HealthWave, is a state and federal funded health insurance program for uninsured children and low income families in Kansas.

• Provides low-cost or no-cost health insurance to eligible families with children.
• Expands the availability of affordable health insurance for uninsured family and children.
• Provides most eligible individuals with a Primary Care Provider (PCP), someone to coordinate all aspects of their health care and preventive services; and
• Increases efficient delivery of health care services and controls costs.

Kansas children, ages birth to 19, whose family's gross income is at or below 200% of the federal poverty level. Pregnant women and some adults may also qualify. (Household size and income guidelines are different). For more information on eligibility go to the web site below or call the HealthWave Clearinghouse at 1-800-792-4884:

www.kansashealthwave.org

Based on income, age of children and household size some members will be required to pay monthly premiums. This is per household not per child.

Once the HealthWave Clearinghouse completes the eligibility determination process, a choice packet of health plan information is mailed. Children's Mercy Family Health Partners is a managed care organization contracted through the State of Kansas as one of the health plan choices for HealthWave 19 and HealthWave 21 beneficiaries. Members are encouraged to call 1-866-305-5147 to make a choice of health plan. Once the choice is made, the chosen health plan will mail an identification card, member handbook, and provider directory.

If the member is HealthWave 19 eligible, they will receive a monthly paper medical card. This card will have the assigned or chosen health plan printed on it. The paper monthly medical card is to be used along with the health plan card when receiving services.

If the member is HealthWave 21 eligible, the member will only have a health plan card to use when receiving services.

• Call the HealthWave Clearinghouse at 1-800-792-4884 and request an application. You can also go to the web site at www.kansahealthwave.org.
• Pick-up an application packet, available at all Social and Rehabilitation Service (SRS) offices or access points in each county. They are also available at many hospitals, community centers, local public health agencies, mental health sites, libraries and schools.
• Call the Children's Mercy Family Health Partners Customer Service Department at 1-877-347-9363 to have an application packet mailed to you.

To apply, please include the following:

• A completed application (signed and dated),
• Verification of income (copies of the following: pay check stubs, complete federal income tax return for self-employed persons, or a statement from an employer of the gross income from the past two or three months),
• Any other household income verification (child support, alimony, social security, disability, etc.),
• Social Security numbers of each person requesting benefits,
• Verification of citizenship and identity for each person requesting benefits,
• Immigration status documents for documented non-US Citizens requesting benefits,
• Copies of health insurance cards if there is other insurance for any person requesting benefits, and
• Copy of pregnancy verification that provides expected due date for those requesting pregnant women (PW) services.

Note: If additional information or documentation is needed to complete a determination a notice will be mailed.

Once determined eligible, children and adults will be enrolled through HealthWave, Kansas health insurance program for children and families. Families will choose coverage or be assigned through a HealthWave managed care health plan. A PCP or facility will be assigned or you can choose one to provide the majority of your health care services.

You will receive notification from the State that you are eligible for HealthWave. If you are a HealthWave Title 19 member, you would have received a paper ID card from the State of Kansas and an ID card from Children's Mercy Family Health Partners. This shows that you are assigned to Children's Mercy Family Health Partners. If you are a HealthWave Title 21 member, you will only receive a white card from Children's Mercy Family Health Partners.

To find out if your coverage is active you can contact Children's Mercy Family Health Partners Customer Service at 1-877-347-9363.

You can also call the HealthWave Clearinghouse at 1-800-792-4884.

If a member has lost eligibility, the health plan assignment ends. Children's Mercy Family Health Partners does not determine eligibility for HealthWave. If you have lost coverage, please contact the HealthWave Clearinghouse at 1-800-792-4884.

If you have private insurance, it is your duty to report it to the HealthWave Clearinghouse at the time of application by providing a copy of the health insurance card.

If private insurance opens or closes during a member's continuous eligibility period (generally 12 months) the private insurance changes should be reported to the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012.

You can have private insurance with your HealthWave 19 (Medicaid) coverage. The private insurance will pay for covered services first and the HealthWave 19 (Medicaid) coverage pays as a secondary benefit.

