1. Primary Adult Care (PAC): An Overview Alice Middleton Planning Administration Department of Health and Mental Hygiene March 27, 2009

2. 2 What is PAC? The Primary Adult Care (PAC) Program began in July 2006  A Medicaid program providing a limited benefit package for adults, including primary care, pharmacy, and outpatient health benefits to those over age 21  Eligible individuals must have incomes below 116% of the Federal Poverty Level (FPL)  Administered through several participating Managed Care Organizations (MCOs)

3. 3 Who is eligible for PAC?  Adults without dependent children between 21 and 64 years old who are: Maryland residents, Not on Medicare, and U.S. Citizens  Previous income requirements were 116% FPL and $4,000 in assets for an individual and 100% FPL and $6,000 in assets for households of more than one April 1, 2009 - regulations will change to exclude asset requirements and income requirements will be 116% FPL for all family sizes  Enrollees do not need to have a medical disability to qualify

4. 4 PAC Eligibility Income Limits Person(s) Monthly Income 1 $1,046 2 $1,408 3 $1,769 4 $2,131 5 $2,493 6 $2,854 7 $3,216 8 $3,577  Beginning April 1, 2009, monthly incomes limits will be 116% FPL for all family sizes, and asset standards will be eliminated

5. 5 5 Medical Assistance Program Coverage (Effective 02/01/09) Note: This chart is for illustrative purposes only. Each coverage group has specific eligibility and some asset requirements, which are not shown. 200 100 300 133 40 Age 65 and Over+ ~ 225 135 100 19610Age 19 to 64 250 PW 185 Poverty Level: 1 person = $10,830 2 persons =$14,570 4 persons = $22,050 As of 1/23/2009 MCHP Premium MCHP Medicaid Medicaid for Parents and Caretaker Relatives & PAC Program Home and Community-Based Waivers (only for very specific populations) Pregnant Women Dual Eligible Medicare & Medicaid QMB- Premium & Cost Sharing SLMB – Premium only. Employed Individuals with Disabilities Program (EID) 300 116

6. 6 Applying for PAC How to apply:  Applications are available for download at http://dhmh.state.md.us/mma/pac/, or http://dhmh.state.md.us/mma/pac/  Call 1-800-226-2142 to have an application sent to you  Send applications to the PAC office: Primary Adult Care P.O. Box 386 Baltimore, MD 21203-0386 A decision regarding the application will be made within 45 days

7. 7 Which health services are covered? PAC Covers the following health services:  Free primary health care  Small pharmacy co-payment Up to $2.50 for generic drugs and $7.50 for brand name drugs  Free in-office mental health services through a counselor or psychiatrist  Limited lab and diagnostic services Some benefits are carved out and covered fee for service, including Specialty Mental Health System services and HIV/AIDS drugs

8. 8 How are services provided? Managed Care Organizations receive a monthly capitation payment for each enrollee 4 MCOs currently provide services to PAC enrollees  Maryland Physicians Care  Priority Partners  United  Jai (Baltimore City & County only) Beginning May 1, 2009, Amerigroup will be a participating PAC MCO To search participating providers by MCO online: https://encrypt.emdhealthchoice.org/searchable/main.action https://encrypt.emdhealthchoice.org/searchable/main.action

9. 9 Can I Change My MCO? Can enrollees change MCOs or be Disenrolled?  An MCO enrollee may elect to change MCOs annually, on the anniversary date of initial enrollment in an MCO. An enrollee may also change MCOs “for cause” if one of the following occurs:  an enrollee moves to another county;  to maintain the family unit;  when special provisions involving children in State- supervised care or children in foster care need to be made; or  to maintain continuity of care with their PCP when the PCP’s contract with the enrollee’s MCO, MCO’s management group or it’s subcontractor is terminating for certain reasons

10. 10 Enrollee Responsibilities PAC enrollees are required to report any changes in status immediately, including income, household size, etc. Eligibility must be determined annually  PAC enrollees must complete and return a redetermination packet to the PAC office

11. 11 PAC Enrollment Total of 25,858 PAC enrollees, as of December 2008  In Frederick County, 571 enrollees Other Counties  Allegany:664  Carroll:200  Garrett:204  Howard:375  Montgomery:1,278  Washington:540

12. 12 How do Providers enroll with a MCO? Call each MCO to enroll and participate:  Maryland Physicians Care 800-953-8854 ext. 3111  Priority Partners 800-654-9728 (Option 4 = Provider Services)  United 1-877-842-3210  Jai 410-433-2200 (Attn Michael Melvin)  Amerigroup (beginning May 1, 2009) 800-454-3730 (Option 2 = Provider Services)

13. 13 PAC Expansion of Services PAC was scheduled to expand services to enrollees in July 2009, but this has been delayed due to budget limitations Tentative Schedule for PAC Expansion  July 2010 – specialty and ER services  July 2011 – outpatient services  July 2012 – inpatient services  July 2013 – full Medicaid benefits

14. 14 Important Contacts To request a PAC application or for questions  1-800-226-2142 Enrollment Help Line  1-866-676-5880 MCOs  Maryland Physicians Care – 1-866-651-7835  Priority Partners – 1-800-654-9728  UnitedHealthcare – 1-800-318-8821  Jai Medical Systems – 1-888-524-1999

15. 15 Additional Information http://www.dhmh.state.md.us/mma/pac Alice Middleton Planning Administration Medical Care Programs Maryland Department of Health and Mental Hygiene amiddleton@dhmh.state.md.us 410.767.3419