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Molina Healthcare Apple Health Medicaid renewal provider FAQs.

Most Medicaid recipients will need to go through a redetermination, or renewal, process to keep their Medicaid eligibility and benefits. Below are answers to some common questions that might help guide your patients through this process.

Q: How are Medicaid clients impacted by the restart of Eligibility Reviews?

A: All Medicaid clients will need to go through the renewal process based on their individual renewal date. Clients who fail to respond to outreach required to complete their renewal will have their Apple Health coverage terminated.

Q: When did the normal Medicaid enrollment and renewal process resume?
A: Washington state resumed redetermination efforts and reinstated pre-PHE process on 4/1/23.

Q: What can individuals do to prepare for their upcoming renewal date?
A: First and foremost, all Medicaid clients should make sure their contact information, including their mailing address and phone number(s) are up to date with their state to ensure they receive important notices about the renewal process.

Learn how our members can update their contact information with their state and Molina online at www.molinahealthcare.com/updatemyinfo/WA.

Ask our members, your patients, to make sure they keep an eye out for information and notices about their coverage and renewal process and respond quickly to any instructions they receive. Learn more about the renewal process for members and the assistance available to them online at www.molinahealthcare.com/keepmyhealthplan/WA.

Q: What is Molina doing to support renewal efforts?
A: Throughout the PHE, Molina continued to send regular reminders and outreach to our members starting 60 days before their renewal date via:

• Text messages
• Emails
• Outreach calls
• Mailers
• My Molina mobile app and member portal notices

 

This outreach has continued after redetermination was reinstated.

We focus on reminding our members to renew their benefits when it’s their turn through an awareness campaign that includes:

• A video explaining what the end of the PHE means for their Medicaid coverage.
• A national landing page to point them to their state-specific resources.
• Social media posts and on-hold messaging to remind members they will need to take action to keep their benefits.
• If there are members who didn't complete the steps to renew their Medicaid benefits, we'll reach out to them and work with them to re-enroll and renew their Medicaid benefits and coverage.

 

Q: How can providers help prepare their patients for redetermination?
A: We need your help reminding patients to update their contact information. We also need your help reminding your Medicaid patients that they need to renew to keep their coverage. Information on how to check your member’s renewal date in Availity Essentials is available here. Renewal information and renewal steps can also be found on our website here.

Share the information and resources located in the Redetermination Resources section with your patients by printing and displaying in your office:

• How to update your contact info flyer (English | Spanish)
• How to renew handout (MAGI clients) (English | Spanish)
• How to renew handout (AHBD/Classic clients) (English | Spanish)
• Available Plan options (English | Spanish)
• 8.5" x 11" renewal display poster (English | Spanish)

 

Q: What happens if a client misses their renewal date and loses coverage?
A: If a client is an Apple Health Family, Apple Health Adult, or CHIP (MAGI) client and missed the deadline to renew but would like to continue coverage:

• The client should contact Washington Healthplanfinder as soon as possible. If they are found eligible within 90 days after the date they lost coverage, they will be covered for the period they were without coverage. The fastest way to renew lost coverage is to go online. They may also call (855) 923-4633.

 

If a client is an Apple Health Blind Disabled (Classic) client and they missed the deadline to renew and coverage was terminated, they will need to reapply.

• The client should contact DSHS as soon as possible at (877) 501-2233 or log in to washingtonconnection.org.

 

If a client needs assistance, they can email Molina at healthplanrenewals@MolinaHealthcare.com or call us at (866) 916-0916.

Q: What happens if an individual is no longer eligible for Medicaid and loses coverage?
A: If an individual no longer qualifies for Medicaid coverage they'll get:

• A notice in the mail from either Washington Healthplan finder or DSHS with the with the date their Medicaid coverage will end.
• Information on how to file an appeal if they think the decision to cancel their coverage was incorrect. If a determination that cancellation of coverage was incorrect occurs within 90 days of the termination date, the client will be retroactively reinstated from the termination date, without a gap in coverage.

 

Q: What are some other health care coverage choices if an individual no longer qualifies for Medicaid?
A: If a member no longer qualifies for Medicaid, they might be eligible for a Marketplace or Medicare health plan.

To learn more about our Marketplace health plans, please visit MolinaMarketplace.com or call (844) 794-3635.

To learn more about our Medicare health plans, please visit MolinaMedicare.com or call (866) 403-8293

Q: How can I get more information about the redetermination process?
A: Please contact your provider services representative if you have any questions or would like more information.

• Update Contact Information Flyer (English | Spanish)
• Apple Health (Medicaid) Renewal Flyer (English | Spanish)
• Molina Available Plan Options Flyer (English | Spanish)
• Molina Medicaid Renew You Poster (English | Spanish)
• Molina Medicaid Renewal Information Flyer (MAGI) Clients (English | Spanish)

• 4/9/2020 Bulletin
• 4/14/2020 Bulletin
• 4/28/2020 Bulletin
• 4/29/2020 Bulletin
• 4/30/2020 Bulletin
• 5/04/2020 Bulletin
• 5/18/2020 Bulletin
• 12/15/2020 Bulletin
• 4/5/2021 Bulletin

Molina will pay providers for a variety of modalities in lieu of in-person visits to support evaluation, assessment and treatment of members. These modalities include telemedicine for HIPAA compliant, interactive, real-time audio and video telecommunications, which are already covered, and other forms of telehealth such as online digital exchange through a patient portal, telephone call, FaceTime, Skype or email.