HealthWave 21 eligibility will be denied at the time of eligibility determination if the child, age birth to 19, is covered by comprehensive health insurance (access to doctor visits and hospital). If the HealthWave 21 member receives private insurance during their continuous eligibility period, the HealthWave 21 coverage will continue until the HealthWave review.

It is very important to report address and phone number changes. It is important to report an address change so you will get important notices about your eligibility or services. You should report every address and phone number change to the HealthWave Clearinghouse at 1-800-792-4884. You should also contact Children's Mercy Family Health Partners Customer Service at 1-877-347-9363.

Call Children's Mercy Family Health Partners (CMFHP) at 1-877-347-9363 for information about your health benefits. Covered services include:

• Allergy testing and treatment
• Audiology or hearing services
• Dental (For complete dental benefits, please call 1-800-766-9012)
• Diabetic supplies, equipment, education, and self-management training
• Durable Medical Equipment (DME), such as oxygen, wheelchairs, walkers, and other things your PCP says you need for medical support
• Early Periodic Screening, Diagnosis and Treatment (EPSDT) or KAN Be Healthy (KBH) exams for children newborn to age 21
• Emergency room
• Family planning
• Home health care services
• Hospice services
• Hospital, when an overnight stay is required
• Immunizations (shots)
• Laboratory tests and x-rays
• Maternity benefits
• Mental health and substance abuse
• Newborn services
• Office Visits
• Outpatient care, when an overnight stay is not required
• Podiatry, medical services
• Pharmacy
• PCP services
• Rehabilitation Services
• Transportation to non emergency medical appointments
• Vision
• Wellness exams/sports physicals

Children's Mercy Family Health Partners will notify you of changes in your benefits, services or service delivery office/site in writing. To view a copy of important facts about CMFHP, click here.

NEMT can be used when you do not have a way to your health care appointment. There is no charge to you for this service. We may use public transportation or bus tokens, vans, or a taxi to get you to your health care appointment. Children's Mercy Family Health Partners will give you a ride that meets your needs. You do not get to choose what kind of car or van or the company that will give you the ride. You may be able to get help with gas costs if you have a friend or a neighbor who can take you. This must be approved before your appointment.

Call 1-800-890-6026 to set up transportation or gas reimbursement. You must call at least 2 days before the day of the appointment or you may not get transportation. You may be able to get a ride sooner if your doctor gives you an urgent care appointment. You can call this number 1-800-347-9369 to talk with a nurse. If you have an emergency, dial 911, or the local emergency phone number.

HealthWave 19 members can call 1-888-547-2878 to obtain information about mental health services. HealthWave 19 members can call 1-866-645-8216 to obtain information about substance abuse services. HealthWave 21 members can call Cenpatico Behavioral Health at 1-866-896-7293 to obtain both mental health and substance abuse services.

HealthWave members can call the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012 to obtain information about dental services.

You should first verify that the member was eligible for HealthWave at the time the service was received. Second, verify the health plan assignment at the time of service. If the member was eligible and assigned to Children's Mercy Family Health Partners ask the provider to bill Children's Mercy Family Health Partners. It is your duty to be sure the provider knows the member has Medicaid or HealthWave. If the provider billed Medicaid and the member, the bill or a copy of the bill should be sent to Children's Mercy Family Health Partners, PO Box 411806, Kansas City, Mo. 64141-1806. Include a note with the patient name and member ID number.

A PCP is a physician or a provider who specializes in the delivery of primary care services. The PCP is responsible for coordinating all of a member's healthcare needs.

Your PCP is the provider that you selected as your personal health care provider. If you did not select a provider, one was selected for you. The name and phone number of your PCP is listed on your membership ID card.

You can change your Primary Care Provider (PCP) at any time. To change your PCP, call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363. You can also change your PCP online by going to our web site at:

www.fhp.org

PCP's sometimes will be open to established patient's only. That means the PCP has limited the number of Children's Mercy Family Health Partners members for whom they can provide care to those that have been treated in their office already. Providers also limit their panels to ensure their current patients are able to continue to have access to care. Providers who are accepting only established patients are indicated in the Provider Directory. If you have a question about a provider that is accepting established patients only, call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363.

