diff --git "a/data/dataset.csv" "b/data/dataset.csv" new file mode 100644--- /dev/null +++ "b/data/dataset.csv" @@ -0,0 +1,186 @@ +Features,Program type,Statewide or region-specific?,Federal operating authority,Program start date ,Waiver expiration date (if applicable),If the program ended in 2020; indicate the end date,Populations enrolled: Low-income adults not covered under ACA Section VIII (excludes pregnant women and people with disabilities),Populations enrolled: Low-income adults covered under ACA Section VIII (excludes pregnant women and people with disabilities),Populations enrolled: Aged; Blind or Disabled Children or Adults,Populations enrolled: Non-Disabled Children (excludes children in foster care or receiving adoption assistance),Populations enrolled: Individuals receiving Limited Benefits (excludes partial duals),Populations enrolled: Full Duals,Populations enrolled: Children with Special Health Care Needs,Populations enrolled: American Indian/Alaska Native,Populations enrolled: Foster Care and Adoption Assistance Children,Populations enrolled: Enrollment choice period,Populations enrolled: Enrollment broker name (if applicable),Populations enrolled: Notes on enrollment choice period,Benefits covered: Inpatient hospital physical health,Benefits covered: Inpatient hospital behavioral health (MH and/or SUD),Benefits covered: Outpatient hospital physical health,Benefits covered: Outpatient hospital behavioral health (MH and/or SUD),Benefits covered: Partial hospitalization,Benefits covered: Physician,Benefits covered: Nurse practitioner,Benefits covered: Rural health clinics and FQHCs,Benefits covered: Clinic services,Benefits covered: Lab and x-ray,Benefits covered: Prescription drugs,Benefits covered: Prosthetic devices,Benefits covered: EPSDT,Benefits covered: Case management,Benefits covered: SSA Section 1945-authorized Health Home,Benefits covered: Home health services (services in home),Benefits covered: Family planning,Benefits covered: Dental services (medical/surgical),Benefits covered: Dental (preventative or corrective),Benefits covered: Personal care (state plan option),Benefits covered: HCBS waiver services,Benefits covered: Private duty nursing,Benefits covered: ICF-IDD,Benefits covered: Nursing facility services,Benefits covered: Hospice care,Benefits covered: Non-Emergency Medical Transportation,Benefits covered: Institution for Mental Disease inpatient treatment for people ages 21-64 defined by 42 CFR $438.6(e) as an 'in lieu of' benefit,Benefits covered: Other (e.g.; nurse midwife services; freestanding birth centers; podiatry; etc.),Quality assurance and improvement: HEDIS data required?,Quality assurance and improvement: CAHPS data required?,Quality assurance and improvement: Accreditation required?,Quality assurance and improvement: Accrediting organization,Quality assurance and improvement: EQRO contractor name (if applicable),Performance incentives: Payment bonuses/differentials to reward plans,Performance incentives: Preferential auto-enrollment to reward plans,Performance incentives: Public reports comparing plan performance on key metrics,Performance incentives: Withholds tied to performance metrics,Performance incentives: MCOs/PHPs required or encouraged to pay providers for value/quality outcomes,Participating plans: Plans in Program,Notes: Program notes,State +Integrated Care Network (ICN),Primary Care Case Management Entity (PCCM Entity),Statewide,1915(b);1915(b)/1915(c),10/1/2018,9/30/2023,, , , , , , , ,Voluntary,Voluntary,Pre-assigned,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,,,,,X,,Alabama Select Network,Only includes nursing home level of care for SNF recipients and those on Elderly and Disabled and Alabama Community Transitions Waivers.,AL +PACE,Program of All-inclusive Care for the Elderly (PACE),Mobile and Baldwin Counties,PACE,1/1/2012,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,Open enrollment that begins the first of every month; disenrollment is effective the last day of the month chosen,X,X,X,X,X,X,X,,X,X,X,,,X,,X,,X,X,X,,X,,X,X,X,,Anything else that is determined to be medically necessary by the interdisciplinary team.,No,No,No,,,,,,,,Mercy Life of Alabama,,AL +Alabama Coordinated Health Network (ACHN),Primary Care Case Management Entity (PCCM Entity),Statewide,1915(b),10/1/2019,9/30/2023,,Mandatory , ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,No,No,,IPRO,X,,X,,,Alabama Coordinated Health Network,7 networks with one per region,AL +Arkansas Total Care,Comprehensive MCO + MLTSS,Statewide,"1915(b)/1915(c),1915(b)/1915(i)",10/1/2017,3/31/2027,,Voluntary , ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,,90 days,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,X,X,X,X,X,X,X,,Yes,No,No,,Qsource,,,,,X,Arkansas Total Care,"This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of need, due to functional deficits.",AR +Summit Community Care,Comprehensive MCO + MLTSS,Statewide,"1915(b)/1915(c),1915(b)/1915(i)",10/1/2017,3/31/2027,,Voluntary , ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,Qsource,90 days,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,X,X,X,X,X,X,X,,Yes,No,No,,Qsource,,,,,X,Summit Community Care,"This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of need, due to functional deficits.",AR +Empower Healthcare Solutions,Comprehensive MCO + MLTSS,Statewide,1915(b)/1915(c),10/1/2017,3/31/2027,,Voluntary , ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,Qsource,90 days,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,X,X,X,X,X,X,X,,Yes,No,No,,Qsource,,,,,X,Empower Healthcare Solutions,"This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of need, due to functional deficits.",AR +Delta Dental Plan Arkansas,Dental only (PAHP),Statewide,1915(b),1/1/2018,12/31/2022,, ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,No,No,No,,,,,,,,Delta Dental Smiles,,AR +MCNA Insurance Company,Dental only (PAHP),Statewide,1915(b),1/1/2018,12/31/2022,, ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,No,No,No,,,,,,,,MCNA Dental,,AR +Central Arkansas Development,Non-Emergency Medical Transportation,Statewide,"1915(b),1902(a)(70) NEMT",1/1/2019,12/31/2022,, ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Central Arkansas Development,,AR +Area Agency on Aging of Southeast,Non-Emergency Medical Transportation,Statewide,"1915(b),1902(a)(70) NEMT",1/1/2019,12/31/2022,, ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Area Agency on Aging of Southeast,,AR +"Southeastrans, Inc",Non-Emergency Medical Transportation,Statewide,"1915(b),1902(a)(70) NEMT",1/1/2019,12/31/2022,, ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,"Southeastrans, Inc",,AR +PCCM,Primary Care Case Management (PCCM),Statewide,1932(a),1/1/2014,,, , , ,Mandatory , , ,Voluntary ,Exempt,Voluntary,N/A,AFMC,,X,X,X,X,X,,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,X,,,,,,Yes,Yes,No,,,X,,X,X,X,Primary Care Case Management,,AR +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,5/27/2008,,, , ,Voluntary , , , , ,Exempt,,N/A,,,X,,X,,,,,,X,X,X,X,,X,,X,,,X,X,X,,,X,X,X,,,No,No,No,,,,,,,,PACE,PACE is incorporated into the AR Medicaid State Plan and is not under waiver authority.,AR +Arkansas Health & Wellness Solutions,Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2014,12/31/2026,,Varies , , , , , , ,Voluntary,Mandatory,Other,,42 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,,No,No,No,,,,,,,X,Arkansas Health & Wellness Solutions,"ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program.",AR +Arkansas Blue Cross Blue Shield,Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2014,12/31/2026,,Varies , , , , , , ,Voluntary,Mandatory,Other,,42 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,,No,No,No,,,,,,,X,Arkansas Blue Cross Blue Shield,"ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program.",AR +"QCA Health Plan, Inc",Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2014,12/31/2026,,Varies , , , , , , ,Voluntary,Mandatory,Other,,42 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,,No,No,No,,,,,,,X,"QCA Health Plan, Inc","ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program.",AR +Qualchoice Life & Health Insurance,Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2015,12/31/2026,,Varies , , , , , , ,Voluntary,Mandatory,Other,,42 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,,No,No,No,,,,,,,X,Qualchoice Life & Health Insurance,"ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program.",AR +"HMO Partners, Inc",Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2021,12/31/2026,,Varies , , , , , , ,Voluntary,Mandatory,Other,,42 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,,No,No,No,,,,,,,X,"HMO Partners, Inc","ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program.",AR +Arizona Health Care Cost Containment