Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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from the recession and the slow recovery. Second, many states are expanding managed care to moremedically complex and fragile populations, for whom the stakes may be especially great. Third, statesare expected to rely heavily on managed care to serve the millions of adults who will become newlyeligible for Medicaid in 2014.In light of the large and growing role of managed care in Medicaid, and the implications for Medicaidbeneficiaries, the <strong>Kaiser</strong> Commission on Medicaid and the Uninsured and Health ManagementAssociates conducted a special survey of Medicaid programs to assess the state of Medicaid managedcare, identify current issues, and gain perspectives on the directions Medicaid managed care may take inthe coming years. This report presents data and findings based on that survey.10 00
About this surveyThe <strong>Kaiser</strong> Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates(HMA) surveyed Medicaid directors in all 50 states and the District of Columbia (DC) to document stateMedicaid managed care policies and programs as of October 1, 2010, and to collect information on likelypolicy directions in the near term and under health reform.The KCMU/HMA survey was emailed to every state Medicaid director in late December 2010. The surveyasked states to report on the Medicaid managed care arrangements that would be in operation in StateFiscal Year 2011, including comprehensive managed care through contracts with risk-based managedcare organizations (MCOs) and primary care case management (PCCM) programs, as well as noncomprehensiveprepaid health plans (PHPs). States were asked to complete only the sections relevant totheir Medicaid managed care programs. For example, states that operate PCCM programs but do notcontract with MCOs were instructed to complete the PCCM section, but not the MCO section. However,all states were asked to complete an overview section, and all states with any form of managed carewere asked to respond to sections on quality, special initiatives, and health reform. <strong>Survey</strong>s werecompleted by state staff and responses were received from every state and DC. This report is basedprimarily on information as recorded by states on the survey instrument. It was not possible toindependently validate all state responses. In addition, not all states responded to all questions relevantto their managed care programs.In a few cases, at the request of a state Medicaid director, HMA staff partially completed the state’ssurvey response based on publicly available information and then forwarded it to the state forverification and completion of remaining items, or completed a state survey response based on atelephone or in-person interview with state staff. Also, when necessary, HMA staff posed follow-upquestions to state staff by telephone or email to clarify survey responses or obtain additionalinformation. In some instances, HMA staff supplemented state responses based on web-based researchand using enrollment data collected for KCMU.The survey instrument is included as Appendix 14.11
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Page 5 and 6: Table of ContentsExecutive Summary
Page 7 and 8: EXECUTIVE SUMMARYMedicaid, the publ
Page 9 and 10: party enrollment brokers to provide
Page 11 and 12: HEDIS©, CAHPS©, and state-specifi
Page 13: ConclusionFor over 30 years, state
Page 18 and 19: A note on Medicaid managed care ter
Page 20 and 21: Managed caremodelTable 1: Medicaid
Page 23 and 24: States are increasingly mandating m
Page 25 and 26: States with Medicaid MCOsKey Sectio
Page 27 and 28: States have “auto-assignment” a
Page 29 and 30: excess of a specified threshold for
Page 31 and 32: Dental care and outpatient and inpa
Page 33 and 34: the second trimester, and within th
Page 35 and 36: eported that they limit PCP panel s
Page 37 and 38: States with non-comprehensive PHPsK
Page 39 and 40: Measuring, monitoring, and improvin
Page 41 and 42: seven states required 10 measures o
Page 43 and 44: CAHPS© surveys. North Carolina is
Page 45 and 46: Special initiatives to improve qual
Page 47 and 48: public health efforts to reduce dis
Page 49 and 50: Medicaid managed long-term care and
Page 51 and 52: (e.g., need to credential Adult <st
Page 53 and 54: In many states, broader efforts foc
Page 55 and 56: Looking ahead: Medicaid managed car
Page 57 and 58: ConclusionFor over 30 years, state
Page 59 and 60: APPENDIX 2: Summary of Medicaid Man
Page 61 and 62: Program Name(e.g., Popular Name, 19
Page 63 and 64: APPENDIX 3: MCO Contracts, Plan Cha
Page 65 and 66: State(No. ofcontracts)NameEnrollmen
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State(No. ofcontracts)NameEnrollmen
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APPENDIX 5: MCO Capitation Rate-Set
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APPENDIX 7: MCO Network Adequacy Re
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State Primary Care Obstetric Care S
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APPENDIX 9: Providers Recognized as
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APPENDIX 11: PCCM Administrative Se
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APPENDIX 13: Initiatives to Improve
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I. MANAGED CARE OVERVIEW1. Total Ma
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4. Enrollment Requirements.a. We ar
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ii. Please indicate whether the fac
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c. Required Providers: We are inter
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IV. NON-COMPREHENSIVE PREPAID HEALT
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. Does your state use CAHPS© surve
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VI. SPECIAL INITIATIVESAll states s
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Appendix I: Managed Care Contracts1
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Appendix II: Clinical Quality Perfo
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1330 G S T R E E T NW, W A S H I N
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