Affinity Health Plan

  • Enriched Health
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    On July 1, 2016, Affinity Health Plan will launch a new HARP (Health and Recovery Plan) line of business. This plan will go by the name Enriched Health. Eligibility for Enriched Health is based on a member’s prior use of mental health and substance abuse services. This new HARP includes all of the behavioral health services that were transitioned into Managed Care on 10/1/15, plus additional services known as Home and Community Based Services (HCBS).

    • Why did I receive a letter?

      You received this letter because you are enrolled in Medicaid. This letter was sent to let you know about changes to NY State’s Medicaid program and how they can help you.

      Also, if you received a HARP Eligibility letter, this is to let you know of additional services known as Home and Community Based Services, or HCBS. Eligibility for HARP and HCBS is based on your use of services in the past.

    • What are the changes to Medicaid?

      A new plan is being introduced called Enriched Health. It includes all of the benefits you already have with Medicaid, plus some other support services for people who qualify, like help finding a job or housing, or education support, family support, crisis care, or helping you be the healthiest person you can be.

    • How can I find out if I am eligible?

      The State has specific rules when joining a HARP. You should have received a letter explaining how you were chosen for this new program.

    • Do I have to join?

      No. Enrollment is voluntary.

    • If I choose not to join now, can I join later?

      As long as you still meet the guidelines, you can join later.

      However, New York State has said that there will be periods for open enrollment or changes that may limit when you can join. We recommend that you contact New York Medicaid Choice (Maximus) to find out about the next enrollment periods.

    • If I join a HARP are my children eligible for these additional benefits / services too?

      There will be no changes to your child’s benefits. However, they will not be able to use these other services and they will not be an Enriched Health member.

    • How do I qualify for a HARP?

      Enriched Health eligibility is based on a member’s past use of certain services. Some members have been recognized as people who could benefit from additional services to help them reach their health goals.

    • How do I get these services if I decide I want them?

      You can contact Beacon Health Options and they can help you.

    • Who coordinates my services? Is there a certain person I need to call?

      You are eligible to have Health Home services coordinate your health care. You have a choice of which Health Home you enroll with. Once you decide, you should receive a welcome letter from Health Home describing how they can help you with your health goals.

      If you are already enrolled with a Health Home, you will still use them for coordinating your care. If you aren’t enrolled in a Health Home, you need to follow the same process that you do today.

      Also, there are case managers at your health plan that can provide extra help for care coordination.

    • What is a Health Home?

      A Health Home is a central point of contact and coordination for your health care needs. There are case managers who work with you and your doctors to make sure you are getting the services you need and want. There are certain conditions you need to meet to be eligible for a Health Home.

    • What does it mean help me find a job?

      For Enriched Health members, there are services that provide education and job training to help you reach your employment goals. These services will be based on answers to questions your Health Home completes with you. The services will be available starting October 2016.

    • What kind of housing assistance can I receive?

      Health Homes help members apply for and obtain housing. For Enriched Health members, there are extra services to help you apply for permanent housing, including assisted housing of different types. These services will be based on answers to questions that your Health Home completes with you. The services will be available starting October 2016.

    • What kind of education support would I receive?

      With Enriched Health, members are offered extra employment training to help them reach their employment goals. These services will be based on answers to questions your Health Home completes with you. The services will be available starting October 2016.

    • What does it mean by family support and training?

      It is important that in helping you, your family is also helped. There are other services for Enriched Health- and SNP/HCBS-eligible members that will assist your family in supporting you as you reach your health goals. These services will be based on answers to questions your Health Home completes with you. The services will be available starting October 2016.

    • What kind of crisis services are available?

      For all Medicaid-enrolled members, these services are designed for individuals going through hard times in their everyday life, that call for treatment in a residential-type setting outside of the home. There is a service called Crisis Respite which offers peer and clinical support, and a service called Intensive Crisis Respite which offers extra clinical support. These services will be based on answers to questions your Health Home completes with you.

    • What is Assertive Community Treatment?

      ACT services are teams of people from psychiatry, nursing, psychology, social work, substance abuse and vocational rehabilitation backgrounds who work together to provide someone combined services based on that individual’s goals. As the goals change, the services are adjusted to support the individual’s changing needs. An ACT team works with you outside the clinical setting. They can come to your home, work or other setting, whichever works best for you. Health Homes assist members with applying for and obtaining housing.

    • What are Personalized Recovery Oriented Services?

      The PROS program is designed for individuals with severe mental illness. It has four (4) parts:

      1. Community Rehabilitation and Support helps people manage their illness and restore skills for living in the community.
      2. Intensive Rehabilitation helps people reach a specific goal in a specific area, like education. It also can be used to prevent falling back on old, bad habits.
      3. Ongoing Rehabilitation helps people manage their symptoms in the workplace.
      4. Clinical Treatment services help stabilize, control or improve a person’s symptoms.

      The overall goals of the PROS program are to improve behavior, reduce relapse, increase employment, get an education and find the best housing.

    • What kind of outpatient services does this include?

      All of the outpatient services available to you today are available to you for all programs. This includes: Outpatient withdrawal services, opioid (pain relief) treatment, substance abuse rehab, outpatient mental health treatment, and many more services. You can call a peer advocacy center for more information. You also will be receiving a new member handbook that includes the added outpatient services.

    • What rehabilitation/residential services are covered?

      Medicaid & HARP: There is Comprehensive Psychiatric Treatment, Substance Abuse rehabilitation, PROS focused on improving behaviors, reducing relapse, increasing employment, getting an education and finding the best housing. There are other peer supports and services based on your need. I can have a clinician reach out to you if you would like to discuss your specific circumstances.

      HARP: There are other programs focused on psycho-social rehabilitation, and community psychiatric support. The programs that you would qualify for are determined based on an assessment. You will be assigned a Health Home Care Manager, who will reach out to you to complete the assessment.

    • Who pays for my services?

      Your care is covered as it is today. You will not be charged for your care.

    • Do I need a referral from my PCP to obtain these services?

      No. To get these additional services, you have to be identified by the New York State as needing them, or your doctor can suggest that you qualify. You will be assigned a Health Home Care Manager to go over your needs and to help coordinate your care.

    • I can have all my old services plus any of the new ones offered that I want?

      The additional HCBS services are only available to members that have been identified by NY State as needing them. You will be assigned a Health Home Care Manager to go over your needs and to help coordinate your care.

    • What is a plan of care? Who does that for me?

      A plan of care is a specially designed way to help you reach your goals. It is designed by your Health Home Care Manager to see what services you need.

    • If I don’t qualify, how do I get qualified? What are the certain guidelines to join?

      Participants are qualified based on their history of services used and on their current needs. To receive specific details, please call: 1-844-HARP-999