Anthem Commonwealth Coordinated Care Plus (CCC Plus)2 Understanding Anthem CCC Plus CCC Plus What is Medicaid? What is Medicare? Your care coordinator A safe place to live Food and - [PDF Document] (2024)

1

Anthem Commonwealth Coordinated Care Plus (CCC Plus)

22

Understanding Anthem CCC Plus

CCC Plus

What is Medicaid?

What is Medicare?

Your care coordinator

A safe place to

live

Food and meal

assistance

Living your life

Getting where you need to go

3

What is CCC Plus?

•Virginia’s health insurance program for people with Medicaid who need extra help managing their care.

•Goal: to provide care focused on you

• Includes medical, behavioral health and long-term services and supports

•Care coordinators help you plan your care and solve problems

•Better communication between your providers

•Help with basic needs like food and a safe place to live

•Extra benefits like dental visits, rides to the doctor and free eye glassesHOME

4

Who’s eligible?

•Virginians who are 65 and older

•Adults and children with disabilities

•People living in nursing facilities

•People who need help to live in the community and have the CCC Plus waiver

•Individuals receiving any of the 3 developmental disability waivers

•Participation is mandatory for eligible members

HOME

5

The CCC Plus waiver

•For Virginians who need help living independently in the community

•If you qualify based on a home visit from the local Department of Social Services (DSS), the cost of personal care services in your home is waived

•Services include adult day care, personal assistance services, respite care, assistive technology, environmental modifications and transition services

HOME

6

Extra benefits for Anthem CCC Plus members

• Two dental exams and cleanings, plus one set of X-rays per year

• Glasses every year (lenses and frames)

• One hearing exam and up to $1,000 for hearing aids, unlimited visits for fitting and 60 hearing aid batteries each year

• Rides to places of worship, grocery stores, the library, the DMV, hair salons and community activities near you

• $50 for assistive devices and $50 for walker or wheelchair accessories, mailed right to your door

• Smartphone with monthly data, minutes and texts, plus free calls to Member Services and health coaching

• Anthem Community Resource Link to search for jobs, food, housing and other resources near you

• HEPA-grade air purifier (prior approval required)

HOME

What is Medicaid?

HOME

8

Medicaid•Provides health insurance for Virginians who meet income and other eligibility guidelines

•The Virginia Department of Medical Assistance Services (DMAS) decides who receives Medicaid and what services they receive

HOME

9

Who’s eligible?

•Must live in Virginia as a legal resident

•Children, pregnant women and adults with family income (before taxes and deductions) within the newly-expanded Medicaid limit

•Children in foster care (automatically eligible) or adoption assistance

HOME

1010

HOME

11

How to apply

To apply for Medicaid:

•Visit the CommonHelp website

•Call Cover Virginia at 1-855-242-8282 (TDD 1-888-221-1590)

•Mail, fax or go in person to your local DSS office

You’ll find out if you qualify within 45 days for most applications. You’ll be notified if more information is needed.

HOME

12

How to renew or switch

To renew your Medicaid benefits:

•Reapply every year the same way you did the first time

• If you don’t, you may lose your benefits

•Make sure to keep your address up-to-date with your local DSS

To switch plans within your first 90 days:

•Visit the CommonHelp website

•Download the Virginia Medallion Medicaid mobile app

•Call Cover VirginiaHOME

What is Medicare?

HOME

14

Medicare

Provides health insurance for most U.S. citizens and some immigrants who are:

• Age 65 and over

•Younger people with certain disabilities

•On kidney dialysis

HOME

15

HOME

1616

The ABC’s of Medicare

HOME

17

Dual Eligible Special Needs Plans (DSNPs)

•Designed to cover services not covered by CCC Plus for those who qualify for both Medicaid and Medicare

•Having the same health plan for Medicaid and Medicare makes coordinating benefits much easier

•There are other ways you can have Medicare coverage (remember your ABCs)

•Our DSNP Plan is called MediBlueDual AdvantageHOME

18

I can get both Medicare and Medicaid (Duals)

Dual-eligible members where Anthem only covers CCC Plus Medicaid benefits

or

Anthem CCC Plus Medicaid

Medicare from another DSNP health plan

Traditional Medicare

HOME

19

I can get both Medicare and Medicaid (Duals)

Dual-eligible members where Anthem covers both of the benefits

MediBlue Dual Advantage Medicare

Anthem CCC Plus Medicaid

One companyOne phone number

HOME

20

DSNP and CCC Plus

CCC Plus

Adult Day Health

Custodial Nursing Home

Transportation

Housing Support

Personal Care Attendants

Social Services

Medicare Copays

Hospital and SNF when Medicare is exhausted

Some Non-Medicare covered OTC Drugs

Incontinence Supplies

DSNP

Lab Services

Prescription Drugs

Skilled Nursing Facility

Rehab Therapies

Home Health

Inpatient Psych

Preventative Care

Physician Office Visits

Outpatient Surgery

Outpatient Psych

ER and Urgent Care

Inpatient Hospital

Prosthetics

Diabetic Monitoring and SuppliesESRD

Vision

Hearing

Dialysis

Behavioral Health Support

All GREEN Services

Medical Equipment

HOME

21

Why choose us as your Medicare plan?

•Extra benefits, just for you

•One team to work with

•Easier to coordinate with all your doctors

•Prescription drugs are included, so one less card to remember

HOME

22

DSNP enrollment

•Enrolling in our DSNP plan is easy.

