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

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VII. LOOKING AHEADAll states should complete this section.1. Planned Changes. Please briefly describe any planned changes or new initiatives in the state’s managed careprogram(s), including enrollment of new populations, expansion to new geographic areas, change in managedcare models, other plan changes, etc.2. Health Home Option. Does your state plan to elect the new state plan option under section 2703 of theAffordable Care Act to establish Health Homes for enrollees with chronic conditions?a. If “yes,” will your state seek the enhanced FMAP available under Section 2703 for any program that alreadyexists?3. Outlook for Medicaid Managed Care in the Futurea. What is the expected future direction for managed care in your state (e.g., new, greater or lesser reliance onmanaged care or on the RB-MCO or PCCM delivery model)?b. What do you believe are the most significant issues, challenges or opportunities that your state’s Medicaidmanaged care program will face over the next year or two?c. Please comment briefly on the implications for your state of the federal requirement that rates be actuariallysound:d. What other federal regulatory requirements are issues for your program?e. What do you currently envision will be the role of Medicaid managed care under health reform?f. For states that currently have comprehensive RB-MCOs:i. Do your state’s health plans have sufficient network capacity currently to add new enrollment?ii. Do you anticipate that your state’s health plans collectively can develop or generate sufficient networkcapacity to accommodate the expected Medicaid enrollment growth under health reform?iii. Have any of your Medicaid health plans expressed interest in becoming Insurance Exchange plans?iv. Is your state considering requiring one or more health plans in the Exchange to participate with Medicaid?v. Is your state considering requiring one or more Medicaid health plans to participate in the Exchange?vi. Please briefly describe any issues or barriers to entry that would prevent or discourage your state’s Medicaidhealth plans from becoming Insurance Exchange plans:g. What do you envision the impact of health reform will be on Medicaid managed care?K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured15HEALTH MANAGEMENT ASSOCIATES
Appendix I: Managed Care Contracts1. Contracted Health Plans. Please list the names of your state’s comprehensive RB-MCOs as of October 1, 2010and the plan enrollments for that month. Indicate whether the RB-MCO exclusively or primarily servesMedicaid/CHIP populations, serves both commercial and Medicaid populations, is a nonprofit or for-profit company,is publicly traded and whether it is a local or national company. If new contracts have been awarded forimplementation sometime in FY 2011 after October 1, 2010, please include those as well and include the plannedimplementation date under “Comments.”1.2.3.4.5.6.7.8.9.10.11.12.13.14.15.16.17.18.19.20.21.22.23.24.25.26.27.2829.30.Health Plan NameOctober2010EnrollmentMedicaid only /MixedCommercial andMedicaidNon-profit/For- ProfitPubliclytradedNational /LocalComments:K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured16HEALTH MANAGEMENT ASSOCIATES
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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
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from the recession and the slow rec
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A note on Medicaid managed care ter
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Managed caremodelTable 1: Medicaid
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States are increasingly mandating m
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States with Medicaid MCOsKey Sectio
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States have “auto-assignment” a
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excess of a specified threshold for
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Dental care and outpatient and inpa
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the second trimester, and within th
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eported that they limit PCP panel s
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States with non-comprehensive PHPsK
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Measuring, monitoring, and improvin
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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 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: VI. SPECIAL INITIATIVESAll states s
Page 97: Appendix II: Clinical Quality Perfo
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