System,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),7/13/1982,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Other,,The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days.,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,,,,X,,X,X,X,X,Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy.,Yes,Yes,No,Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf.,Health Services Advisory Group,X,X,X,X,X,United Healthcare; Care 1st; DCS/CHP; Health Choice Arizona; Arizona Complete Health-Complete Care Plan; Mercy Care; Molina Complete Care of Arizona; Banner University Family Care,*Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to choose a different plan. Most members in these groups are mandatorily enrolled; but American Indian/Alaska Native members of these populations are voluntarily enrolled.,AZ +Arizona Health Care Cost Containment System (MLTSS),MLTSS only (PIHP and/or PAHP),Statewide,1115(a) (Medicaid demonstration waivers),7/13/1982,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Other,,The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days.,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy.,Yes,Yes,No,Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf.,Health Services Advisory Group,X,X,X,X,X,DES/Division of Developmental Disabilities (MLTSS); United Healthcare (MLTSS); Mercy Care (MLTSS); Banner University Family Care (MLTSS),*Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to choose a different plan. Most members in these groups are mandatorily enrolled; but American Indian/Alaska Native members of these populations are voluntarily enrolled.,AZ +Arizona Health Care Cost Containment System (SMI),Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1115(a) (Medicaid demonstration waivers),7/13/1982,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Other,,The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days.,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,,,,X,,X,X,X,X,Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy.,Yes,Yes,No,Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf.,Health Services Advisory Group,X,X,X,X,X,Mercy Care RBHA (SMI); Arizona Complete Health- Complete Care Plan RBHA (SMI); Health Choice Arizona RBHA (SMI),*Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to choose a different plan. Most members in these groups are mandatorily enrolled; but American Indian/Alaska Native members of these populations are voluntarily enrolled.,AZ +County Organized Health Systems (COHS) Model,Comprehensive MCO + MLTSS,"Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, Yolo",1115(a) (Medicaid demonstration waivers),10/1/1995,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE)",Yes,Yes,No,,Health Services Advisory Group,X,,X,,X,CenCal Health/San Luis Obispo; CenCal Health/Santa Barbara; Health Plan of San Mateo; Partnership HealthPlan of CA/Northeast; Partnership HealthPlan of CA/Northwest; Partnership HealthPlan/Southeast; Partnership HealthPlan/Southwest; Central California Alliance for Health/Merced; Central California Alliance for Health/Monterey Santa Cruz; CalOptima/Orange; Gold Coast Health Plan/Ventura,"Full duals have the option to enroll in Cal Medi-Connect in CCI counties, otherwise, they are mandatory for enrollment. Children with Special Health Care Needs (CSHCN) are mandatory in all COHS counties except Ventura. CSHCN is voluntary in Ventura. For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that will provide directed payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention.",CA +Regional Model,Comprehensive MCO,"Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne, Yuba",1115(a) (Medicaid demonstration waivers),10/2/2013,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Voluntary ,Mandatory ,Voluntary,Voluntary,Other,Health Care Options/MAXIMUS,Approximately 45 days,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE).",Yes,Yes,No,,Health Services Advisory Group,X,X,X,,X,Molina Healthcare of CA-Imperial; Anthem Blue Cross Partnership Plan/San Benito; California Health & Wellness Plan/Imperial; California Health & Wellness Plan/Region 1; California Health & Wellness Plan/Region 2; Anthem Blue Cross Partnership Plan/Region 1; Anthem Blue Cross Partnership Plan/Region 2,San Benito is voluntary due to only one commercial plan in the county. For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that will provide directed payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention. In non-COHS plan model types ICF-DD and nursing facility benefits are only covered for a limited period of time (month of admission plus 1 month) and then the member is disenrolled to FFS.,CA +Geographic Managed Care (GMC) Model,Comprehensive MCO + MLTSS,"Sacramento, San Diego",1115(a) (Medicaid demonstration waivers),6/1/1991,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Varies ,Mandatory ,Voluntary,Voluntary,Other,Health Care Options (Maximus),Approximately 45 days,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE).",Yes,Yes,No,,Health Services Advisory Group,X,X,X,,X,KP Cal LLC-Placer; KP Cal LLC-El Dorado; KP Cal LLC-Amador; Aetna Better Health of CA/Sacramento; Blue Shield of California Promise/San Diego; Health Net/San Diego; KP Cal LLC/San Diego; Molina Healthcare of CA Partner Plan/San Diego; Aetna Better Health of CA/San Diego; UnitedHealthcare Community Plan/San Diego; Anthem Blue Cross Partnership Plan/Sacramento; Health Net/Sacramento; KP Cal LLC/Sacramento; Molina Healthcare of CA Partner Plan/Sacramento; Community Health Group-San Diego,Full duals are mandatory for managed care enrollment in CCI Counties (San Diego) and voluntary for all other counties (Sacramento). For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that will provide directed payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention.,CA +Senior Care Action Network (SCAN),Comprehensive MCO + MLTSS,"Los Angeles, Riverside, San Bernardino",1915(a),1/1/1996,12/31/2021,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,,,,X,,X,X,X,X,X,X,X,X,X,X,,X,,X,,,,,,,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, speech therapy, and provisional post-partum care extension (PPCE)",Yes,No,"No, but accreditation considered in plan selection criteria",Private credentialling organizations approved by DHCS,Health Services Advisory Group (HSAG),,,,,,SCAN Health Plan/Los Angeles; SCAN Health Plan Riverside/San Bernardino,,CA +Program of All-Inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),"Alameda, Contra Costa, Fresno, Humboldt, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Clara, Kings, Tulare, Madera, San Joaquin, Stanislaus, Kern, Placer, El Dorado, Sutter, Yuba",PACE,1/1/1998,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,,X,X,X,,"PACE is responsible for covering all Medicaid services, all Medicare services, and any other service determined necessary by the PACE Interdisciplinary Team to maintain a participant in their home or community.",No,No,No,,,,,,,,Bakersfield PACE (Tulare); InnovAge California PACE Sacramento (San Joaquin); InnovAge California PACE- Sacramento (Sutter); InnovAge California PACE- Sacramento (Yuba); Neighborhood PACE (Riverside); Neighborhood PACE (San Bernardino); Redwood Coast Pace/Humboldt; San Diego PACE; St. Paul's PACE/San Diego; Sutter SeniorCare PACE/Sacramento; AltaMed Senior Buenacare/Los Angeles; Brandman Centers for Senior Care/Los Angeles; CalOptima PACE/Orange; Center for Elders Independence/Alameda; Center for Elders Independence/Contra Costa; Fresno PACE; InnovAge PACE/Riverside; InnovAge PACE/San Bernardino County; On Lok Lifeways/Alameda; On Lok Lifeways/Santa Clara; On Lok Lifeways/San Francisco; Family Health Centers of San Diego; Gary and Mary West PACE of Northern San Diego; Pacific PACE/Los Angeles; Stockton PACE/San Joaquin; Stockton PACE/Stanislaus; AltaMed Senior Buenacare/Orange; Bakersfield PACE (Kern); Central Valley PACE (Stanislaus); Central Valley PACE (San Joaquin); InnovAge California PACE- Sacramento (El Dorado); InnovAge California PACE- Sacramento (Placer); InnovAge California PACE- Sacramento- Sac; Coastline PACE; North East Medical Services; Sequoia PACE (Fresno); Sequoia PACE (Kings); Sequoia PACE (Tulare); Sequoia PACE(Madera),,CA +Dental Managed Care/Los Angeles,Dental only (PAHP),Los Angeles,"1115(a) (Medicaid demonstration waivers),1915(a)",4/1/1998,12/31/2021,,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary,Voluntary,60 days,Health Care Operations (Maximus),,,,,,,,,X,,X,,,X,X,,,,X,X,,,,,,,X,,,Yes,Yes,"No, but accreditation considered in plan selection criteria",Private credentialling organizations approved by DHCS,Health Services Advisory Group,,,X,,X,Health Net Dental Plan/Los Angeles; Access Dental Plan/Los Angeles; LIBERTY Dental Plan/Los Angeles,,CA +Dental Managed Care/Sacramento,Dental only (PAHP),Sacramento,1115(a) (Medicaid demonstration