Member Disenrollment Rights

The times when your plan membership may end are:

• When you no longer qualify for New Hampshire Medicaid.
• If you decide to switch to another plan during the Annual Open Enrollment Period:
  • When is the Annual Open Enrollment Period? The Annual Open Enrollment Period is described in the open enrollment notice sent to you each year by NH DHHS. The notice will provide instructions on when and how to switch health plans if you choose to do so, including when your membership ends in your current plan.
  • For information on care transitions between plans, refer to Section 5.3 (Continuity of care, including transitions of care) of your Member Handbook (PDF).
• In certain situations, you may also be eligible to leave the plan at other times of the year for cause. These situations include:
  • When you move out of state.oWhen you need related services to be performed at the same time and not all related services are available within the network; and when receiving services separately would subject you to unnecessary risk.
  • For other reasons, such as poor quality of care, lack of access to NH Medicaid covered services, violation of your rights, or lack of access to network providers experienced in dealing with your needs.

When you request disenrollment from the plan for a reason above (except when you move out of state), you must first file a grievance with the plan to seek a decision about your grievance. If you are dissatisfied with the plan’s response and still want to request disenrollment, you may call NH DHHS to learn if you are eligible to disenroll from the plan.

• You may also be eligible at other times of the year to leave the plan without cause, including:
  • Once during the 90 calendar days following the date of your initial Medicaid eligibility.
  • During the first twelve (12) months of enrollment for members who are auto-assigned to a plan, and have an established relationship with a PCP that is only in the network of a non-assigned health plan.
  • During open enrollment related to NH DHHS’s new contracts for New Hampshire Medicaid managed care plans.
  • For 60 calendar days following an automatic reenrollment if the temporary loss of Medicaid has caused you to miss the Annual Open Enrollment Period. (This does not apply to new applications for New Hampshire Medicaid.)
• When NH DHHS grants members the right to terminate enrollment without cause and notifies affected members of their right to disenroll from the plan.
• When your plan chooses not to provide a service you need due to moral or religious reasons.
• When members are involuntarily disenrolled from the plan as described in Section 11.2 (When you may be involuntarily disenrolled from the plan) of your Member Handbook (PDF).

To request disenrollment from your plan, call or write to NH DHHS. Contact the NH DHHS Customer Service Center at 1-844-ASK-DHHS (1-844-275-3447) (TDD Access Relay: 1-800-735-2964), Monday through Friday, 8:00 a.m. – 4:00 p.m. ET.

Until your new coverage begins you must continue to get your health care and prescription drugs through our plan.