When will the Medicaid integration be completed?

Total Health Care (THC) Medicaid will end September 30, 2021, and will become Priority Health Choice, Inc. starting October 1, 2021.

THC Medicaid members will move to the Priority Health Choice Medicaid Plan on October 1, 2021.

Why is this happening?

To benefit our members and expand statewide. This partnership joins two of the longest-serving Michigan Medicaid plans, enabling us to deliver enhanced, high-quality care to serve our communities and members.

Will I get a new ID card?

Yes, a Priority Health ID card will be mailed to you. Effective October 1, 2021, show your new Priority Health Choice, Inc. ID card when you visit a doctor or pharmacy. You will have the same contract ID number. You should not use your old Total Health Care, Inc. ID card after September 30.

When will I receive my new ID card?

You will receive your new Priority Health Choice, Inc Medicaid ID card, included in your welcome kit, in the mail before October 1, 2021.  These cards will be mailed out in the last two weeks of September.

Will my ID number stay the same?

Your contract number on your Priority Health Medicaid ID card will be your 10-digit State Medicaid ID.  Your State Medicaid ID is the same no matter what Medicaid Health Plan you are enrolled in.

What tools are available to me?

Priority Health Member Center

Beginning October 1, Medicaid members can sign up for an online member account at member.priorityhealth.com, or you can download our Priority Health app for 24/7 access to your health information, digital member ID card, and virtual care.

Find A Doctor (FAD)

As a Priority Health Choice, Inc. member, you will use our website, priorityhealth.com, to find important plan information. Use the Find A Doctor tool, starting on September 1, to know if your doctor, pharmacy, or other provider is covered.

Approved Drug List (ADL)

Priority Health Choice, just like THC Medicaid, covers medications according to the State of Michigan’s Common Formulary. Drug coverage information is available online; priorityhealth.com/formulary/medicaid 

Customer Service

If you have any additional questions, you may contact Priority Health Customer Service.

Can I choose a different Medicaid plan?

THC Medicaid members have until September 17, 2021, to choose a different Medicaid plan. If you do not take action by this date, you will be enrolled with Priority Health Choice.

·         If you would like to change your plan, contact MICHIGAN ENROLLS at 1.800.975.7630 (TTY: 888.263.5897) by September 17. They are available Monday – Friday 8:00 a.m. – 7 p.m.

·         After October 1, members have 90 days to change their plan once enrolled, they will do so by contacting MI Enrolls.

Will my doctor change?

Priority Health Medicaid is accepted by 97% of Michigan Doctors and Facilities including nearly all major systems and physicians in SE Michigan. We are confident that many THC members will be able to keep their doctors.

Please use Priority Health’s Find A Doctor tool on our website, priorityhealth.com, starting on September 1, or call Priority Health’s Customer Service at any time to know if your doctor, pharmacy, or other provider is covered.

Will my medical benefits change?

Your medical benefits will remain the same.

To learn more about the plan and covered services:

·         Go to  priorityhealth.com/michigan-medicaid/member to access the Member Handbook and COC online, or 

·         Call Priority Health Customer Service at 888.975.8102 to request a copy to be mailed to you.

Will my dental benefits change?

Your dental network and provider (Healthy MI Dental) is not changing.  In addition, many of your dental benefits will remain the same.  However, some restorative services will no longer be covered.

Please refer to the Healthy MI Dental handbook for benefit information, which is located priorityhealth.com/michigan-medicaid/member

Will my transportation benefits or vendor change?

There will not be a change to your transportation benefits.

Region 10 members (members located in Wayne, Oakland, and Macomb Counties) will still utilize the transportation broker: Veyo.

Will my pharmacy benefits change?

Your pharmacy benefits will remain the same.  Priority Health Choice, just like THC Medicaid, covers medications according to the State of Michigan’s Common Formulary. Drug coverage information is available online; priorityhealth.com/formulary/medicaid 

The pharmacies available for you to use may be different.

Please see Pharmacy section for additional information.

How do I know if a drug is covered by Priority Health Choice?

Pharmacy Benefit Drugs

For members enrolled in traditional Medicaid, Medicaid CSHCS, or Healthy MI plans, use the Medicaid Approved Drug List (ADL) to know how drugs are covered by Priority Health Choice.

Members enrolled in a Medicaid Dual Eligible plan (Medicaid-Medicare dual enrolled) will have most medications covered by their Medicare Part D plan. Contact your Medicare Part D plan for drug coverage.