waivers),1/1/1995,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Voluntary,60 days,Health Care Operations (Maximus),,,,,,,,,X,,X,,,X,X,,,,X,X,,,,,,,X,,,Yes,Yes,"No, but accreditation considered in plan selection criteria",Private credentialling organizations approved by DHCS,Liberty and Health Net: Attest Health Care Advisors and for Access: Crowe LLP,,,X,,X,Health Net Dental Plan/Sacramento; Access Dental Plan/Sacramento; LIBERTY Dental Plan/Sacramento,,CA +Two-Plan Model,Comprehensive MCO + MLTSS,"Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare",1115(a) (Medicaid demonstration waivers),1/1/1996,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Varies ,Mandatory ,Voluntary,Voluntary,Other,Health Care Options/MAXIMUS,Approximately 45 days,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE).",Yes,Yes,No,,Health Services Advisory Group,X,X,X,,X,L.A. Care Health Plan/Los Angeles; Contra Costa Health Plan; Alameda Alliance for Health; Inland Empire Health Plan/Riverside; Inland Empire Health Plan/San Bernardino; Molina Healthcare of CA Partner Plan/Riverside; Molina Healthcare of CA Partner Plan/San Bernardino; San Francisco Health Plan; Health Plan of San Joaquin/San Joaquin; Health Plan of San Joaquin/Stanislaus; Santa Clara Family Health Plan; Health Net/Kern; Health Net/Los Angeles; Health Net/San Joaquin; Health Net/Stanislaus; Health Net/Tulare; CalViva Health/Fresno; CalViva Health/Kings; CalViva Health/Madera; Anthem Blue Cross Partnership Plan/Fresno; Anthem Blue Cross Partnership Plan/Kings; Anthem Blue Cross Partnership Plan/Madera; Anthem Blue Cross Partnership Plan/Alameda; Anthem Blue Cross Partnership Plan/Contra Costa; Anthem Blue Cross Partnership Plan/San Francisco; Anthem Blue Cross Partnership Plan/Santa Clara; Anthem Blue Cross Partnership Plan/Tulare; Kern Family Health Care,"Full duals are mandatory for managed care enrollment in CCI Counties (Los Angeles, Riverside, San Bernardino, and Santa Clara) and voluntary for all other counties (Alameda, Contra Costa, Fresno, Kern, Kings, Madera, San Francisco, San Joaquin, Stanislaus, and Tulare). For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that will provide directed payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention. In non-COHS plan model types ICF-DD and nursing facility benefits are only covered for a limited period of time (month of admission plus 1 month) and then the member is disenrolled to FFS. Additionally, Two-Plan Model Plans operating in Los Angeles, Riverside, San Bernardino, and Santa Clara Counties cover some nursing facility benefits as part of Skilled Nursing Facility and Subacute Care Services past the limited period of time.",CA +Positive Healthcare/Los Angeles,Comprehensive MCO,Los Angeles,1915(a),4/1/2002,12/31/2021,,Voluntary ,Voluntary , , , ,Voluntary , ,Voluntary,Voluntary,,,,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,X,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE).",Yes,Yes,No,,Health Services Advisory Group (HSAG),,,,,X,Positive Healthcare/Los Angeles,"AHF was formerly a Primary Care Case Management (PCCM) model and became a full-risk plan effective July 2019, however, their enrollment remains limited to specific populations. For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that will provide directed payments to providers for meeting specific measures aimed at improving care for certain high-cost or high-need populations. These risk-based incentive payments will be targeted at physicians that meet specific achievement on metrics targeting areas such as behavioral health integration; chronic disease management; prenatal/post-partum care; and early childhood prevention.",CA +Rady Children's Hospital San Diego (RCHSD),Comprehensive MCO,San Diego,1115(a) (Medicaid demonstration waivers),8/1/2018,12/31/2021,, , ,Voluntary ,Voluntary , , ,Voluntary ,Voluntary,Voluntary,,,,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,X,,X,X,,"Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE).",Yes,No,No,NCQA,Health Services Advisory Group (HSAG),,,,,,Rady Children's Hospital San Diego (RCHSD),"RCH was a pilot program which began in August 2018 serving special needs children and this contract will be terminating December 2021. The five eligible conditions for participation are Cystic Fibrosis, Hemophilia, Sickle Cell, Acute Lymphoblastic Leukemia, and Diabetes.",CA +Accountable Care Collaborative (ACC),Primary Care Case Management Entity (PCCM Entity),Statewide,1915(b),7/1/2018,6/30/2023,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,"Maximus Health Services, Inc.",Beneficiaries are passively enrolled and can choose their primary care provider at any time.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Note that all members enrolled in ACC are eligible for all 1932(a) state plan benefits (most of these benefits are state plan benefits and are paid FFS). They also get benefits covered under the 1915(b) waiver. All plans are responsible for providing behavioral health benefits under the 1915(b) waiver.,Yes,Yes,No,,"Health Services Advisory Group, Inc.",X,,X,X,X,"RAE 1: Rocky Mountain Health Plans; RAE 2: Northeast Health Partners; RAE 3: Colorado Access; RAE 4: Health Colorado, Inc.; RAE 5: Colorado Access; RAE 6: Colorado Community Health Alliance; RAE 7: Colorado Community Health Alliance; Denver Health Medicaid Choice (DMHC); Rocky Mountain Health Plans Prime",The Accountable Care Collaborative (ACC) program has seven regional plans called Regional Accountable Entities (RAEs). The RAEs operate as both PCCM Entity and PIHP program types. The state pays the RAEs a full-risk capitation payment for behavioral health services under the PIHP authority. The RAEs also get an administrative (not risk-based) per member per month payment for functions performed as a PCCM Entity. Denver Health Medicaid Choice (DHMC) and Rocky Mountain Health Plans Prime (RMHP Prime) both operate under MCO authority and receive a physical health capitation.,CO +Program of All-inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),"Adams, Arapahoe, Broomfield, Denver, Jefferson, Boulder, Weld (Southwest), Pueblo, El Paso, Delta, Montrose",PACE,10/1/1991,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,"Maximus Health Services, Inc.",There is no enrollment period; existing Medicaid members that meet the level of care may apply for PACE at any time. Members are enrolled on the first of the month.,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,,X,,X,X,X,,"PACE is an all-inclusive program. Some of the other available services include optometry, podiatry, rehabilitative services, adult day health center services, and transportation.",No,No,No,,,,,,,,InnovAge - Loveland (PACE); VOANS (PACE); TRU Community Care (PACE); InnovAge - Thornton (PACE); Total Longterm Care; Rocky Mountain Health Care Services (PACE); InnovAge - Pueblo (PACE); InnovAge - Aurora (PACE); InnovAge - Lakewood (PACE),,CO +Medicaid Managed Care Program,Comprehensive MCO,Statewide,1932(a);1945 Health Homes,4/1/1994,,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Voluntary , ,Mandatory,Exempt,30 days,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,,,,X,X,X,Freestanding birth centers,Yes,Yes,Yes,NCQA,Qlarant,X,,X,X,X,AmeriHealth Caritas District of Columbia; CareFirst Community Health Plan District of Columbia; MedStar Family Choice-DC,Full duals are eligible for enrollment if there is a Medicaid-enrolled dependent child in the household. Nursing facilities are covered by MCO for the first 30 consecutive days. The managed care P4P program is funded through a pre-determined withhold (generally the established profit margin for each MCO that is factored into the base per member per month payment rate) of each MCO's actuarially sound capitation payments during the applicable period of performance. MCOs must meet the minimum threshold for improvement for all three performance measures in order to earn any portion of the withhold. The P4P program is suspended due to managed care solicitations that have limited successive contract periods and MCOs for effective administration. DHCF plans to reinstitute quality incentive requirements in future years and continues to monitor MCOs' performance; absent any monetary withholds. Effective October 1; 2020 (FY 2021); the District requires managed care enrollment of aged; blind; and disabled adults (age 21+) who are not dually eligible for Medicare. As a result; comprehensive managed care enrollment increased as of this date.,DC +Child and Adolescent Supplemental Security Income Program,Comprehensive MCO,Statewide,1915(a),1/1/1996,,, , ,Voluntary , , ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,,Enrollment is voluntary; else beneficiary stays in fee-for-service.