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

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Table 14 continuedEnrolls dual CMS design grant forContracts with Dual eligible initiativeState eligibles duals initiativeMedicare SNPsunder developmentFL x x xGA x xHI xIA xID x xKY x xMA x x x xMExMI x x xMN x x x xMOxNC x x xNExNJ x xNM xNY x x x xOHxOK x x xOR x x xPA x xRIxSC x x x xTN x x xTX x x xUT x xVT x xWA x x x xWI x x x xTotal 25 15 21 2148 00
Looking ahead: Medicaid managed care expansion and health reformKey Section Findings: States expect to rely increasingly on managed care to serve Medicaid beneficiaries.Severe budget pressures remain a key challenge for states, and new demands associated withhealth reform also emerge as issues.While some states see barriers to Medicaid MCOs becoming Exchange plans, others expectMCOs to seize the Exchange as a market opportunity.Key health reform implications for Medicaid managed care are yet to come into focus in manystates.Under the ACA, beginning in 2014, Medicaid eligibility will expand to reach nearly all Americans underage 65 with income below 133 percent of the federal poverty level, and others up to 400 percent of thepoverty level will be eligible for subsidies to purchase coverage offered through new health insuranceExchanges. An estimated 16 million additional people – mostly, uninsured adults – are expected to gainMedicaid coverage by 2019, and a similar number will gain coverage through the Exchanges. The healthreform law envisions seamless transitions and coordination between coverage programs when peoplemove from one to the other due to changes in their income or other circumstances.Although it is widely expected that managed care will play a growing role in Medicaid under healthreform, until this survey, there has been no systematic assessment of states’ plans in this regard, or ofthe capacity of their MCOs to absorb new Medicaid enrollment. To gauge how prepared states are forthe Medicaid expansion and the coordination challenges ahead, the survey asked states that contractwith MCOs several questions about the future of Medicaid managed care under health reform.States expect to rely more on managed care in the near term. Continued budget pressures and interestin improving service delivery and payment systems are fueling states’ plans to expand the use ofmanaged care in Medicaid. In all, 27 states (of 45 responding) indicated that they expect to rely onMedicaid managed care to a greater extent. Of these 27 states, six specified that they have plans tomandate managed care enrollment for additional Medicaid populations (California, Kentucky, Louisiana,Michigan, New Jersey, and South Carolina), and four reported that they have plans to expand managedcare to additional geographic areas (Florida, Kentucky, Texas, and Virginia).States see significant issues, challenges, and opportunities in the next couple of years. State budgetstrains and enrollment increases are both challenges that states cited frequently. The lingeringeffects of the recession – reduced tax revenues, high unemployment, and high demand for healthand human services programs (Medicaid, in particular) – all continue to generate intense pressure onstates already struggling to meet competing needs with limited resources.States also identified concerns about new demands on their capacity stemming from health reform,along with other issues. Increased Medicaid enrollment, adequacy of provider networks, Exchangedevelopment, and development of systems for claiming the proper federal matching rate wereamong the challenges states mentioned. States also cited a need for more flexibility to integrate carefor dual eligibles. Individual states identified several other issues and pressures, including the need49
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kaisercommission onmedicaidand theu
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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: In many states, broader efforts foc
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
Page 67 and 68: State(No. ofcontracts)NameEnrollmen
Page 69 and 70: APPENDIX 5: MCO Capitation Rate-Set
Page 71 and 72: APPENDIX 7: MCO Network Adequacy Re
Page 73 and 74: State Primary Care Obstetric Care S
Page 75 and 76: APPENDIX 9: Providers Recognized as
Page 77 and 78: APPENDIX 11: PCCM Administrative Se
Page 79 and 80: APPENDIX 13: Initiatives to Improve
Page 81 and 82: I. MANAGED CARE OVERVIEW1. Total Ma
Page 83 and 84: 4. Enrollment Requirements.a. We ar
Page 85 and 86: ii. Please indicate whether the fac
Page 87 and 88: c. Required Providers: We are inter
Page 89 and 90: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 91 and 92: . Does your state use CAHPS© surve
Page 93 and 94: VI. SPECIAL INITIATIVESAll states s
Page 95 and 96: Appendix I: Managed Care Contracts1
Page 97: Appendix II: Clinical Quality Perfo
Page 100: 1330 G S T R E E T NW, W A S H I N
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