Molina's Detailed COVID-19 Telehealth Billing Policy for Physical Health Providers

EPSDT Appointments via Telemedicine/Telehealth & In-Person Follow-up

For an EPSDT appointment via telemedicine/telehealth, bill per the below guidance:

• Services provided via a telehealth modality choose the appropriate EPSDT visit code, with modifier CR and the POS indicator that best describes Services provided via a telehealth modality choose the appropriate EPSDT visit code, with modifier CR and the POS indicator that best describes where the client is.
• Services provided via a telehealth modality choose the appropriate EPSDT visit code, with modifier CR and the POS indicator that best describes Services provided via telemedicine modality, choose the appropriate EPSDT visit code, with modifier CR, POS 02 Telehealth Provided Other than in Patient’s Home or POS 10 - Telehealth Provided in Patient’s Home
• Services provided via a telehealth modality choose the appropriate EPSDT visit code, with modifier CR and the POS indicator that best describes For the in-person follow-up appointment to complete EPSDT components, bill:
  • 99429 with modifier CR (see COVID-19 fee schedule)

Note: remember to add any of the additional procedure codes that are applicable to other services/screenings provided (see HCA’s EPSDT billing guide and Physician-related/healthcare services billing guide)

Telehealth for Apple Health (Medicaid) Physical, Occupational and Speech Therapy Providers

Molina follows the Apple Health telehealth requirements for physical, occupational and speech therapy guidance found on the HCA COVID-19 Resource Page.

Telehealth for Apple Health (Medicaid) Physical, Occupational and Speech Therapy Providers

Molina follows the Apple Health telehealth requirements for physical, occupational and speech therapy guidance found on the HCA COVID-19 Resource Page.

Resources

CMS Provider Telehealth and Telemedicine Toolkit

HHS Office of Civil Rights (OCR) Notice on Telehealth Remote Communications for COVID-19

DEA COVID-19 and prescribing via telemedicine guidelines

FCC announces new plan dedicating additional funds to support telehealth programs

COVID-19 Remote Consultations Quick Guide

How to transition to virtual care

Molina Guidance for Audio Only Visits

Molina will extend authorizations for all elective surgeries, procedures, physical therapy, speech therapy, DME and occupational therapy until 06/30/2021. This does not include extending or adding services not included in the primary request. Extension will be provided on all new outpatient elective service authorization (surgeries, procedures, therapies and DME) requests for 6 months from effective date.

Molina will relax refill timing on all* prescriptions for the time being. Members can receive an early refill for 30 days, plus two additional refills, up to a 90-day supply. Additionally, Molina will allow 90-day prescription volumes on many routine medications currently or can approve a 90-day supply via an exception request. This includes new prescriptions and refills. Please allow 90-day supply of maintenance medications through both mail order and retail pharmacies, especially for members discharging from an inpatient facility given the current availability of follow-up appointments. CVS offers free prescription delivery through their mail order pharmacy at www.caremark.com.

*Certain controlled medications require prior authorization prior to refill.

Molina has options in place for temporary and expedited credentialing. Providers can email their request for provisional credentialing to: MHWProviderContracting@molinahealthcare.com.

• Temporary providers will not require credentialing and include:
  • Covering practitioners (e.g., locum tenens)
  • Providers who are not part of the network and are providing care to our members as part of a federal, state or local government emergency response team.
  • Rental network practitioners who provide out-of-area care only, and members are not required or given an incentive to seek care from them.
  • Practitioners who practice exclusively in free-standing facilities and provide care for organization members only because members are directed to the facility
  • Practitioners who practice exclusively in an inpatient or group practice setting and provide care for members only because members are directed to the hospital or another inpatient setting or group practice
• Provisional Credentialing will be expedited and completed within 5 business days. Full credentialing will be required to be completed within 180-days of the provisional approval date.
• Recredentialing - Providers who are due to be recredentialed that have closed their office or are not able to respond to recredentialing requests will be placed on a temporary hold status.
• Site Reviews - Molina will not be conducting provider site reviews in any Molina state where Site Reviews are required as part of initial and/or recredentialing.

• HCA COVID-19 Information Website – a wealth of information including:
  • BH provider office closures
  • Clinical policy
  • COVID-19 billing and coding
  • No-cost telehealth for providers
  • Opioid Treatment program
  • Changes to eligibility and enrollment for Apple Health (Medicaid) clients
• CMS COVID-19 Information
• Molina COVID-19 internet and phone plan resources
• TruConnect No-Cost Cell Phone Program


• CMS's Accelerated Advance Payments program: offers providers three months of payments during COVID emergency.
• All Clear COVID Testing location finder
• DOH Power of Provider Initiative