clinical Services Sue Gorecki, Operations Manager

15 Contact Information (cont’d) Julie Antholine, Provider Relations & Contracting Rep Laura Kerecman, Member Advocate or Children’s Community Health Plan Member Services Medicaid & BadgerCare Enrollment Specialist


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