Your Primary Care Provider (PCP) will help you find a specialist if you need one. They can help you see any provider in the Children's Mercy Family Health Partners network. If you need care from a provider outside of the network, a prior authorization is needed.

Yes. The services you can receive without coordinating with your PCP are:

• Family planning or birth control
• Dental services
• Mental health services
• Local public health agencies for immunizations, lead screening, tests and treatment for sexually transmitted diseases, tuberculosis or HIV/AIDS
• Vision services (must use participating providers)
• Women's health services. You can go to any of the participating GYN providers.

If your situation is an emergency, go directly to the nearest Emergency Room or dial 911. Be sure to call your Primary Care Provider (PCP) the following day and schedule follow-up care.

If your situation is not an emergency you should call either your PCP or the Nurse Advice Line. Either your PCP or Nurse Advice can give approval for you to seek urgent care if needed. The Nurse Advice Line for Children's Mercy Family Health Partners members is 1-800-347-9369.

If you are unhappy with your health care or unhappy with the decision to not cover a service, you can file a grievance or appeal by calling the Children's Mercy Family Health Partners Customer Service and request the Quality Management Nurse in charge of grievances and appeals at 1-877-347-9363.

You must choose a Primary Care Provider (PCP). If you do not, we will choose one for you. Your PCP will manage your health care. Your PCP's phone number is on the front of your member ID card. The PCP knows Children's Mercy Family Health Partners network and can guide you to specialists if you need one. You may ask for a specialist as your PCP if you have a chronic illness or disabling condition. We will work out a plan to make sure you get the care you need. You have a right to change PCPs in our HealthWave Managed Care health plan at any time.

To report a loss of your Children's Mercy Family Health Partners ID card, call Customer Service at 1-877-347-9363. A new ID card can be mailed to you.

To report a loss of your HealthWave Title 19 paper ID card, you should call the Medical Assistance Customer Service Center (MACSC) at 1-800-766-9012.

Services outside the United States are not covered.

Emergency: Emergency services are covered as long as the out of state treating provider agrees to enroll and accept the Kansas Medicaid amount. Emergency services are services required when there is a sudden or unforeseen situation or occurrence or a sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:

• 1. Placing the patient's health in serious jeopardy; or
• 2. Serious impairment to bodily functions; or
• 3. Serious dysfunction of any bodily organ or part.

Non-Emergency: Non-Emergency: Out of state is defined as "not within the physical boundaries of Kansas or any of the states that border Kansas." All non-emergent, Medicaid covered services that are to be obtained out of state must be approved before the services are received. To get the approval for out of state services a written request must be sent by a physician to:

Children's Mercy Family Health Partners, PO Box 411806, Kansas City, Mo. 64141-1806 or by calling our Prior Authorization line at 1-888-691-4874.

The written request must include a brief past medical history, services attempted in Kansas, where the services are being requested and who will provide them, and why the service cannot be done in Kansas. The out of state provider must agree to enroll and accept the Kansas Medicaid amount.

You receive your pharmacy benefits directly by using your Children's Mercy Family Health Partner's member ID card. Remember to take your member ID card with you when you go to the pharmacy.

You do not have a co-payment for medications if you are a Children's Mercy Family Health Partners member.

Yes, there are some over the counter medications that are covered. You can find this information here or by calling 1-877-347-9363 for a complete listing.

The members must provide their Children's Mercy Family Health Partners member ID card to the pharmacist. If the member ID card is not presented, the pharmacy can not fill the prescription. If the member is in urgent need to fill the prescription and does not have the member ID card, please call Children's Mercy Family Health Partners Customer Service at 1-877-347-9363 for additional assistance.

You can contact the Customer Service department at 1-877-347-9363. New ID cards can be mailed to you.

You can click here or call Customer Service at 1-877-347-9363. Your doctor can also help you with medications that require prior authorization.

A list of the participating providers can be obtained on this web site by clicking here.

You can get your covered diabetic supplies from any of our contracted DME providers. Call The Children's Mercy Family Health Partners Customer Service Department at 1-877-347-9363. Someone will direct you to the correct provider. Members can only receive emergency diabetic supplies or equipment at the local participating pharmacy. Prescriptions for diabetic medications, such as insulin, may be presented at a participating pharmacy.