QUESTIONS TO ASK BEFORE SELECTING YOUR HEALTH CARE PROVIDER
What is the Mountain Health Trust Program?
Mountain Health Trust is a program developed by the Bureau for Medical Services, Department of Health and Human Resources of
West Virginia. The program began in 1996. Medicaid consumers in all counties in West Virginia are being enrolled into
their choice of Managed Care Organizations (MCO). Choices vary by county and may include Health Maintenance
Organizations (HMO) and/or the Physician Assured Access System (PAAS). Both an HMO and PAAS are a group of doctors,
nurses and clinics who provide health care services. Each person enrolled would also need to choose a Primary Care Provider
(PCP) to coordinate care and refer to specialists as needed. The PCP is a doctor, nurse practitioner, or physician assistant
and may already be your "family doctor". Once you pick an MCO, you need to use the doctors, hospitals and clinics in that MCO.
This is called a "network".
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What are the choices in my county?
You can find out which choices are available in your county by looking at the map below or by going to Plan/Provider Wizard
and clicking on your county.
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Does everyone with a Medical Card have to enroll?
No. You will not have to enroll if you are:
- Under the Aged/Disabled Waiver
- Covered under Medicare only
- Covered under both Medicare and Medicaid
- Living in a long term care facility
- Under the MR/DD Waiver
- On the spend down program.
If you receive SSI or are a foster child, you can choose to enroll with
PAAS but not with an HMO. If you qualify for any of the above, you should call 1-800-449-8466 to let the Enrollment
Specialist know.
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Can I change my MCO and PCP?
Yes, you can change one or both. Call 1-800-449-8466 to change your MCO. If you are in an HMO and want to change to another
PCP, just call your HMO. You will find the HMO toll free number on your medical card.
If you are with PAAS and wish to change your PCP, call 1-800-449-8466. The date the change will be effective depends upon
when you call. You will remain with the HMO/PCP appearing on your medical card until the change is effective (and the new
HMO/PCP appears on your medical card).
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What if I have a problem or complaint?
Each MCO has a person who will handle any concerns or complaints. This person is called the Medicaid Advocate. The Medicaid
Advocate can be reached by calling your MCO. If you would prefer to file a formal complaint, please call an Enrollment
Specialist at 1-800-449-8466.
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How do I get medical care when I am out of my area?
If you are enrolled with an MCO, you will need to make sure that you always have your current medical card with you and, if
you belong to an HMO, the HMO membership card. You will need to show both cards to obtain services. If you are enrolled
in PAAS, you will need only your medical card.
If you belong to an HMO, are out of the area and have an emergency, you should go immediately to the nearest medical care
facility for treatment. If it is not an emergency, you should call your HMO first. To determine what is and is not an
emergency, ask your HMO for more information.
If you are a member of PAAS, are out of the area and have an emergency, go immediately to the nearest medical facility. If
it is not an emergency, call your PCP first.
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How do I know when I will have to enroll?
You will receive an enrollment packet in the mail which will include an enrollment form for each eligible member of your
family. Please complete and sign the form(s) promptly, send it back in the postage-paid envelope or call 1-800-449-8466 to
enroll by phone.
Please remember an Enrollment Specialist is here to answer your questions from 8 a.m. until 8 p.m. every weekday. If you
call after hours or on weekends, please leave a message and your call will be returned the next business day.
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