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

StateProgram Name(e.g., Popular Name, 1915(b) or1115 Waiver Name)StatewideModelMCO PCCM PHPSSIChildrenFosterChildrenMedicaidExpansionCHIPAll OtherChildrenEligibility Groups EnrolledVAMedallion II X X X X X X X X XMEDALLION X X X X X X X XVT Global Commitment: 1115 X X X X X X X X X XHealthy Options X X X X XWashington Medicaid IntegrationPartnership (WMIP)X X X X X XWAWIWV 16PregnantWomenParents/CaretakersNon-DualAgedNon-DualBlind/DisabledChildlessAdultsDualEligibles OtherDisability Lifeline X X X XKing County Care Partners X XCowlitz County X XRegional Support Networks X X X X X X X X X X1115 BadgerCare Plus X X X X X X X1915(a) Children Come First X X X X X<strong>Family</strong> Care X X X X<strong>Family</strong> Care Partnership X X X XMountain Health Trust/1915(b) X X X X X XMountain Health Choices/Benchmark X X X X XAppendix 2 Notes1 Delaware: Maintains a small "enhanced FFS" managed care program (reflected as PCCM in the table above but not otherwise counted as a PCCM program in this report) that was created to maintain client choice when the state had only one MCO.Per approval of CMS, enrollment may be limited.2 Florida: MediPass: Adoption Subsidy children may also enroll. Women who are enrolled in Medicaid only due to pregnancy are excluded from MediPass. Prepaid Mental Health Plans: In all areas of the state except Baker, Broward, Clay, Duval, andNassau counties (where 1115 Waiver operates). Medicaid managed care eligibles that voluntary select MediPass for their health care services are automatically enrolled in the prepaid mental health for their behavioral health services. Child WelfarePrepaid Mental Health Plans (CWPHPs): Foster care children mandatory enrolled. CWPHPs provide behavioral health services and operate statewide (except for Area 1, and Polk, Manatee, Hardee, and Highlands Counties only). Nursing HomeDiversion: Includes elderly age 65 or older and disabled adults 55 or older. Plan members must: (1) live in county offering program services, (2) be age 65 or older, (3) be eligible for Medicare Part A and B and the Medicaid Institutional Care Program(ICP), (4) meet additional impairment criteria beyond nursing home level of care requirements, and (5) not be enrolled with the PACE program or any other Medicaid managed care program.3 Idaho: Idaho Smiles does not cover dual eligibles age 65 and over. Coordinated Care Plans cover Medicare Advantage dual eligibles.4 Illinois: During FY 2011, Illinois will implement a new Integrated Care Program (MCO) to serve approximately 40,000 seniors and adults with disabilities residing in Lake, Kane, DuPage, Will, Kankakee, and suburban Cook Counties.5 Indiana: On October 1, 2010, Care Select changed from a mandatory enhanced PCCM program to a voluntary disease management PCCM program for the populations checked above. However, the member must also have at least one of a specifiedlist of disease conditions to be enrolled.6 Massachusetts: Dual eligibles are excluded from 1115 managed care enrollment. However, dual eligible children must enroll with the Massachusetts Behavioral Health Partnership.7 Minnesota: MNDHO contract terminated on December 31, 2010. In Special Needs Basic Care (SNBC), SSI children are 18 -21. SNBC no longer statewide effective January 1, 2011.8 Missouri: “Other” includes Refugees and children in a separate CHIP program.9 Nebraska: In February 2011, the state announced the implementation of a two-year patient centered medical home pilot in two medical practices utilizing a PCCM model that is included in the table above but not otherwise counted as s PCCMprogram in this report.10 New Jersey: "Other" is General Assistance, a state-only population.11 Oklahoma: Also includes TEFRA and women under treatment for breast or cervical cancer.12 Pennsylvania: For dual eligibles age 21 and older are not enrolled in Health Choices (PH) or ACCESS Plus.13 Rhode Island: RIte Share is the state's employer sponsored insurance program.14 Tennessee: TennCare includes one Prepaid Inpatient Health Plan (TennCare Select) and two Prepaid Ambulatory Health Plans (a DBM and a PBM). Persons in any of the populations named may be served in TennCare Select, depending upon theircircumstances. The DBM serves only children under 21. The PBM serves all enrollees except dual eligibles.15 Texas: STAR: limited income families, pregnant women, children, SSI/SSI-related recipients without Medicare. STAR+PLUS: aged. blind, disabled SSI recipients. STAR: Federally recognized tribes. Exception: If any of the above are in waiverprograms i.e. 1915 ⌐ they are excluded from PCCM.16 West Virginia: PCCM only applies when state is primary.56 00