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Freestanding birth centers,Yes,Yes,Yes,NCQA,Qlarant,,,,,,Health Services for Children with Special Needs,Aged; Blind; or Disabled children and adults are eligible up to the age of 26. CASSIP enrollees receive medically necessary services for physical health; behavioral health; nursing home care; intermediate care facilities for individuals with intellectual disabilities; and residential treatment services.,DC +Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,10/1/2007,,, , ,Mandatory , ,Mandatory ,Mandatory ,Mandatory ,Exempt,Mandatory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No; but accreditation considered in plan selection criteria,,,,,,,,Medical Transportation Management; Inc.,The DC Department of Health Care Finance pays for non-emergency medical transportation only for its fee-for-service members. For managed care members; non-emergency medical transportation is paid by the District's Medicaid managed care organizations for low-income adults and children. Effective 10/1/2020 (FY 2021); the District requires managed care enrollment of aged; blind; and disabled adults (age 21+) who are not dually eligible for Medicare. As a result; NEMT enrollment (which is limited to fee-for-service beneficiaries) decreased.,DC +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,2/1/2013,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,X,X,X,X,X,X,X,,Yes,Yes,No,,,,,,,,Saint Francis Life,,DE +Diamond State Health Plan & Diamond State Health Plan Plus,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),1/1/1996,12/31/2023,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,Automated Health Systems,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,X,X,,X,Freestanding birth centers; home-delivered meals; emergency response system; home modifications; day habilitation,Yes,Yes,Yes,NCQA; NCI-AD,Mercer Government Human Services Consulting,X,,X,,X,Highmark Health Options of Delaware; AmeriHealth Caritas of Delaware,,DE +ModivCare Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,7/1/2002,,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,,ModivCare,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,ModivCare Non-Emergency Medical Transportation,,DE +Managed Medical Assistance Program,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),8/1/2014,6/30/2030,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,Automated Health Systems,Beneficiaries are enrolled immediately after being determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so.,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,X,,X,X,X,X,Midwife; birth center; podiatry; and targeted case management. In addition; the Agency also negotiated expanded benefits above the Medicaid state plan service package. These expanded benefits vary by plan and include expanded outpatient hospital visits; physician home visits; and many other expanded benefits. The following link contains a listing of the expanded benefits http://ahca.myflorida.com/medicaid/statewide_mc/pdf/mma/EB_by_Plan_March_2021.pdf.,Yes,Yes,Yes,NCQA; AAAHC; Nationally recognized accrediting organizations,Health Services Advisory Group,X,,X,,X,Aetna Better Health; Florida Community Care; Humana Medical Plan; Molina Healthcare of Florida; Prestige Health Choice; Community Care Plan; Simply Healthcare Plans; Inc.; Staywell Health Plan of Florida; Sunshine Sate Health Plan; Inc.; United Healthcare of Florida; Inc.; Magellan Complete Care; LLC; Clear Health Alliance; Staywell Serious Mental Illness; Sunshine State Health Plan - Child Welfare; Children's Medical Services Network; Vivida Health,Individuals fully eligible for Medicare and Medicaid are required to enroll in an MMA plan for covered Medicaid services. These individuals will continue to have their choice of Medicare providers as this program will not impact individual's Medicare benefits. Medicare-Medicaid beneficiaries will be afforded the opportunity to choose an MMA plan. However; to facilitate enrollment; if the individual does not elect an MMA plan; then the individual will be assigned to an MMA plan by the state using the auto-assignment criteria.,FL +Long-Term Care Program,MLTSS only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),8/1/2013,12/27/2021,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,Automated Health Systems,Beneficiaries are enrolled the beginning of the first month after they are determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so.,,,,,,,,,,,,,,X,,X,,,,X,X,X,,X,X,X,,Home Health Prosthetic Devices; Intermittent and Skilled Nursing Services. In addition; the Agency also negotiated expanded benefits above the Medicaid state plan service package and 1915. These expanded benefits vary by plan and include; but are not limited to; cellular phone service; mobile personal emergency response system; over-the-counter medications and supplies; and support to transition out of a nursing facility.,Yes,Yes,Yes,NCQA; AAAHC; Nationally recognized accrediting organizations,Health Services Advisory Group,X,,,,,Aetna Better Health; Florida Community Care; Humana Medical Plan; Inc.; Molina Healthcare of Florida; Inc.; Sunshine State Health Plan; Inc.; United Healthcare of Florida; Inc.; Staywell; Simply Healthcare Plans; Inc.,A recipient must be 18 years of age or older and meet Nursing Facility level of care in order to enroll. Recipients aged 18 to 64 must be eligible for Medicaid by reason of a disability as determined by the Social Security Administration. Recipients enrolled with a plan have 120 days to change plans.,FL +Dental,Dental only (PAHP),Statewide,1115(a) (Medicaid demonstration waivers),12/1/2018,6/30/2030,,Mandatory , ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,Automated Health Systems,Beneficiaries are enrolled immediately after being determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so.,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,Yes,Yes,Yes,NCQA; Nationally recognized accrediting organizations,Health Services Advisory Group,X,,,X,,DentaQuest; Liberty; MCNA Dental,Dental services are available to recipients in the Medically Needy program. Recipients are enrolled in the same plan each month that the recipient meets the share of cost requirement.,FL +Program of All- Inclusive Care for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,1/1/2003,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,Automated Health Systems,Continuous while slots are available.,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,,X,,,X,X,X,,All other FL Medicaid covered services and other services as determined by the multidisciplinary team.,No,No,No,,,,,,,,Florida Pace Center; Hope Select Care; Morselife Home Care; Inc.; Suncoast Neighborly Care; Inc.; NE PACE Partners,At the time of the enrollment; an individual must be able to live in a community setting without jeopardizing his or her health or safety. While enrolled in a PACE program; the participant must receive all Medicare and Medicaid benefits solely through the PACE organization.,FL +Georgia Families,Comprehensive MCO,Statewide,1932(a),6/1/2006,,,Mandatory , , ,Mandatory , , , ,Exempt,Exempt,30 days,Maximus,,X,X,X,X,,X,X,X,X,X,X,X,X,X,,,X,X,X,,,,X,,,,,,Yes,Yes,Yes,NCQA; JCAHO; URAC,Health Services Advisory Group (HSAG),,X,,,,Amerigroup Community Care; CareSource Georgia; Peach State Health Plan,Georgia Families is a program that delivers health care services to members of Medicaid and Peach Care for Kids. The program is a partnership between the Department of Community Health (DCH) and private care management organizations (CMOs). Georgia Families provides members a choice of health plans; allowing them to select a health care plan that fits their needs.,GA +Georgia Families 360,Comprehensive MCO,Statewide,1932(a),3/3/2014,,, , , , , , , ,Exempt,Mandatory,30 days,Maximus,,X,X,X,X,,X,X,X,X,X,X,X,X,X,,,,X,X,X,,,X,X,,,,Podiatry; Nurse Midwife,Yes,Yes,Yes,NCQA; JCAHO,Health Services Advisory Group (HSAG),X,,,,,Amerigroup Community Care,Georgia Families 360 enrolls children; youth; and young adults in foster care; children and youth receiving adoption assistance; and select youth involved in the juvenile justice system.,GA +Planning for Healthy Babies,Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1115(a) (Medicaid demonstration waivers),1/1/2011,12/31/2029,, , , , ,Voluntary , , ,Exempt,Exempt,Other,,Women who are enrolled in the P4HB program are granted a 30 day period to select a CMO of their choice. Furthermore; effective 1/1/2015; once a woman selects a CMO; she transitions to her selected CMO the day following her CMO selection. If the woman does not select a CMO within the 30 day choice period; she is auto assigned to a CMO; in order to receive P4HB services ; based on DCH's auto assignment algorithm.,,,,,,,,,,,,,,,,,X,,,,,,,,,,,,No,No,No,,,,,,,,CareSource Georgia; Peach State Health Plan; Amerigroup Community Care,,GA +Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,10/7/1997,,,Voluntary , ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Exempt,Mandatory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,NEMT; NEMT,The Georgia Department of Community Health's (DCH) Non-Emergency Medical Transportation (NEMT) services are defined as medically necessary; cost-effective transportation for any eligible Medicaid member (and escort; if required) with no other means of transportation available to any Medicaid-reimbursable service to receive treatment; medical evaluation; obtain prescription drugs or medical equipment. NEMT is a ride-share program and multiple members may be riding in the same vehicle. To provide the necessary non-emergency medical transportation; DCH utilizes a brokerage system and it is these two Brokers; ModivCare (formerly LogistiCare) and Southeastrans; who coordinate and provide NEMT services for the state's five regions (North; Atlanta; Central; East and Southwest). NEMT brokers are paid a monthly capitated rate based on the number of eligible Medicaid members residing in their contracted region(s). Transportation services are provided at no cost.,GA +Med-QUEST,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1902(a)(70) NEMT,8/1/2019,7/31/2024,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,,Applicants are allowed to pre-select a health plan upon completing the Medicaid application to avoid auto-assignment. Staff will process the pre-enrollment; which pends up to 90 days to receive eligibility. If the client does not select a health plan upon submitting the Medicaid application; Med-QUEST assigns a health plan. The client will have 90 days to choose a different health plan. Enrollment in the new plan begins on the first day of the following month. Once the 90-day period ends; the client can select a different plan during the annual plan change period from October 1-31; and enrollment is effective January 1.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,,Smoking Cessation Services; Urgent Care Services; Vaccinations; Vision and Hearing Services; Podiatry Services,Yes,Yes,Yes,NCQA,Health Services Advisory Group,X,X,X,X,X,AlohaCare Integration (QI); Hawaii Medical Service Association (HMSA) (QI); Kaiser Foundation Health Plan (QI); 'Ohana Health Plan (QI); UnitedHealthcare Community Plan (QI),,HI +Iowa Health Link,Comprehensive MCO + MLTSS,Statewide,1915(b);1915(b)/1915(c);1937 Alt Benefit Plan;1945 Health Homes,4/1/2016,3/31/2026,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,X,X,X,Tobacco Cessation; Vision Care Exams,Yes,Yes,Yes,NCQA,Health Services Advisory Group (HSAG),,,X,X,X,Amerigroup of Iowa; Inc.; Iowa Total Care,EPSDT is not covered under Hawki (State CHIP Plan); Private duty nursing and personal care services are covered as a benefit under EPSDT as provided through a home health agency for up to 16 hours per day; ICF/ID Must meet level of care; nursing facility - must meet level of care; Hospice --use utilization management guidelines; IMD <15 days: When the member is served in an IMD for 15 days or less in a calendar month; the MCO reimburses the IMD for the IMD member days using the current weighted average inpatient and hospitalization rate; IMD > 15 days: When the member's stays that exceed the 15 member days permitted the MCI Contractor will not reimburse the IMD for any of the IMD member days in that month; Vision: Routine eye examinations are covered once in a 12-month period; NEMT is available to all IA Health links members except for the Iowa Health and Wellness Plan (IHAWP) Non-Medically Exempt population. Members that have Medically Exempt status are eligible for NEMT services.,IA +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,8/1/2018,,, , ,Voluntary , , ,Voluntary , ,Exempt,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,,X,X,X,X,X,X,X,X,X,X,,No,No,No,,,,,,,,PACE,,IA +Dental Wellness Plan,Dental only (PAHP),Statewide,1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan,5/1/2014,12/31/2024,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,Maximus,,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,No,No,No,,Health Services Advisory Group (HSAG),,,,X,X,Delta Dental of Iowa; MCNA Dental Plans; Inc.,Delta Dental covers all of our Hawki (State CHIP) members,IA +Healthy Connections,Primary Care Case Management (PCCM),Statewide,1932(a),10/1/2006,,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary ,Voluntary , ,Voluntary,Voluntary,N/A,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No; but accreditation considered in plan selection criteria,NCQA,,,,,,,Multiple Primary Care Providers,NCQA is the accrediting organization for tier 3 of the Healthy Connections program.,ID +Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,9/1/2010,,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Mandatory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,MTM (Medical Transportation Management),,ID +Idaho Behavioral Health Plan,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b)/1915(i),9/1/2013,3/21/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Voluntary , ,Mandatory,Mandatory,,,,,,,X,,X,X,X,,,,,X,X,,,,,,,,,,,,,,Peer Support; Family Support,Yes,Yes,Yes,NCQA,,X,,X,X,X,United Healthcare/Optum Idaho,,ID +Idaho Smiles,Dental only (PAHP),Statewide,1915(b),8/1/2008,6/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Mandatory,,,,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,No,Yes,No,NCQA; AAAHC,,,,,X,,MCNA (Managed Care of North America; Inc.),,ID +Medicare/Medicaid Coordinated Plan,Comprehensive MCO + MLTSS,Ada; Bannock; Bingham; Boise; Bonner; Bonneville; Boundary; Canyon; Cassia; Clark; Elmore; Fremont; Gem; Jefferson; Kootenai; Madison; Minidoka; Nez Perce; Owyhee; Payette; Power; and Twin Falls counties,1915(a)/1915(c),7/1/2014,9/30/2022,, , , , , ,Voluntary , ,Voluntary,Exempt,,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,,,X,X,,X,X,X,,,Medicaid Primary Services not covered by Medicare,No,No,Yes,NCQA,Telligen,,,X,X,X,Blue Cross of Idaho; Molina of Idaho,,ID +Idaho Medicaid Plus,Comprehensive MCO + MLTSS,Ada; Bannock; Bingham; Boise; Bonner; Bonneville; Boundary; Canyon; Cassia; Clark; Elmore; Fremont; Gem; Jefferson; Kootenai; Madison; Minidoka; Nez Perce; Owyhee; Payette; Power; and Twin Falls counties,1915(b)/1915(c),11/1/2018,9/30/2022,, , , , , ,Mandatory , ,Voluntary,Exempt,Other,,90 days - Enrollment open for ninety days,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,,,X,X,X,X,X,X,,,Medicaid Primary Services not covered by Medicare,No,No,Yes,NCQA,Telligen,,,X,X,X,Blue Cross of Idaho; Molina of Idaho,,ID +HealthChoice Illinois,Comprehensive MCO + MLTSS,Statewide,1915(b);1932(a)/1915(c),1/1/2018,6/30/2024,, ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Voluntary,Mandatory,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,X,X,X,X,Telehealth; ambulatory; surgical treatment center; assisted living; assistive/augmentative communication devices; audiology; behavioral; blood and blood components; chiropractic; diabetes prevention; durable medical equipment; environmental accessibility; immunization; physical/occupational and speech therapy; podiatry; renal; specialized medical equipment and supplies; and vision,Yes,Yes,Yes,NCQA,Health Services Advisory Group,,X,X,X,X,Aetna Better Health; Blue Cross Community Health Plans; CountyCare Health Plan; Meridian Health; Molina HealthCare; YouthCare,HealthChoice Illinois is a statewide program that was implemented on January 1; 2018 and is comprised of populations that were previously included in the Integrated Care Program; the Family Health Plan/Affordable Care Act Program and the Managed Long Term Services and Supports Program. Low income pregnant women are mandatorily enrolled into the Program. Pursuant to 305 ILCS 5/5-30 (a) and (h); if a managed care organization (MCO) is serving at least 5;000 SPDs (Senior or Persons with Disabilities) or 15;000 individuals in other populations covered by Illinois Medicaid and has received full risk capitation for at least one (1) year; the MCO is considered eligible for accreditation and shall receive accreditation by the NCQA within two (2) years after the date the MCO became eligible for the accreditation. P4P withholds were again returned to the health plans during this reporting period for COVID Community Reinvestment Efforts. Pre-assigned (0 day choice) enrollment was implemented and applied during this reporting period as a result of the COVID Public Health Emergency in an effort to move prospective enrollees into managed care/care coordination as soon as possible. In June 2022; the Department reinstated the 30 day enrollment choice period. The HealthChoice Illinois Program includes enrollees from the same 1915(c) waivers as the HealthChoice Illinois - Managed Long Term Services and Supports program,IL +HealthChoice Illinois - Managed Long Term