office of children families executive leadership council june 15 2006 l.
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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.

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medicaid managed care
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
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 today covered eligibility categories
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 today program facts
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
Why Managed Care Program Expansion?
  • Legislative Mandate
  • Added Program Value
  • Cost Savings
why managed care legislative mandate
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
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 value9
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 value10
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 value11
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
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 savings ohio medicaid expenditures by provider category sfy 2004
Why Managed Care? Cost SavingsOhio Medicaid Expenditures by Provider CategorySFY 2004

Source: OHP 2005 Annual Report

why managed care cost savings medicaid eligibles vs costs by category of eligibility sfy 2004
Why Managed Care? Cost SavingsMedicaid Eligibles vs. Costs by Category of EligibilitySFY 2004

Source: OHP 2005 Annual Report

managed care today
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 update cfc statewide expansion
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 expansion preliminary mcp selections by region
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 expansion preliminary mcp selections by region19
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 update cfc statewide expansion20
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
MCPs in the East Central
  • Buckeye Community Health Plan, Inc.
    • Debra Collins, VP of Contracting
    • (614)220-4900 Ext. 24114
    • dcollins@centene.com
    • www.centene.com
  • CareSource
    • Provider Recruitment Connection
    • (877) 725-4577
    • connect@care-source.com
    • www.care-source.com
  • Unison Health Plan of Ohio, Inc.
    • Amanda Hewett
    • (614) 890-6853
    • Amanda.Hewett@unisonhealthplan.com
    • www.unisonhealthplan.com
program status update cfc statewide expansion23
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
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 questions mcp membership card
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 questions new member information
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 questions enrollment process
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
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 expansion29
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
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 expansion31
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 expansion32
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
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

bmhc@odjfs.state.oh.us

On the Web at: