Office of Children & Families Executive Leadership Council June 15, 2006 Medicaid Managed Care in Ohio—A Status Report
Medicaid Managed Care • Goals: • Share the implementation plan and timeline for the statewide expansion of the Medicaid Managed Health Care Program. • Discuss the impact of program expansion on PCSAs. • Gather input regarding PCSA issues concerns related to mandatory Medicaid managed care.
Today’s Presentation • Medicaid Today • Why Managed Care Program Expansion? • Medicaid Managed Care Today • Program Expansion-Status Update • CFC Statewide Expansion • ABD Statewide Expansion • PCSA Issues and Concerns
Medicaid TodayCovered Eligibility Categories • COVERED FAMILIES & CHILDREN (CFC) (Also known as Healthy Start and Healthy Families) • Children (Up to age 19) • Pregnant Women • Families (Parents & Children) • Total Covered ~ 1.2 million • AGED, BLIND & DISABLED (ABD) • Seniors (65 & over) • People with disabilities • Total Covered ~ 440,000
Medicaid TodayProgram Facts Nationally • Larger than Medicare • 53 Million Americans covered • $300 Billion in expenditures • Main payer for long term care Ohio • Coverage for 2 million Ohioans (1 in 6) including: • 1 million children (1 in 3 births) • 490,000 low income parents • Pays for 70 percent of all nursing home care • $12 billion program • 25% of state budget • Largest payer of claims in the state
Why Managed Care Program Expansion? • Legislative Mandate • Added Program Value • Cost Savings
Why Managed Care?Legislative Mandate • The Ohio Commission to Reform Medicaid recommendation: • Establish a statewide care management program for all Medicaid consumers by: • Expanding the current full-risk program to all CFC consumers statewide, and • Applying a care management approach to selected ABD populations. • Ohio’s 2006-2007 Budget Mandate • Governor, House of Representatives, & Senate • Final Budget Mandate: Transform Ohio Medicaid by implementing the full-risk, managed care model for all CFC consumers, as well as a portion of the ABD population.
Why Managed Care?Added Program Value • Key Managed Care Plan Benefits Include: • Focused attention on prevention and care coordination within a Medical Home setting • Advice and direction for medical issues via a 24/7 nurse hotline • Help in accessing services through a dedicated call center and a provider directory listing PCPs, hospitals, and specialists • Additional services for consumers with special health care needs including case management
Why Managed Care?Added Program Value • Some MCPs may provide more services and benefits than the regular Medicaid fee-for-service (FFS) program offers. These might include: • Transportation, e.g. cab fare, shuttle services, etc. • Extended hours for member services (after 4:30 PM and/or weekends) • Annual eye exams for adults • Additional routine dental visits
Why Managed Care?Added Program Value • Additional services continued: • Gifts/gift certificates for obtaining prenatal care • Gifts/gift certificates for getting immunizations and/or keeping Healthchek • Waiver of co-payments
Why Managed Care?Added Program Value • Accountability/Quality of Care • Contracting MCPs are held accountable to standard levels of performance for • Access • Quality • Consumer satisfaction • Administrative capacity • Performance is monitored through various oversight and assessment activities, e.g. independent external quality review.
Why Managed Care?Cost Savings • The use of managed care has resulted in savings to the Ohio Medicaid Program. • The SFY 2003 cost savings were approximately $55 million. • The SYF 2004 cost savings were approximately $72 million • Managed care reduces overall costs by 3-5% when compared to the fee-for-service delivery system.
Why Managed Care? Cost SavingsOhio Medicaid Expenditures by Provider CategorySFY 2004 Source: OHP 2005 Annual Report
Why Managed Care?Ohio Per Member Per Month Costs Source: OHP 2005 Annual Report
Why Managed Care? Cost SavingsMedicaid Eligibles vs. Costs by Category of EligibilitySFY 2004 Source: OHP 2005 Annual Report
Managed Care Today • Began contracting with Health Maintenance Organizations (HMOs) in 1978 • Medical Foundation of Bellaire (Belmont Co.) • HealthAmerica (Cuyahoga Co.) • 697,475 CFC Medicaid enrollees • Approximately 75% of enrollees are children • MCPs Operating in 17 counties: • 12 mandatory: Butler, Clark, Cuyahoga, Franklin, Hamilton, Lorain, Lucas, Mahoning, Montgomery, Stark, Summit, Trumbull • 5 voluntary: Clermont, Greene, Pickaway, Warren, Wood • ODJFS Contracts with 9 MCPs: AMERIGROUP, Buckeye, CareSource, Gateway, MediPlan, Molina Healthcare, Paramount, QualChoice Health Plan, Unison
Program Status UpdateCFC Statewide Expansion • Procurement Approach • County vs. Regional Approach • 8 regions • 2-3 MCPs per region • Regions phased in • 500,000 additional CFC Medicaid consumers enrolled with this expansion by December 31, 2006
CFC Statewide ExpansionPreliminary MCP Selections (by Region) • Central Region (2 Plans)* • CareSource Molina • East Central Region (3 Plans) • CareSource Unison Buckeye • North East Region (3 Plans) • CareSource WellPoint QualChoice • North East Central Region (3 Plans) • CareSource WellPoint Unison • North West Region (3 Plans) • Paramount WellPoint Buckeye • South East Region (3 Plans) • CareSource Molina Unison • South West Region (3 Plans) • CareSource AMERIGROUP Molina • West Central Region (3 Plans) • CareSource AMERIGROUP Molina * A targeted RFA has been released to secure a third MCP for this region.