Services and Supports,MLTSS only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),1/1/2018,9/30/2023,, , ,Mandatory , , ,Mandatory , ,Voluntary,Exempt,Pre-assigned,Maximus,,,,,,,,,,,,,,,,,,,,,,X,,,X,,X,,non-medical behavioral health; telehealth,Yes,Yes,Yes,NCQA,Health Services Advisory Group,,X,X,X,X,Aetna Better Health; Blue Cross Community Health Plans; CountyCare Health Plan; Meridian Health; Molina HealthCare,The Program includes enrollees of multiple 1915(c) waivers; which have different end dates as follows: The current Persons with Disabilities 1915(c) waiver will expire on 06/30/2026; the current Elderly 1915(c) waiver will expire on 09/30/2026; the current Traumatic Brain Injury 1915(c) waiver will expire on 06/30/2027; the current Supportive Living Facility 1915(c) waiver will expire on 09/30/2027; and the current HIV/AIDS 1915(c) waiver will expire on 09/30/2023. Pursuant to 305 ILCS 5/5-30 (a) and (h); if a managed care organization (MCO) is serving at least 5;000 SPDs (Seniors and Persons with Disabilities) or 15;000 individuals in other populations covered by Illinois Medicaid and has received full-risk capitation for at least one (1) year; the MCO is eligible for accreditation and shall receive accreditation by the NCQA within two (2) years after the date the MCO became eligible for the accreditation. P4P withholds were given back to the health plans during this reporting period for COVID Community Reinvestment Efforts. Pre-assigned (0 day choice) enrollment was implemented and applied during this reporting period as a result of the COVID Public Health Emergency in an effort to move prospective enrollees into managed care/care coordination as soon as possible. In June 2022; the Department reinstated the 30 day enrollment choice period.,IL +Healthy Indiana Plan,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),2/1/2015,12/31/2030,,Mandatory ,Mandatory , , , , , ,Voluntary,Exempt,Other,Maximus,Members are auto-assigned if no health plan selection is made at application. Individuals who are auto-assigned have a 60 day window to make a health plan change. Members cannot change plans after having made a POWER account contribution.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,,,,,X,X,X,X,Podiatry; Chiropractic; Vision,Yes,Yes,Yes,NCQA,Qsource,X,,X,X,X,Anthem; Caresource Indiana; Inc; Managed Health Services; MDWise,Home health and nursing facility care is covered for a short period of time; no more than 100 days. IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver.,IN +Hoosier Care Connect,Comprehensive MCO,Statewide,1915(b),4/1/2015,3/31/2023,, , ,Mandatory , , , , ,Voluntary,Voluntary,60 days,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,,,,,X,X,X,X,Podiatry; Chiropractic; Vision,Yes,Yes,Yes,NCQA,Qsource,X,,X,X,X,Anthem; United Healthcare Community Plan; Managed Health Services,Home health and nursing facility care is covered for a short period of time; no more than 30 days. IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver.,IN +Hoosier Healthwise,Comprehensive MCO,Statewide,1932(a),1/1/2000,,, , , ,Mandatory , , , ,Voluntary,Exempt,Other,Maximus,Members are auto-assigned if no health plan selection is made at application. Individuals who are auto-assigned have a 90 day window to make a health plan change.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,,,,,X,,X,X,Podiatry; Chiropractic; Vision,Yes,Yes,Yes,NCQA,Qsource,X,,X,X,X,Anthem; Caresource Indiana; Inc; Managed Health Services; MDWise,IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver; Nursing facility and home health care is limited to short term needs.,IN +PACE,Program of All-inclusive Care for the Elderly (PACE),Regions covered include Lake; Johnson; Allen; Fayette; Franklin; Henry; Randolph; Union; Wayne; the following Marion County zip codes; 46107; 46201; 46202; 46203; 46204; 46217; 46218; 46219; 46221; 46222; 46225; 46227; 46229; 46237; 46239; 46241; 46259; and the following Elkhart; Marshall; and St. Joseph County zip codes: 46506; 46514; 46516; 46517; 46526;46530; 46536; 46544; 46545; 46552; 46554; 46556; 46561; 46574; 46601; 46613; 46614; 46615; 46616; 46617; 46619; 46628; 46635; 46637; 46563; 46573,PACE,10/1/2012,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,,X,,X,X,X,,,No,No,No,,,,,,,,Franciscan Senior Health and Wellness-DYER; Franciscan Senior Health and Wellness- Indy; Reid Health Pace Center; Saint Joseph Pace,The PACE state plan amendment was approved with an effective date of 10/1/2012. But; Indiana's first PACE program agreement was not effective until 1/1/2015. In 2021 we saw an expansion to our PACE programs with current plans expanding and new plans being added.,IN +KanCare,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1915(a);1905(t);1937 Alt Benefit Plan;1945 Health Homes,1/1/2013,12/31/2023,, ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,60 days,Gainwell Technologies,,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,Yes,Yes,Yes,NCQA,Kansas Foundation for Medical Care,,,X,X,X,Aetna Better Health of Kansas; Sunflower State Health Plan; United HealthCare Community Plan of Kansas,Kansas operates KanCare Medicaid Managed Care Program under the 1115(a) demonstration waiver concurrently with seven 1915(c) waivers.,KS +PACE,Program of All-inclusive Care for the Elderly (PACE),Dickinson; Douglas; Ellsworth; Harvey; Jackson; Jefferson; Leavenworth; Lincoln; Lyon; Marion; Marshall; McPherson; Nemaha; Osage; Ottawa; Pottawatomie; Reno; Rice; Saline; Sedgwick; Shawnee; Wabaunsee; and Wyandotte counties,PACE,8/1/2002,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,Gainwell Technologies,,X,X,X,X,X,X,X,,X,X,X,X,,,,X,,X,X,,,,,X,X,X,,Adult day care; recreational therapy; meals; social services; social work counseling; etc.,No,No,No,,,,,,,,Via Christi; Midland Care; Bluestem PACE; Inc.,,KS +Kentucky Managed Care,Comprehensive MCO,Statewide,1915(b),1/1/2021,12/25/2025,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,,90,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,,,,,,X,,,,Yes,Yes,Yes,NCQA; URAC,Island Peer Review Organization,,,,,X,Aetna Better Health of Kentucky; Anthem BCBS; Humana; Passport by Molina; United Healthcare; Wellcare of Kentucky,,KY +Kentucky Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1915(b),12/1/1998,12/31/2021,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Voluntary,Mandatory,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,NEMT Human Services Transportation Delivery,,KY +Healthy Louisiana,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b),12/12/2015,6/30/2027,, , ,Mandatory , , ,Mandatory ,Varies ,Exempt,Mandatory,,Maximus Health Services,,,X,,X,X,X,X,X,X,,,,X,X,,,,,,X,X,,,,,X,X,,Yes,Yes,Yes,NCQA,IPRO; Myers & Stauffer LC,,,X,X,X,Aetna Better Health of Louisiana; AmeriHealth Caritas Louisiana; Healthy Blue; Louisiana Healthcare Connections; UnitedHealthcare Community Plan,Children enrolled in the Coordinated System of Care (CSC) PIHP program receive specific behavioral services through that program and physical health and other health care coverage through the Healthy LA MCO program. Medicaid members who are considered "BH only" receive those specific BH services through the Healthy LA BHO program. The Healthy LA BHO program is a limited benefit MCO program. Only behavioral health services and NEMT are covered. These enrollees are individuals who receive fee-for-service Medicaid for most of their health services; including physical health services and prescription benefits. The limited benefit MCO program covers behavioral health services for residents in long term care facilities as well as those outside of long term care facilities. Personal care is provided through the 1915(b) authority.,LA +Dental Benefit Management Program,Dental only (PAHP),Statewide,1915(b),7/1/2014,6/30/2026,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,Maximus Health Services,Enrollee has the opportunity to choose a DBPM at Medicaid application. If no plan is chosen the enrollee is pre-assigned.,,,,,,,,X,X,X,,,X,,,,,X,X,,,,,,,,,,Yes,Yes,No,,Myers & Stauffer LC,,,,,,DentaQuest; MCNA of Louisiana,EPSDT dental benefits are provided by the DBPM for members ages 0-20. Adult Denture benefits are provided to members age 21+. Effective 1/1/2021 LDH contracted with a second dental plan; DentaQuest; to provide a second plan to all eligible members and expanded enrollment in the DBPMs to include beneficiaries in ICF/DD facilities.,LA +Coordinated System of Care,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),3/1/2012,6/30/2027,, , , , , , ,Voluntary ,Exempt,,,,,,X,,X,,X,X,X,X,,,,X,X,,,,,,,X,,,,,,,Mental health rehabilitation services including: Psychosocial rehabilitation; Crisis Intervention; Crisis stabilization; Youth Support and Training (YST); Parent Support and Training (PST); Short-term Respite; and Independent Living/Skills