Specialty Plan Sensitivity Quiz

A plan for recipients in a special region.

A new type of plan that will serve all Medicaid recipients.

A plan that will serve Medicaid recipients who have special needs based on age, medical conditions, or diagnosis.

A plan for the elderly and disabled recipients only.

LTC Non-COMP

Child Welfare (HOMESAFENET)

HIV/AIDS

Children's Medical Services (CMS)

Serious Mental Illness (SMI)

Diabetes, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF)

Magellan Complete Care

Sunshine Health Child Welfare Plan

Children's Medical Services Network Specialty Plan

Sunshine Health

Prestige Health Choice

Clear Health Alliance

Molina Health Care of Florida

Magellan Complete Care

Ask the member to tell you their condition; repeat the condition to confirm you heard them correctly, and explain to them they can only enroll into the specialty plan addressed in the letter.

Ask: "Do you have any special medical needs such as pregnancy or HIV/AIDS?" Document the special need and provide all plan options available in the member's region.

Tell the member to ignore the letters because they can enroll in to any plan in the region.

Say: "If you have HIV/AIDS the best plans for your condition are Clear Health Alliance or Positive Health Choice."

Ask the caller if there is someone else around that speaks more clearly.

Ask the member to hold and call PA Language Line for assistance.

Transfer to a supervisor.

Be understanding to the member's condition, actively listen, and repeat what you heard for clarification.

Disregard the extra information stated by the parent and proceed with the call since the parent answered "No".

Document the child needs therapy without the parent's knowledge and just refer the parent to CMS for further explaination.

Advise the caller, "According to the information provided your child may qualify for CMS." Proceed with asking the caller the CMS screening questions.

Explain to the parent the child might need to enroll into CMS since the teacher said the child needs therapy.

Magellan Complete Care

Positive Healthcare

Children's Medical Services

Sunshine Health

Explain to the Caseworker that you are only allowed to access one case per phone call.

Focus on enrolling the children into the correct plan; one case at a time. Be patient and keep in mind the call could take a little more time.

Place the caseworker on hold and take time to gather yourself because this call is going to take a long time.

Caseworkers with multiple enrollments should complete them on the website only.

Explain to the caller that Clear Health Alliance is a plan for members with an active HIV/AIDS special condition on file and her brother received the letter to inform him about his plan options.

Tell the member she needs to talk to her brother about his personal business.

Tell the caller you will send her an enrollment package with information about the plan because you cannot talk about the plan over the phone.

Say: "If your brother received this letter, that means he has HIV/AIDS. Didn't he tell you?