•Dual eligible CCC Plus members can enroll at any time.

•Just call 1-855-558-1434

HOME

Your care coordinator

Here to helpHOME

24

What is a Care Coordinator?

•A nurse or social worker assigned to help you

•Listens to your goals and creates a plan to help you reach them

•Helps you manage your medical conditions

•Helps you use and understand your insurance benefits

•Help you find community resources

•Makes sure everyone who supports you can work together to help you

HOME

25

What do I do?You go to a pharmacy and the pharmacist says your insurance won’t pay for your medicine.

What do you do?

Call your care coordinator.HOME

26

What do I do?You get a letter from the insurance company and you don’t know what it means.

What do you do?

Call your care coordinator.HOME

27

What do I do?You just left your doctor’s office, and you did not feel they listened to you. You want to find a new doctor.

What do you do?

Call your care coordinator.HOME

28

Your care coordinator can also help you with basic needs like:

Transportation

Housing Support

Personal Care Attendants

Social Services

Medicare Copays

Some Non-Medicare covered OTC Drugs

Behavioral Health Support

All GREEN Services

Medical Equipment Food and water

Clothing

A safe place to liveHOME

Food and meal assistanceHOME

30

We can help you

•Get rides to farmer’s markets and grocery stores (up to 12 round trips each year)

•Plan your meals and budget

•Make sure you have healthy food to eat

•Find tools and resources, like recipes and tips for healthy eating on a budget or help finding a food pantry near you

•Enroll in programs you may qualify for like Meals on Wheels, FeedMore or adult day centers if you need help cooking or eating

HOME

31

Tips and tricks

•Save time and money by making a weekly meal plan that shares common ingredients

•Supplement your grocery budget with staples from your local food pantry

•Use your EBT card at farmers’ markets that double your money

HOME

A safe place to live

HOME

33

We can help you:

•Find new housing

•Modify your current housing

•Make your home safer

•With other housing-related needs

Contact your care coordinator. They’ll help you get the resources you need.

HOME

Making your home more accessibleEnvironmental modifications

HOME

35

What is an environmental modification (EMOD)?

•Modifications made to your main home or car to make it safer or more accessible

•To qualify, a modification must have a medical benefit and help you function with greater independence

•Available to CCC Plus waiver members

•$5,000 maximum per fiscal year (July 1 through June 30)

•Contact your care coordinator to request modifications. They’ll set up a meeting with you to discuss your needs. You may need your doctor to complete a form stating the modification is necessary.HOME

36

Pest control services

Transportation

Housing Support

Personal Care Attendants

Social Services

Medicare Copays

Some Non-Medicare covered OTC Drugs

Behavioral Health Support

All GREEN Services

Medical Equipment

• CCC Plus provides some pest control services, like routine and bed bug extermination services

• If you need pest control services, contact your care coordinator. They may need to visit your home to identify specific needs.

Quick tips for pest prevent: • Remove trash, especially food• Don’t leave dirty dishes out• Tightly close all food containers

HOME

37

Other resources

•Non-profits

•No Wrong Door Virginia

•Call 2-1-1

•Your local Department of Social Services Office (DSS)

•Your local Community Service Board (CSB)

•Your local housing authority office

HOME

Living your life

HOME

39

Adult day centers•Located throughout the state

•Free rides to and from your home

•Get professionally prepared meals

•Take field trips and classes, play games and meet new people

•Have help with health screening, personal care and medication

•For CCC Plus members who need personal care assistance, are experiencing memory loss or are limited in independent functioning

HOME

40

We can help with money management, too

Transportation

Housing Support

Personal Care Attendants

Social Services

Medicare Copays

Some Non-Medicare covered OTC Drugs

Behavioral Health Support

All GREEN Services

Medical Equipment

• Create a budget or spending plan• Apply for programs like food stamps, social security and

medical assistance if you qualify• Check into food pantries in your neighborhood • Look into energy assistance programs if you qualify for

Supplemental Security Income (SSI) and food stamps• Look for income-based housing• Ask your doctor for samples and join discount prescription

programs• Look into school meal programs to see if your child may qualify

for free or reduced lunch

HOME

Getting you where you need to go

HOME

42

Non-emergency rides

•We use Southeastrans (SET) to coordinate our transportation benefits

•As a CCC Plus member, you get rides to appointments, the pharmacy and community events and activities

• If you have an emergency, call 911, not SET

•We provide safe, clean and timely transportation to routine medical appointments, including wheelchair and handicapped-accessible vans, stretcher vans and taxis

• SET also provides overnight travel, lodging and gas reimbursem*nt

•As an extra benefit for CCC Plus members, you also get 12 trips to community events and locations, like libraries, places of worship and the DMV each yearHOME

43

Rides in your community

•We offer rides to non-medical activities like community and educational events as an extra benefit for CCC Plus members

•These rides are available every day from 8 a.m. to 5 p.m.

•You get three round trips every three months, and no more than 12 trips each year. In cities, a round trip cannot exceed 30 miles. In rural locations, a round trip cannot exceed 60 miles.

HOME

44

How to set up your ride

•Call SET once you make an appointment to setup your ride. Remember your care coordinator can help!

•Make a reservation by calling SET at 1-855-325-7581 (TTY 711) or visiting their website and registering for an account — it’s easy! Then you can just log in to request a trip. Send an email to [emailprotected] if you need help.

•Remember to write down your trip ID in case you run into any problemsHOME

Thank you.Have questions?

HOME