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

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kaisercommissionmedicaiduninsuredand theThe <strong>Kaiser</strong> Commission on Medicaid and theUninsured provides information and analysison health care coverage and access for thelow-income population, with a special focuson Medicaid’s role and coverage of theuninsured. Begun in 1991 and based in the<strong>Kaiser</strong> <strong>Family</strong> <strong>Foundation</strong>’s Washington, DCoffice, the Commission is the largestoperating program of the <strong>Foundation</strong>. TheCommission’s work is conducted by<strong>Foundation</strong> staff under the guidance of a bipartisangroup of national leaders andexperts in health care and public policy.James R. TallonChairmanDiane Rowland, Sc.D.Executive Director
kaisercommission onmedicaidand theuninsuredA Profile of Medicaid Managed Care Programs in 2010:Findings from a 50-State <strong>Survey</strong>Prepared byKathleen Gifford, Vernon K. Smith, and Dyke SnipesHealth Management AssociatesandJulia Paradise<strong>Kaiser</strong> Commission on Medicaid and the Uninsured<strong>Kaiser</strong> <strong>Family</strong> <strong>Foundation</strong>September 2011
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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 16 and 17: from the recession and the slow rec
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
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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
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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
Page 77 and 78:
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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