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

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State(No. ofcontracts)NameEnrollmentComposition*Not-for-Profitor For-ProfitPubliclyTradedNational orLocalEnrollment as ofOctober 2010NY cont. MVP Health Plan Mixed Not-for-Profit Local 35,024Neighborhood Health Providers Medicaid only Not-for-Profit Local 193,480NYPS Select Health SN Medicaid only Not-for-Profit Local 1,988NYS Catholic Health Plan Medicaid only Not-for-Profit Local 543,726NYS Catholic Health Plan 1199 Medicaid only Not-for-Profit Local 3,662SCHC Total Care Medicaid only Not-for-Profit Local 37,826United Healthcare Plan of NY Mixed For-Profit X National 243,034Univera Community Health Medicaid only Not-for-Profit Local 39,115WellCare Of New York Medicaid only For-Profit X National 75,234VNS Choice Medicaid only Not-for-Profit Local 8,487GuildNet Medicaid only Not-for-Profit Local 6,295HomeFirst Medicaid only Not-for-Profit Local 3,597Comprehensive Care Management Medicaid only Not-for-Profit Local 2,537Senior Health Partners Inc Medicaid only Not-for-Profit Local 2,393CCM Select Medicaid only Not-for-Profit Local 1,764Independence Care Systems Medicaid only Not-for-Profit Local 1,578OH Buckeye Community Health Plan (Centene) Medicaid only For-Profit National 159,607(7) CareSource Medicaid only Not-for-Profit National 812,503Molina Healthcare of Ohio Medicaid only For-Profit X National 241,153Paramount Advantage Medicaid only For-Profit Local 88,559Unison Health Plan of Ohio Mixed For-Profit X National 122,351WellCare of Ohio Medicaid only For-Profit X National 102,014Amerigroup Community Care Medicaid only For-Profit X National 56,453OR Care Oregon Medicaid-only Not-for-Profit Local 135113(15) Cascade Comprehensive Medicaid-only For-Profit Local 9021Central Oregon Individual Health Solutions Mixed Not-for-Profit National 31918Doctors of the Oregon Coast South Medicaid-only For-Profit Local 10511DCIPA Medicaid-only For-Profit Local 14518<strong>Family</strong> Care Medicaid-only For-Profit Local 45508Inter Community Health Network Mixed Not-for-Profit Local 26139<strong>Kaiser</strong> Permanente Oregon Plus Mixed Not-for-Profit National 11651Lane IPA Medicaid For-Profit Local 41899Marion/Polk Community Health Plan Medicaid For-Profit Local 53683Mid Rogue IPA Medicaid For-Profit Local 18970ODS Community Health Medicaid For-Profit Local 9930Oregon Health Management Services Medicaid For-Profit Local 4996Providence Health Plan Mixed Not-for-Profit National 20858Tuality Health Mixed Not-for-Profit Local 9658PA Aetna Better Health Mixed For-Profit X National 31,144(9) AmeriChoice of Pennsylvania Mixed For-Profit X National 76,900AmeriHealth Mercy Health Plan (AMHP) Medicaid only Not-for-Profit National 107,067Coventry Cares Mixed For-Profit X National 9,249Gateway Health Plan Medicaid only For-Profit Local 250,196Health Partners of Philadelphia Medicaid only Not-for-Profit Local 165,191Keystone Mercy Health Plan Medicaid only Not-for-Profit National 303,318Unison Health Plan Mixed For-Profit X National 151,985UPMC for You Mixed Not-for-Profit Local 137,089RI Neighborhood Health Plan of Rhode Island Medicaid only Not-for-Profit Local 85,444(3) UnitedHealthcare of New England Mixed For-Profit X National 38,336Blue Cross Blue Shield of Rhode Island Mixed Not-for-Profit Local 10,156SC Absolute Total Care (Centene) Medicaid only For-Profit X National 88,998(4) BlueChoice Health Plan Mixed For-Profit Local 30,620First Choice Health Plan Medicaid only Not-for-Profit National 201,127Unison Health Plan of SC (United) Mixed For-Profit X National 70,688TN AmeriGroup Tennessee, Inc. Mixed For-Profit X National 200,204(3) UnitedHealthcare Plan of the River Valley, Inc. Mixed For-Profit X National 554,210Volunteer State Health Plan, Inc. Medicaid only For-Profit Local 465,029TX Amerigroup Medicaid only For-Profit X National 455,105(16) Superior Health Plan & Bankers Reserve (Centene) Medicaid only For-Profit X National 307,557Texas Children's Health Plan Medicaid only Not-for-Profit Local 198,081Community Health Choice Medicaid only Not-for-Profit Local 125,916Evercare/United Health Mixed For-Profit X National 69,825Parkland Health Plan Medicaid only Not-for-Profit Local 156,07060 00
