Below are some frequently asked questions of CommunityCARE RECIPIENTS. CommunityCARE PROVIDERS CLICK HERE.

CommunityCARE Recipient FAQs
• How will CommunityCARE help me?
• How will I know when to enroll in CommunityCARE?
• Can I choose a PCP, or will one be assigned to me?
• How will I know who my PCP is?
• What if I don’t want the PCP who is assigned to me?
• My doctor wasn’t on the CommunityCARE list last month, but she is now. Can I change my PCP to her?
• How long will it take for my new PCP to be effective?

Q. How will CommunityCARE help me?
A. Your CommunityCARE PCP will provide you with a medical home. He/she will see you for basic medical care and will follow your care if you are referred for specialty care. CommunityCARE focuses on the relationship between the patient and his/her PCP.



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Q. How will I know when to enroll in CommunityCARE?
A. You will receive a letter in the mail explaining the CommunityCARE program and how to choose a PCP. You can also call the CommunityCARE hotline toll free at 1-800-259-4444 for assistance.


Q. Can I choose a PCP, or will one be assigned to me?
A. You will receive a list of providers that you may choose from and a deadline for making your selection. If you do not call the hotline number and choose a PCP by the deadline, one will be assigned to you.


Q. How will I know who my PCP is?
A. You will receive a letter in the mail telling you who your PCP is.You may also contact the CommunityCARE Hotline for assistance.


Q. What if I don’t want the PCP who is assigned to me?
A. You may change your PCP at any time during the first 90 days you are enrolled in CommunityCARE by calling the hotline number. You also have a chance to change your PCP at least once a year or during open enrollment.


Q. My doctor wasn’t on the CommunityCARE list last month, but she is now. Can I change my PCP to her?
A. Yes. You can change your PCP at any time within the first 90 days that you are enrolled in CommunityCARE and then at least once every 12 months after this time.

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Q. How long will it take for my new PCP to be effective?
A. It may take up to 60 days for the new PCP to be effective, depending upon when you call the hotline to make the change. Continue to see your current PCP until the new one becomes effective, or ask your current PCP to give you a referral to the new PCP until the change is effective.

Provider FAQs
• If I am already a Medicaid provider and want to be a CommunityCARE Primary Care Provider (PCP), do I have to enroll in CommunityCARE?
• How does CommunityCARE affect providers who are not PCPs?
• Do all services require a CommunityCARE referral?
• Which Medicaid recipients will be in CommunityCARE? Is the program voluntary?
• So how do I determine which recipients are CommunityCARE and which are not?
• What is the schedule for statewide CommunityCARE implementation?
• I have a large family practice and am not a CommunityCARE PCP. If I don’t enroll in the program when my parish becomes effective with CommunityCARE, will I lose all my Medicaid patients?
• If I am enrolled as a CommunityCARE Primary Care Provider (PCP), do I have to provide KIDMED screenings?
• How can a recipient who has used their twelve annual visits obtain additional visits?
• How can recipients who have Medicare or HMO coverage become exempt from participation in the CommunityCARE program?


Q. If I am already a Medicaid provider and want to be a CommunityCARE Primary Care Provider (PCP), do I have to enroll in CommunityCARE?
A. Yes. The following provider types may become CommunityCARE PCPs: family practice, general practice, internal medicine, pediatrician, and obstetrician (if willing to provide primary care services for CommunityCARE patients). To request a CommunityCARE enrollment packet, call toll free 1-800-473-2783.


Q. How does CommunityCARE affect providers who are not PCPs?
A. Unless the service provided is an exempt service, the provider must obtain a referral from the PCP in order for Medicaid to pay for the services.

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Q. Do all services require a CommunityCARE referral?
A. Most services do require a CommunityCARE referral unless provided by the patient's PCP. However, there are exempt services that do not require a PCP referral. These are listed in the CommunityCARE manual as well as the web site in the Referrals section.


Q. Which Medicaid recipients will be in CommunityCARE? Is the program voluntary?
A. The program is mandatory for most Medicaid enrollees. There are some recipients that are exempt from the program, including recipients who have Medicare, recipients age 65 or older, and residents of nursing homes. A complete list of exempt categories of recipients can be found in the CommunityCARE manual as well as Home Page of the web site.


Q. So how do I determine which recipients are CommunityCARE and which are not?
A. You should check each patient's eligibility using the REVS, MEVS or eMEVS system. If the recipient is in the CommunityCARE program, the name and telephone number of the PCP will be listed. If no PCP information is listed, the recipient is not in CommunityCARE. If you are a PCP, you will receive a monthly list (the CP-0-92) that lists your CommunityCARE patients.

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Q. I have a large family practice and am not a CommunityCARE PCP. If I don’t enroll in the program , will I lose all my Medicaid patients?
A. Your CommunityCARE patients become linked to a CommunityCARE enrolled PCP and will be required to obtain their primary care from their PCP.


Q. If I am enrolled as a CommunityCARE Primary Care Provider (PCP), do I have to provide KIDMED screenings?
A. You are responsible for KIDMED services for your CommunityCARE patients under age 21. However, you may subcontract the actual screening services to a KIDMED provider(s).

Q. How can a recipient who has used their twelve annual visits obtain additional visits?
A. The doctor must see the patient and submit the Form 158A AFTER THE VISIT to request approval for payment for the additional visit. The request for extension is reviewed at Unisys, and either approved or disapproved.

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Q. How can recipients who have Medicare or HMO coverage become exempt from participation in the CommunityCARE program?
A. Recipients who have Medicare or HMO coverage are automatically exempted from the CommunityCARE program if this coverage information is correctly entered on their Medicaid file. If a recipient who has Medicare or HMO coverage has been enrolled in CommunityCARE, they should submit a copy of their Medicaid card, as well as their Medicare or insurance card, to their parish office so that the insurance information can be correctly entered. The CommunityCARE linkage will close automatically at the end of the month.