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Rosa is a single mother with two children living in Lancaster county, PA.

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Rosa recently lost her job during the pandemic.  They just couldn't stay open anymore because of the state of the economy so she is having a hard time right now.  She found some part-time work, but it's not much to get by with while taking care of two children.  She calls Highmark Wholecare's customer service line to inquire, because a neighbor told her that we might be able to help because we provide insurance to people who are in similar situations.

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A Highmark Wholecare customer service agent tells Rosa that in order to qualify for Highmark Wholecare health insurance, she needs to first qualify for Medicaid.

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Since Medicaid is a state run program, Rosa needs to go to the Pennsylvania Compass website, call 1-800-440-3989, or complete a paper application at her local county assistance office.

https://www.dhs.pa.gov/HealthChoices/HC-Services/Pages/How-to-Apply.aspx

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Once Rosa is deemed eligible for Medicaid, she can either go to the Pennsylvania Enrollment Services website to enroll in Highmark Wholecare, or call Enrollment Services at 1-800-440-3989 to select Highmark Wholecare.

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It's important to enroll! Here are three ways to enroll. To check your enrollment status after you enroll, go to Check my case.

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After Rosa's application has been approved, the County Assistance Office will create a "Case File" for Rosa.  It will have a specific "Case Number".  Each member of her family will have an "individual ID" on the case. The case information is "transmitted" over to Highmark Wholecare as an eligibility file so that we know she is an eligible Medicaid recipient who has chosen us to manage her benefits.  She should soon show up in our systems, have a member ID, and everyone at the company will be able to see her account.

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Pennsylvania Medicaid - Lancaster County Assistance Office (CAO)

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Pennsylvania Medicaid - Lancaster County Assistance Office (CAO)

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Because Rosa lives in Lancaster County, her case will be managed by the Lancaster County Assistance Office.  They determine continued eligibility.  It is important that Rosa continues to stay in contact with the Lancaster CAO because Highmark Wholecare gets ALL of her demographic and eligibility information from them.

Once Rosa is enrolled in the Highmark Wholecare plan, you can see that she will fall under the Highmark Wholecare Blue Shield plan!

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Now that Rosa (and probably her children, too) is an active Highmark Wholecare member, she might call and ask us to update certain pieces of information.  We can do a lot of this for her BUT there are certain changes that MUST be managed by her local county assistance office.  Those are demographics and eligibility.  We cannot change name, birthdate, address, head of household info, effective and termination dates, or lock in status on our end until those are reflected in eCIS (The PA State Website).