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

Overview of of Medicaid managed careKey Key Section Section Findings: Findings:Nearly Nearly all all states states operate operate comprehensive comprehensive Medicaid Medicaid managed managed care care programs programs through through contracts contractswith with MCOs MCOs or or a state-administered state-administered PCCM PCCM program. program. Overall, Overall, 35.5 35.5 million million Medicaid Medicaidbeneficiaries, beneficiaries, or or about about 66 66 percent, percent, are are enrolled enrolled in in comprehensive comprehensive managed managed care. care.Thirty-six Thirty-six states states contract contract with with MCOs MCOs and and 31 31 states states operate operate a PCCM PCCM program. program. More More states states have haveboth both MCOs MCOs and and a PCCM PCCM program program than than just just one one or or the the other. other. Half Half the the states states also also contract contract with withnon-comprehensive non-comprehensive PHPs PHPs to to provide provide specific specific categories categories of of services. services.The The benefit benefit that that state state officials officials most most often often attributed attributed to to managed managed care care was was improved improvedbeneficiary beneficiary access access to to care. care. In In addition, addition, states states cited cited improvements improvements in in quality quality and and improved improved value valuefor for state state dollars. dollars.Nearly Nearly all all states states operate operate comprehensive comprehensive Medicaid Medicaid managed managed care care programs. programs. Across Across all all 50 50 states states and andDC, DC, only only three three states states (Alaska, (Alaska, New New Hampshire Hampshire and and Wyoming) Wyoming) reported reported that that they they did did not not have have any anyMedicaid Medicaid managed managed care care as as of of October October 2010 2010 (Figure (Figure 1). 1). Overall, Overall, 36 36 of of the the 48 48 states states with with comprehensivecomprehensivemanaged managed care care programs programs reported reported contracting contracting with with MCOs MCOs and and 31 31 reported reported operating operating a PCCM PCCM program. program. 3States States were were more more likely likely to to have have both bothMCOs MCOs and and a PCCM PCCM program program than than to tohave have just just one one or or the the other. other. The The 36 36states states contracting contracting with with MCOs MCOs include include17 17 states states with with MCOs MCOs alone alone and and 19 19states states operating operating both both MCO MCO and and PCCM PCCMprograms programs (Table (Table 1). 1). The The 31 31 states states with witha PCCM PCCM program program include include the the 19 19 states stateswith with both both a PCCM PCCM program program and and MCOs MCOsand and 12 12 states states operating operating only only a PCCM PCCMprogram. program.Figure 1Figure 1Comprehensive Medicaid Managed Care Models Comprehensive ComprehensiveComprehensive Medicaid MedicaidMedicaid Opera4ngManaged ManagedManaged in the 6tates7Care Care in Care Models in 2919the the States, States, 2010 2010Opera4ng in the 6tates7 2919 WA VT ME WA MT ND VT ME NH MT ND MN NH OR SD MN WI NY MA OR ID WI MI NY MA RI ID WY SD CT MI PA WY IA CT RI NJ NE OH PA IA NJ DE NV NE IL IN OH DE MD NV UT IL IN WV CO VA MD DC UT CA KS MO KY WV CO VA DC NC CA KS MO KY TN NC OK AR SC AZ TN NM OK AR SC AZ NM MS AL GA AK MS AL GA TX LA AK TX LA FL FL A total total of of 25 25 states states operated operated noncomprehensivcomprehensivePHPs PHPs alongside alongside their theirComprehensive Medicaid PCCM MCO MCO MCO only and and PCCMHI non-MCO MCO only only (17only only states) (17(17 (16 states)HI states) states and DC) MCO only (17 states)MCO PCCM PCCM PCCM only (16 only (12 states)only (12 only (12 states)states) (12 states) and DC) and PCCM and (12PCCM (24 states) (19PCCM (24 (19 states) states) comprehensive Managed Care Enrollment = 66% comprehensive managed managed careComprehensive Medicaid MCO No No and MMC MMCcareNo No MMC MMC PCCM (3 states) (3 states)(3 states) (3 (19 states) states) Managed Care Enrollment = 66% No MMC (3 states) programs. programs. States States contracted contracted withSOURCE: KCMU/HMA <strong>Survey</strong> of Medicaid Managed Care, September 2011.withSOURCE: SOURCE: KCMU/HMA <strong>Survey</strong> of Medicaid Managed Care, Care, September September 2011. 2011. SOURCE: KCMU/HMA <strong>Survey</strong> of Medicaid Managed Care, September 2011. these these plans plans to to provide provide specific specificcategories categories of of services. services. Most Most frequently, frequently, states states contracted contracted with with non-comprehensive non-comprehensive PHPs PHPs to to provide provideinpatient inpatient and and outpatient outpatient behavioral behavioral health health services services and and substance substance abuse abuse treatment, treatment, dental dental care, care, nonemergencemergencytransportation, transportation, and and pharmacy pharmacy services.non-services.Appendix Appendix 1 provides provides a state-by-state state-by-state summary summary of of managed managed care care programs programs in in operation operation as as of of October October2010. 2010. Appendix Appendix 2 provides provides a more more detailed detailed inventory inventory of of state state managed managed care care programs, programs, the the models modelsunder under which which they they operate, operate, and and the the Medicaid Medicaid populations populations enrolled. enrolled.3 ForForeaseeaseofofpresentation,presentation,DCDCisiscountedcountedasasa statestateininthisthisreport,report,includingincludingallalltablestablesandandcharts.charts.13