State(No. ofcontracts)NameEnrollmentComposition*Not-for-Profitor For-ProfitPubliclyTradedNational orLocalEnrollment as ofOctober 2010TX cont. Community First Health Plans Medicaid only Not-for-Profit Local 83,775Aetna Mixed For-Profit X National 58,134Cook Children's Health Plan Medicaid only Not-for-Profit Local 60,990Molina Medicaid only For-Profit X National 29,542Driscoll Children's Health Plan Medicaid only Not-for-Profit Local 42,707El Paso First Health Plans Medicaid only Not-for-Profit Local 48,441SHA dba FirstCare Health Plans Mixed Not-for-Profit National 28,801UniCare (WellPoint) Mixed For-Profit X National 17,456Bravo (HealthSpring) Mixed For-Profit X National 0UT (1) Molina Medicaid only For-Profit X National 52,100VA Anthem HealthKeepers Mixed For-Profit X National 193,529(5) CareNet by Southern Health (Coventry) Mixed For-Profit X National 21,821Optima <strong>Family</strong> Care Mixed Not-for-Profit Local 137,607Virginia Premier Medicaid only For-Profit Local 139,801Amerigroup Medicaid only For-Profit X National 34,602WA Molina Healthcare of Washington Medicaid only For-Profit X National 333,473(6) Community Healthcare of Washington Medicaid only Not-for-Profit Local 224,256Clark United Providers Medicaid only For-Profit Local 41,954Asuris Northwest Health Mixed Not-for-Profit Local 2,880Regence BlueShield Mixed Not-for-Profit National 38,945Group Health Cooperative Mixed Not-for-Profit National 21,088WI Children's Community Health Plan Medicaid only Not-for-Profit Local 37,062(18) CommunityConnect Health Plan Medicaid only For-Profit Local 8,241Compcare Mixed For-Profit Local 29,434Dean Health Plan Mixed For-Profit Local 41,027Dean Southeast Mixed For-Profit Local 3,415Group Health Cooperative of Eau Claire Mixed Not-for-Profit Local 40,020Group Health Cooperative of South Central Mixed Not-for-Profit Local 4,132Gunderson Lutheran Health Plan Mixed Not-for-Profit Local 16,465Health Tradition Health Plan Mixed For-Profit Local 9,021Independent Care Health Plan Medicaid only For-Profit Local 3,009Managed Health Services Medicaid only For-Profit X National 39,056MercyCare Insurance Company Mixed For-Profit Local 15,071Molina Medicaid only For-Profit X National 30,538Network Health Plan Mixed For-Profit Local 37,873Physicians Plus Insurance Company Mixed Not-for-Profit Local 7,527Security Health Plan Mixed For-Profit Local 52,250UnitedHealthcare Mixed For-Profit X National 237,874Unity Healthplans Insurance Co Mixed Not-for-Profit Local 12,187WV UniCare Health Plan of WV (WellPoint) Mixed For-Profit X National 79,563(3) Carelink Health Plan (Coventry) Mixed For-Profit X National 53,726Total EnrollmentThe Health Plan Mixed Not-for-Profit National 27,55926,475,260* "Mixed" indicates mix of Medicaid and commercial enrollment.61
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kaisercommission onmedicaidand theu
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kaisercommission onmedicaidand theu
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Table of ContentsExecutive Summary
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EXECUTIVE SUMMARYMedicaid, the publ
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party enrollment brokers to provide
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HEDIS©, CAHPS©, and state-specifi
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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
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: 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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Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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