CFC Statewide ExpansionPreliminary MCP Selections (by Region) • Central Region Applications submitted 6/6/06 • Anthem Blue Cross Blue Shield Partnership Plan of Ohio, Inc. (WellPoint) • Unison Health Plan of Ohio, Inc. • Northeast Region • Anthem / Qualchoice Purchase • WellCare of Ohio, Inc.
Program Status UpdateCFC Statewide Expansion • Counties Making up the East Central Region (9) Ashland Stark Carroll Summit Holmes Tuscarawas Portage Wayne Richland
MCPs in the East Central • Buckeye Community Health Plan, Inc. • Debra Collins, VP of Contracting • (614)220-4900 Ext. 24114 • email@example.com • www.centene.com • CareSource • Provider Recruitment Connection • (877) 725-4577 • firstname.lastname@example.org • www.care-source.com • Unison Health Plan of Ohio, Inc. • Amanda Hewett • (614) 890-6853 • Amanda.Hewett@unisonhealthplan.com • www.unisonhealthplan.com
Program Status UpdateCFC Statewide Expansion • Procurement Timeline Highlights • August, 2005 – Letters to interested stakeholders (including providers) announcing program expansion • September, 2005 - Minimum provider panel requirements released • November 30, 2005 – RFA released • January 6, 2006 – Due date for MCP Letters of Intent • February 7, 2006 - Applications due • March 17, 2006 – Announcement of MCPs (no more than 3) selected to enter readiness review phase • August to December, 2006 - Enrollment of consumers
Exempted Populations • Certain CFC consumers may choose to be exempted from enrollment into an MCP. These are children under nineteen (19) years of age who are: • Eligible for Supplemental Security Income (SSI) • Receiving federal foster care maintenance or federal adoption assistance under Title IV-E • In foster care or out of home placement • Receiving services through the Ohio Department of Health’s Bureau of Children with Medical Handicaps (BCMH)
Frequently Asked QuestionsMCP Membership Card • MCP members do not receive monthly cards. • A permanent ID card is issued on the first day of initial enrollment. • The ID card includes: • MCP Name • Member Name • MMIS Billing Number • Effective Date of Coverage • MCP’s Emergency Procedures/Contact • Toll-free Member Services Number • Name of Member’s PCP
Frequently Asked QuestionsNew Member Information • Members receive the following information: • Member Handbook • Provider Directory • Member’s Rights • New Member Materials • How to Notify their MCP about Current Health Care Needs • How to Change PCP • Population Groups Not Affected
Frequently Asked QuestionsEnrollment Process • ODJFS/Selection Services Contractor • Current Contractor -- Automated Health Systems (AHS) • AHS has served as the SSC since 1998 • Extensive experience providing healthcare information to • Medicaid consumers in NJ, NY, OH, PA, WV, WI • Provides consumers with information on doctors, hospitals, • and other providers contracting with MCPs • Assist consumers with making selection of the plan that • best meets their needs • Toll-Free 1-800-605-3040; • TTY 1-800-292-3572 • Hours: Monday – Friday, 8 AM to 8 PM
PCSA Issues for Statewide Expansion • Short Term • Limit administrative burden for PCSA staff • Remove any barriers to access to care • Residence of eligibility information • CRIS-E vs. FACSIS • Disenrollment of children from MCP when in custody • PCSA must develop a process for handling monthly notification to PAMSS for disenrollment (OAC 5101:3-26-02.1) • Staff training • PAMSS Assistance
PCSA Issues for Statewide Expansion • Long Term • PCSAs must develop long term policies for how they wish to interact with MCPs • Issues for consideration in policy development • Statewide Expansion of Managed Care • Change in Administration • Conversion to SACWIS • Recommendations from Medicaid Study Council
ABD Statewide Expansion • Proposed Procurement Timeline • RFA released on May 31, 2006 • Letter of Intent Due June 30, 2006 • Applications due September 1, 2006 • Preliminary selections for readiness review announced September 29, 2006 (estimated) • December 1, 2006 – Enrollment of consumers (estimated)
ABD Statewide Expansion • Excluded ABD populations • Dual-Eligibles (Medicare/Medicaid) • Children 20 years of age and under • Waiver Service Consumers • Institutionalized Consumers • Consumers with a Spend-down
ABD Statewide Expansion • Proposed Procurement Process • Maintain regional approach • Applicants must submit applications for a minimum number of regions that total in excess of 45,000 ABD consumers • Applicants already selected for the CFC expansion have this requirement waived • 125,000 ABD Medicaid consumers enrolled with this expansion by December 31, 2006
Questions and Answers http://www.jfs.ohio.gov/ohp/bmhc/statemhc.stm (Statewide Expansion Website) http://www.jfs.ohio.gov/ohp/bmhc/pro-man-care.stm (Providers and Managed Care Website) http://www.jfs.ohio.gov/ohp/bmhc/con-man-care.stm (Consumers and Managed Care Website) http://www.jfs.ohio.gov/ohp/bmhc/mhcri.stm (Reports and Information Website) Jeff Corzine Bureau of Managed Health Care 614.466.4693 email@example.com On the Web at: