Maryland Medicaid Health Choice Program Administrative Care Coordination/Ombudsman Services

1025 Memorial Drive Oakland Maryland 21550 US
1.800.284.45101.800.284.4510

What is HealthChoice?
HealthChoice is Maryland’s Medicaid managed care program. Most people who qualify for Medicaid are required to enroll in a Managed Care Organization (MCO). It is best to select an MCO that your doctor participates with. If your doctor does not participate in the MCO you select or are assigned to, you will need to choose another primary care doctor (PCP) to over see your medical care.
What is a HealthChoice MCO?
An MCO is a group of doctors, clinics, and other health care providers who work together to take care of HealthChoice member health care needs.
MCOs are responsible to provide or arrange for most of your health care services including most pharmacy services. Some services such as mental health and substance use disorder services. Some services such as mental health and substance use disorder services and certain drugs are covered by the State and not your MCO. The ACC serves as a local resource for all HealthChoice memebers. The ACC can:
Help you understand your HealthChoice benefits and how to access services
Explain your MCO choices
Help you find a primary care doctor or specialist in your MCO’s network (You can change PCPs at any time)
Help you find a denist for our child (MCOs are not required to cover dental services for adults)
Help link you to Medicaid transportation services (MCOs are not required to provide transportation.)
Help you get your prescriptions filled
Explain the health care services you can get out of network and without a referral, like prenatal care (if you already started prenatal care) and family planning services
Explain your annual right to change MCOs
More examples of help that is only a phone call away
Explain how to renew your Medicaid benefits through the Maryland Health Connection
Explain how to keep your information updated and how to get a new Medicaid card if your card is lost or stolen
Help you resolve a billing issue
Explain your appeal & grievance rights
Target population include children, pregnant and postpartum women, individuals with disablities (physical, mental, or develpmental), and homeless individuals. The ACC can help anyone who is eligible for HealthChoice.
Ombudsman
The local Ombudsman acts as an advocate for your health care needs. An Ombudsman may contact you when there are complex medical issues involving care coordination with MCO. The HealthChoice Program may also request that an Ombudsman contact you to ensure that any complaints that you have about your health care or MCO have been resolved.

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