Customers now have 3 ways to apply for insurance:

• • One-to-one enrollment assistance will be provided by our Health Department MCHP Staff.
  • Call ahead for an appointment at 410-819-5600, or 410-819-5642 for Interpretation and Translation Services.
  • Go online to: https://www.marylandhealthconnection.gov/ and set up an account and enroll.

For Further Assistance

Talbot County Health Department has insurance eligibility workers available for walk-ins for questions and for enrollment assistance on a first come first served basis, but appointments are preferred.

Call the Maryland Health Connection (MHC) call center: 1-855-642-8572 (TTY: 1-855-642-8573).

Go to https://www.marylandhealthconnection.gov/ for enrollment or to see if you might qualify for Maryland Medicaid.

 Applicants must set up their own accounts on a computer, call the toll free number, or seek assistance locally as noted.

Information needed to complete your application includes:

• • Social security number (or document number for legal immigrants)
  • Birth date and general information
  • Employer and income information (W-2 forms, wage and tax statements)
  • Policy numbers for current health insurance
  • Employer identification number (EIN) for any job-related insurance.

This information will be needed for all family members applying for coverage.

Los solicitantes deberán crear suspropias cuentas en unacomputadora, ar al número 1-855-642-8572 osolicitar ayuda local, como se ha indicado anteriormente.

Si necesitaayuda para crear su cuenta e introducir la información en elsitio web aquí en el Departamento de Salud del Condado de Talbot, usted deberáprogramar una cita con nuestro personal de MCHP favor de llamar al 410-819-5600.

Para obtenermás información por favor consulte el folleto de Maryland Health Connection o visite el sitio web.

Individuals who do not meet the eligibility requirements for Maryland Medicaid and wish to enroll in a Qualified Health Plan will be asked to schedule an appointment with our Talbot County Navigator:

Robin Monahan (Navigator)
443-515-0069
rmonahan@esahec.org

Administrative Care Coordination (ACC) and the Nurse Ombudsman at Talbot County Health Department

The primary purpose of the ACC and Ombudsman Program is to assist HealthChoice eligible Medicaid and MCHP beneficiaries in accessing and appropriately using their health care benefits.

Information typically covered when providing ACC-Ombudsman assistance to HealthChoice enrollees:

• • Case specific information; for example specific protocols for pregnant women
  • Fee-for-service system and how to use prior to MCO enrollment
  • Importance of selecting and using a primary care provider
  • Renewing or updating Medicaid MCHP coverage
  • Select an MCO and how the managed care system works
  • The importance of timely follow-up, especially when appointments or treatments have been missed
  • Benefits and the importance of preventive health care, dental care, lead screening, and immunizations for children
  • Availability and importance of preventive services such as pap smears, mammograms, etc
  • Self-referred services such as the ability to maintain your established prenatal care provider, ability to access out-of-network family planning services and substance use/behavioral health services
  • “Carve-out” services, such as mental health and dental services for children and pregnant women
  • Family planning and preconception health services
  • Transportation and the M.A. Transportation program
  • MCOs for disease management, care coordination or case management services
  • The HealthChoice Help Line, and local ACC/Ombudsman services
  • A list of local HealthChoice providers and resources.

Provider Support

The ACC-Ombudsman program offers support to local providers. Our staff is knowledgeable about the changes in health care systems and financing to the extent that they can answer basic questions and refer providers to additional resources when needed.

We are able to:

• • Link potential Medicaid providers to Provider Enrollment for assistance with the enrollment process
  • Provide education about MA web-based resources and Eligibility Verification Systems
  • Provide contact numbers for central office program staff who can answer provider questions and resolve problems
  • Provide updates on changes to Medicaid operations, such as changes to CMS 1500 claim form and ICD 10
  • Inform providers about the Local Health Services Request referral process
  • Promote completion of the Maryland Prenatal Risk Assessment and referral process by prenatal care providers
  • Convey new and emerging topics of importance to the Medicaid Program to providers and stakeholders.

The Talbot County Health Department Ombudsman is a Registered Nurse who assists with resolving complaints by assisting Maryland Medicaid recipients with problems they may have with their insurance or Managed Care Organization.

The Ombudsman may work with HealthChoice recipients to:

• • Attempt to resolve any dispute by reviewing the decisions with the MCO or the enrollee
  • Work towards resolution by mediation or other dispute resolution techniques
  • Assist the enrollee in negotiating the MCO’s internal grievance process
  • Advocate on behalf of the enrollee throughout the MCO internal grievance and appeals process
  • Refer dispute back to Complaint Resolution Unit at the State for a decision if the dispute is one that cannot be resolved by the local ombudsman’s intervention.
  • Provide education and resources specific to the recipient’s individual needs or medical conditions.

 A licensed Registered Nurse is available at all times during business hours for consultation to address the more complex nature of Medicaid issues.