Medical Benefit Drugs

Medications that are administered by IV infusion or by a medical professional are covered under the medical benefit. Members enrolled in traditional Medicaid, Medicaid CSHCS, or Healthy MI plans, can reference the Medical Benefit Drug List (MBDL) to know how these drugs are covered.

Members enrolled in a Medicaid Dual Eligible plan (Medicaid-Medicare dual enrolled), should contact their Medicare Part B policy for coverage information.

Does Priority Health Choice cover the same medications as THC Medicaid?

Michigan Medicaid Health Plans (MHPs), like THC and Priority Health Choice, work with the Michigan Department of Health and Human Services (MDHHS) to determine what drugs will be covered for Medicaid.

All MHPs must cover drugs according to the Medicaid Health Plan Common Formulary. This formulary applies to traditional Medicaid, Medicaid CSHCS, and Healthy MI plans. MHPs have some flexibility to cover different drugs, but all MHPs must at least cover the drugs on this list. Refer to the Medicaid ADL for how Priority Health Choice covers drugs.

Members enrolled in a Medicaid Dual Eligible plan will have most medications covered by their Medicare Part D policy. However, there are some Medicare excluded drugs covered by this type of Medicaid plan.

Will my current drug authorization be transferred?

The Pharmacy teams from both THC Medicaid and Priority Health Choice are working closely to ensure most active authorizations are transferred. This applies to medication authorizations under Pharmacy and Medical benefits.

Diabetic Testing Supplies

Diabetic testing supplies are not included on the MI Medicaid Common Formulary. THC Medicaid and Priority Health Choice cover these products differently.

THC Medicaid

Members are currently required to fill testing supplies (strips, lancets, and alcohol swabs) under the Pharmacy benefit with one vendor, J&B Medical, and will continue to do so through September 30.

Priority Health Choice

Priority Health Choice members may have testing supplies billed to either the Pharmacy or Medical benefit.

Refer to the Medicaid ADL for Pharmacy coverage. The following test strips are covered at any in-network pharmacy for up to 200 strips per 30 days:

·         Contour

·         Coutour NEXT EZ

·         FreeStyle Insulinx

·         FreeStyle Lite

·         FreeStyle

·         Precision PCX

·         Precision PCX Plus

·         Precision Point of Care

·         Precision Q-I-D

·         Precision Xtra

Members should contact Priority Health customer service for coverage under the Medical benefit.

Beginning October 1, your diabetic testing supplies will need to be billed to Priority Health.

Specialty Medications

Both Priority Health and THC require members to fill specialty medications at specialty pharmacies.

Drugs listed on the Medicaid ADL with the specialty pharmacy indicator (see icon below) must be filled at a preferred in-network specialty pharmacy.

Priority Health Choice Pharmacy team is working on a transition plan for current THC members using specialty medications to our specialty pharmacies.

Can I have my prescriptions mailed to me?

Neither THC Medicaid nor Priority Health Choice offer mail order services for prescriptions.

Some in-network pharmacies, like Meijer and Walgreens may offer home delivery. Members should check with their pharmacy to see if home delivery is offered.

Any potential cost associated with home delivery will not be covered by Priority Health Choice.

Can I continue using my current pharmacy?

There may be instances where you may need to switch pharmacies after becoming a Priority Health Choice member.  However, Priority Health has worked to expand our pharmacy network.

Major chains like Walgreens, Rite Aid, Walmart, Meijer, and Spartan Nash are all in-network. Additionally, many independent and health system pharmacies on the East side of Michigan are available to members.

If you are one of the members that will be negatively impacted by the pharmacy network change from THC Medicaid to Priority Health Choice:

·                 A letter will be sent to you after October 1, with information on the pharmacies that you can use.

·                 You may need to transfer your prescription from your previous pharmacy to the new in-network pharmacy.

Please contact Priority Health Customer Service or use Priority Health’s Find A Doctor tool on our website, priorityhealth.com, starting on September 1, to know if your doctor, pharmacy, or other provider is covered.

How do I transfer a prescription to a new pharmacy?

If you need to transfer your prescription to a new pharmacy:

o        The prescription must not be expired,

o        The prescription must have refills,

o        Your new pharmacy can use your most recent prescription bottle for medication and pharmacy information, or

o        You can have your doctor send a new prescription to your new pharmacy.

Please note that certain types of controlled medications cannot be transferred, this is the law.

Where should my doctor send authorization requests?

All medication authorization requests for THC Medicaid members will be processed by THC Medicaid now through September 30, 2021.

Starting October 1, 2021, Priority Health Choice will review all medication authorization requests. Members and providers should reference the Medicaid ADL for drug coverage and criteria.