WASHTENAW COUNTY HEALTH PLAN
http://www.ewashtenaw.org/government/departments/public_health/ph_whp.html
Social workers should be knowledgeable about and able to provide education to patients, families and staff about Washtenaw County Plan(WHP). They need to educate patients and families about:
Resources for the process are linked below. Social workers should also be able to determine if the patient and/or family member needs assistance in this process and to make a determination if the need is urgent. Individuals may require assistance due to language barriers, limitations in education, inability to follow through due to health or mental health issues, urgency of need, etc.
What is the Washtenaw County Health Plan?
Washtenaw Health Plan is a program for qualified Washtenaw County residents without health insurance to receive primary health care from local doctors and clinics.
Who is eligible?
Washtenaw County Health Care Program is not an Insurance company. Patients eligible for Washtenaw County Health Care Program must meet specific criteria, including:
Members must be residents of Washtenaw County
What coverage does WHP provide?
Members enrolled in Washtenaw County Health Care Program can visit their assigned doctor or clinic for primary care services, like check-ups & routine physicals, or when they become ill. Other services like necessary hospitalizations and some specialty care may be covered.
How to apply?
Patients can apply directly during Walk-In hours at WHP (Mon-Fri 1-4PM ). Morning hours are available by appointment only. To access the most up-to-date brochures and application materials (available in several languages), go to the website:
http://www.ewashtenaw.org/government/departments/public_health/ph_whp.html
What the Social Worker needs to do to assist the patient in Initiating Enrollment can be located at this link.
Provide the following materials to patient for their own reference (available online):
“Information for Applicants” brochure, List of WHP Primary Providers, List of WHP Pharmacies.
Emergency 90-Day Coverage
Patients whose income is at or less than $3000/year or who may not have all required documentation at time of SW assistance with enrollment can apply for WHP and potentially receive emergency 90 day coverage which can begin immediately. These patients are enrolled only in 90-day coverage with full coverage contingent upon proof that they do not qualify for another program and/or submission of missing documentation. During this 90-day period, the patient should apply for DHS benefits and have Medicaid or Adult Benefit Waiver (ABW) Program eligibility determined. (ABW program currently frozen.) SW should direct patient to DHS and provide application as patient’s emergency coverage (and their ability to get this emergency coverage in the future) will be contingent on the patient’s follow-up.
Items of Note:
Social Work can request that the patient’s “start date” for WHP eligibility be retroactive back to the 1 st day of the current month. This option must be specifically requested by Social Work to take effect. Contact WHP Case Manager for approval.
Emergency WHP coverage can be obtained for inpatients who meet criteria. Fax application as soon as possible during patient’s stay. Coverage can be initiated very quickly and WHP can fax a copy of the patient’s card to Social Work for patient to use for discharge meds. Reminder: Social Work must request a retroactive start date in order for patient’s hospitalization to be covered.
If a patient was covered under the 90-day option and has not yet received acceptance or denial from Medicaid, Social Work can request that the patient’s coverage be extended an extra 30 days. Social Work or patient must contact the WHP Case Manager for approval.
Social Work can request verification of enrollment. When SW is faxing an application to assist with enrollment, please use the WHP fax cover sheet (available in Ambulatory Care Manual/Financing Medical Care/Washtenaw Health Plan). Social Work can request that a copy of the patient’s card be faxed to the Social Worker for our records and for the pharmacy. The patient will receive their card as well as enrollment materials in the mail.
WHP Prescription Coverage
WHP has limited prescription coverage for its members. A formulary can be found online at: https://ummcpharmweb.med.umich.edu/formulary/. WHP formulary is listed under “Payor References.” You can search the formulary available to your specific patient by entering the patient’s first initial, last name, and either WHP ID# or birthdate. There is a co-pay of $3 for generic medications and $5 for brand-name medications. Psychotropic medications are $5 for generic and $10 for brand-name.
WHP will, at times, authorize temporary coverage for non-formulary medications. WHP will assist patients with applications for prescription assistance programs for these medications or will expect that patients will follow-up with their physicians or clinics to do this.
WHP Specialty Services
Specialty services include care such as blood work, ultrasounds, radiology, a physician specialist, etc. These services need to be prescribed by a patient’s PCP. Patients should contact the specialty care authorization phone number on their WHP member card to get pre-approval or for questions. At U of M, specialty authorization can be requested from: Dionne Slater 647-5216. Patients should have their appointment scheduled prior to requesting this authorization.
PRESCRIPTIONS:
Patient’s discharge medications can be filled with only the co-pay charge when patient is given a WHP ID number. This can usually happen within the day if a WHP representative is available to assist. If the patient is discharged prior to receiving an ID number, an OK to bill form can be completed. To insure that the pharmacy fills only medications that will be reimbursed, write “Follow WHP guidelines” on the OK to bill form. It is important to follow-up on the WHP ID number for the patient, as the medications must be retroactively billed within 14 days. Contact Judy Miller with the ID number and patient’s name and CPI when obtained.
Suggestions for documentation of the WHP process and education can be located through the following link.
If corrections or modifications are needed in this process, please notify: mlbowden@umich.edu.