Building (ILSB),No,No,Yes,NCQA,,,,,,,Magellan,Children enrolled in the Coordinated System of Care (CSC) PIHP program receive specific behavioral services through that program and physical health and other health care coverage through the Healthy LA MCO program. Medicaid members who are considered "BH only" receive those specific BH services through the Healthy LA BHO program.,LA +PACE,Program of All-inclusive Care for the Elderly (PACE),Baton Rouge; Greater New Orleans; Lafayette: 70112; 70113; 70114; 70115; 70116; 70117; 70118; 70119; 70122; 70124; 70125; 70126; 70127; 70128; 70129; 70130; 70131; 70032; 70043; 70001; 70002; 70003; 70005; 70006; 70053; 70121; 70501; 70503; 70506; 70507; 70508; 70517; 70518; 70520; 70529; 70578; 70583; 70584; 70592; 70704; 70710; 70714;70719; 70720;70722; 70729; 70736; 70739; 70748; 70767; 70770; 70775; 70777; 70791; 70801; 70802; 70803; 70804; 70805; 70806; 70807; 70808; 70809; 70810; 70811; 70812; 70813; 70814; 70815; 70816; 70817; 70818; 70819; 70820; 70821; 70822; 70823; 70825; 70826; 70827; 70831; 70833; 70835; 70836; 70837; 70873; 70874; 70879;70883; 70884; 70891; 70892; 70893; 70894; 70895; 70896; 70898,PACE,9/1/2007,,, , , , , ,Voluntary , ,Voluntary,,N/A,,,X,X,X,X,,X,X,X,X,,,,,X,,X,,X,X,X,X,X,,X,X,X,,All specialized services authorized by IDT; including podiatry.,No,No,No,,,,,,,,PACE - Baton Rouge; PACE - Greater New Orleans; PACE - Lafayette,,LA +Healthy Louisiana,Comprehensive MCO,Statewide,1915(b);1932(a),2/1/2012,6/30/2027,,Mandatory ,Mandatory ,Varies ,Mandatory , , ,Varies ,Voluntary,Mandatory,Other,Maximus Health Services,Enrollee has the opportunity to choose an MCO at Medicaid application. If no plan is chosen; the enrollee is pre-assigned.,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,,,,X,X,X,Similar to Private Duty Nursing; Louisiana offers Extended Home Nursing to recipients under 21 only; Certified Nurse Midwives are covered and practice within the scope of their license; Podiatry services are covered; but limited to a list of payable procedures.,Yes,Yes,Yes,NCQA; URAC,IPRO; Myers & Stauffer LC,,,X,X,X,Aetna Better Health of Louisiana; AmeriHealth Caritas Louisiana; Healthy Blue; Louisiana Healthcare Connections; UnitedHealthcare Community Plan,Personal care (state plan option) services are available to enrollees aged 0 - 20. Mandatory vs. Voluntary Enrollment for Aged; Blind; or Disabled Children and Adults: Some of our disabled children can voluntarily opt out.,LA +Primary Care Accountable Care Organization (Primary Care ACO),Primary Care Case Management Entity (PCCM Entity),Statewide,1115(a) (Medicaid demonstration waivers),3/1/2018,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Voluntary,Other,Maximus until 12/2/21; Automated Health Systems (12/3/2021 - present),14 days with 90 day plan selection period for new enrollees. Annual 90 day plan selection period for existing enrollees.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,No,No,No,,Innovative Resource Group; LLC D/B/A Kepro,X,,X,X,X,Mass General Brigham ACO; Community Care Cooperative; Inc.; Steward Health Choice,Services; other than behavioral health; provided to PCC Plan enrollees are paid for by MassHealth through FFS directly to providers not through capitation. Behavioral health services are provided by the Massachusetts Behavioral Health Partnership. Regarding quality assurance and improvement; MassHealth does not require PCACOs calculate HEDIS measures but rather calculates select HEDIS and other performance measures using a certified HEDIS vendor. Additionally; MassHealth conducts a CAHPS survey for the PCACOs.,MA +Primary Care Clinician Program,Primary Care Case Management (PCCM),Statewide,1115(a) (Medicaid demonstration waivers),1/1/1995,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Voluntary,N/A,Maximus until 12/2/2022; Automated Health Systems 12/3/2022 - present,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,No,No,No,,Innovative Resource Group; LLC D/B/A Kepro,,,,,,Multiple primary care providers,Services; other than behavioral health; provided to PCC Plan enrollees are paid for by MassHealth through FFS directly to providers not through capitation. Behavioral health services are provided by the Massachusetts Behavioral Health Partnership. Regarding quality assurance and improvement; MassHealth calculates HEDIS and other performance measures using a certified HEDIS vendor. Additionally; MassHealth conducts a CAHPS survey for the PCC Plan.,MA +Managed Care Organization,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),7/7/1998,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Voluntary,Other,Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present,14 days with a 90 day plan selection period for new enrollees. Annual 90 day plan selection period for existing enrollees.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,,,X,,,X,X,X,Acupuncture; audiology; breast pump; chiropractic; diabetes self-management; training; dialysis; DME; early intervention; emergency services; fluoride varnish; hearing aids; infertility diagnosis; dentures; medical nutrition therapy; orthotics; podiatry; radiology and diagnostic tests; tobacco cessation; vision care; speech therapy; occupational therapy; physical therapy; NF (provided at a nursing facility; chronic or rehabilitation hospital or any combination thereof) up to 100 days per contract year per enrollee; and home health (nursing and therapies). LTSS are covered through FFS (Note: this list is not fully inclusive).,Yes,Yes,Yes,NCQA,Innovative Resource Group; LLC D/B/A Kepro,X,,X,X,X,Tufts Health Together; BMC HealthNet Plan,Private duty nursing is covered under capitation for SKSC population only.,MA +Accountable Care Partnership Plans,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),3/1/2018,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Voluntary,Other,Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present,14 days with a 90-day selection period for new enrollees. Annual 90-day selection period for existing employees.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,,,,,X,X,X,X,Acupuncture; audiology; breast pump; chiropractic; diabetes self- management training; dialysis; DME; early intervention; emergency services; fluoride varnish; hearing aids; infertility diagnosis; dentures; medical nutrition therapy; orthotics; podiatry; radiology and diagnostic tests; tobacco cessation; vision care; speech therapy; occupational therapy; physical therapy; NF (provided at either a nursing facility; chronic or rehabilitation hospital or any combination thereof) up to 100 days per contract year per enrollee; and Home Health (nursing and therapies). LTSS are covered through FFS. (Note: this list is not fully inclusive).,Yes,Yes,Yes,NCQA,Innovative Resource Group; LLC D/B/A Kepro,X,,X,X,X,Cambridge Health Alliance (CHA) in partnership with Tufts Health Public Plans (THPP); Atrius Health in partnership with Tufts Health Public Plans (THPP); Beth Israel Deaconess Care Organization (BIDCO) in partnership with Tufts Health Public Plans (THPP); Boston Children's Health ACO in partnership with Tufts Health Public Plans (THPP); Merrimack Valley ACO in partnership with AllWays Health Partners (My Care Family); Baystate Health Care Alliance in partnership with Health New England (Be Healthy Partnership); Boston Accountable Care Organization in partnership with BMC HealthNet Plan; Mercy Medical Center in partnership with BMC HealthNet Plan; Signature Healthcare in partnership with BMC HealthNet Plan; Southcoast Health in partnership with BMC HealthNet Plan; Health Collaborative of the Berkshires in partnership with Fallon Health; Reliant Medical Group in partnership with Fallon Health; Wellforce in partnership with Fallon Health,N/A,MA +MassHealth BH/SUD PIHP,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1115(a) (Medicaid demonstration waivers),7/1/1997,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Voluntary,Other,Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present,Daily,,X,,X,X,X,X,,X,,X,,,X,,,,,,,,,,,,,X,Children's Behavioral Health Initiative (CBHI) services; Emergency Services Program; and Diversionary Services: Community Crisis Stabilization; Community-Based Acute Treatment for Children and Adolescents (CBAT); Acute Treatment Services (ATS) for Substance Use Disorders (Level III-7); Clinical Support Services (CSS) for Substance Use Disorders (Level III.5); and Transitional,Yes,No,Yes,NCQA,Innovative Resource Group; D/B/A Kepro,X,,X,,,Massachusetts Behavioral Health Partnership,Full duals are only enrolled mandatorily if less than 21 years of age.,MA +Senior Care Options,Comprehensive MCO + MLTSS,Counties of Barnstable; Berkshire; Bristol; Essex; Franklin; Hampden; Hampshire; Middlesex; Norfolk; Plymouth; Suffolk; and Worcester,1915(a)/1915(c),7/1/2004,12/31/2023,, , ,Voluntary , , ,Voluntary , ,Voluntary,,Other,Maximus until 12/2/2021; Automated Health systems 12/3/2021,Medicaid members are eligible to enroll all year; with enrollment effective the first day of the month following the month in which the member decided to enroll. Dual eligible members are eligible to enroll in accordance with the Medicare Advantage enrollment period; with enrollment effective the first day of the month following the month in which the member decided to enroll; to the extent that they have a quarterly Special Election Period or other Special Election Period available.,X,,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,X,X,X,X,X,X,,All MassHealth covered LTSS and all services described in the Commonwealth 1915(c) Frail Elder Waiver.,Yes,Yes,No,,Innovative Resource Group; D/B/A Kepro,,,X,,X,Boston Medical Center Healthnet Plan; Commonwealth Care Alliance; Navicare HMO; Senior Whole Health; Tufts Health Plan; United Healthcare,,MA +Plan All-Inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),Counties of Bristol; Essex; Franklin; Hampden; Hampshire; Middlesex; Norfolk; Plymouth; Suffolk; Worcester; and Berkshire,PACE,7/10/1990,,, , ,Voluntary , , ,Voluntary , ,Voluntary,,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,,X,X,X,X,X,,The PACE program covers all medically necessary services for the enrolled population; including but not limited to all covered Medicare and Medicaid services.,No,No,No,,,,,,,,Element Care Inc; Serenity Care PACE Program; Mercy Life Inc; Neighborhood PACE; Elder Service Plan of Cambridge Health Alliance; Upham's Elder Service Plan; Elder Service Plan of Harbor Health; Fallon Health Summit Eldercare,The Enrollment numbers do not include private pay enrollees; if any.,MA +HealthChoice,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),7/1/1997,12/31/2026,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Mandatory,Other,Maryland Health Benefit Exchange,Individuals may apply for Medicaid and HealthChoice at any time.,X,,X,,,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,,X,X,,,Nurse midwives; freestanding birthing centers; podiatry (routine footcare for <21 and diabetics); diabetes prevention and telehealth.,Yes,Yes,Yes,NCQA,Qlarant Quality Solutions; Inc.,X,,X,,X,Aetna Better Health of Maryland; Amerigroup Community Care; CareFirst BCBS Community Health Plan Maryland; Jai Medical Systems; Kaiser Permanente of the Mid-Atlantic States; Maryland Physicians Care; MedStar Family Choice; Priority Partners; UnitedHealthcare of the Mid-Atlantic,The nursing facility services provided by HealthChoice is only for the first 90 days in the facility. Individuals requiring services beyond 90 days are then disenrolled into the fee-for-service program.,MD +PACE,Program of All-inclusive Care for the Elderly (PACE),21202; 21205; 21206; 21213; 21214; 21217; 21218; 21219; 21220; 21221; 21222; 21224; 21227; 21231; 21237; 21052,PACE,11/1/2002,,, , ,Voluntary , , ,Voluntary , ,Exempt,Exempt,N/A,,,X,,X,,,X,X,X,X,X,X,X,X,X,,X,,,,X,,X,,X,,,,Multidisciplinary assessment and treatment planning; Social work services; Nutritional counseling; Recreational therapy; Certain meals; Medical specialty services; prosthetics; orthotics; corrective vision devices; such as eyeglasses and lenses; hearing aids; dentures; and repair and maintenance of these items; Assisted living; and other services determined necessary by the multidisciplinary team to improve and maintain the participant's overall health status.,No,No,No,,,,,,,,Hopkins ElderPlus,,MD +MaineCare,Primary Care Case Management (PCCM),Statewide,1932(a),5/1/1999,,, , ,Mandatory ,Mandatory , , , ,Voluntary,Voluntary,N/A,,28 Days,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,No,No,,,X,,X,,,Multiple Primary Care Providers,,ME +NET,Non-Emergency Medical Transportation,Statewide,1915(b),8/1/2011,3/31/2022,, , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Modivcare; Penquis CAP; MidCoast Connector,,ME +MI Choice,MLTSS only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),10/1/2003,9/30/2023,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,Other,,Enrollments and disenrollments are allowed at any time. Enrollments are always voluntary for qualified individuals. Must meet NFLOC to qualify.,,,,X,,,,,,,,,,X,,,,,,,X,X,,,,X,X,Adult Day Health; Chore; Community Health Workers; Community Living Support; Community Transition; Counseling; Environmental Accessibility Adaptions; Fiscal Intermediary; Goods and Services; Home Delivered Meals; Nursing Services; Personal Emergency Response Systems (PERS); Private Duty Nursing/Respiratory Care; Respite Services; Specialized Medical Equipment and Supplies; and Training in a variety of independent living skills.,No,No,No,,,,,,,,A & D Home Health Care; Inc.; Area Agency on Aging 1-B; Area Agency on Aging of Northwest Michigan; Area Agency on Aging of Western Michigan; Detroit Area Agency on Aging; Macomb-Oakland Regional Center Home Care; Inc. (MORC); Northern Healthcare Management; Region 2 Area Agency on Aging; Region 3B Area Agency on Aging; Region 4 Area Agency on Aging; Region 7 Area Agency on Aging; Region 9 Area Agency on Aging; Reliance Community Care Partners; Senior Resources of West Michigan; Milestone Senior Services; Inc.; The Information Center; Tri County Office on Aging; The Senior Alliance; UPCAP; Valley Area Agency on Aging,Cover HCBS only. Must be elderly or a disabled adult (at least 18 years of age); meet Nursing Facility Level of Care (NFLOC); and require supports coordination and at least one additional waiver service to qualify. *Attestation is not required; but some plans do this voluntarily.,MI +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,11/1/2003,,, , ,Voluntary , , ,Voluntary , ,Exempt,Exempt,N/A,,,X,X,X,X,,,,,,X,X,X,,X,,X,,X,X,X,X,,,X,,X,,Transportation,No,No,No,,,,,,,,Senior Care Partners; Senior Community Care; Thome PACE; Ascension Living PACE; Care Resources; Community PACE; Great Lakes PACE; Huron Valley PACE; Life Circles; PACE Central Michigan; PACE North; PACE of Southeast MI; PACE of Southwest MI,Enrollment is voluntary and is not restricted to individuals who are Medicare beneficiaries and/or Medicaid recipients. The PACE organization receives a prospective monthly payment for each Medicare participant based on a rate similar to the rate paid to Medicare Advantage; and a prospective monthly payment for each Medicaid participant that is negotiated between the PACE organization and the State administering agency. The Medicaid capitation must be less than the amount that would have been paid under the State plan if the individuals were not enrolled in PACE. PACE organizations may charge a premium to individuals who do not have Medicaid eligibility. The PACE benefit package for all participants; regardless of the source of payment; must include all Medicaid-covered services; as specified in the State's approved Medicaid individual's overall health status. While enrolled in a PACE program; the participant must receive all Medicare and Medicaid benefits solely through the PACE organization.,MI +Healthy Kids Dental,Dental only (PAHP),Statewide,1915(b),4/1/2009,12/31/2022,, , ,Mandatory ,Mandatory , , , ,Voluntary,Mandatory,Other,,90 days for new enrollees. For all other enrollees; they are able to switch plans one time per year.,,,,,,,,,,,,,,,,,,,X,,,,,,,,,,No,No,No,,,,X,,X,X,Blue Cross Blue Shield of Michigan; Delta Dental of Michigan,MDHHS contracts for the administration of the Medicaid dental benefit called Healthy Kids Dental in all 83 counties. The contractor administers the Medicaid dental benefit to all Medicaid beneficiaries under age 21 in the participating counties. The dental services provided through the contractors mimic the dental services provided through the Fee-For-Service Medicaid program. Medicaid beneficiaries have access to dentists through the contractors participating dental networks. Beneficiaries must see a dentist who participates with the Healthy Kids Dental contract.,MI +Healthy Michigan Plan,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),4/1/2014,12/31/2023,, ,Voluntary , , , , , ,Voluntary,Exempt,Other,Michigan Enrolls,New enrollees have up to 90 days to switch Medicaid Health Plans; otherwise there is a rolling open enrollment based on the last digit of the individual's case number.,X,,X,X,,X,X,X,X,X,X,X,X,X,,,X,X,X,,,,,X,X,X,,Ambulance and other emergency medical transportation; certified midwife services; chiropractic services; DME and supplies; emergency services; end stage renal disease services; health education; hearing and speech services; hearing aids (under 21 years old); medically necessary weight reduction services; parenting and birthing classes; podiatry services; prosthetics and orthotics; tobacco cessation treatment; speech; language; physical; and occupational therapies; transplant services; transportation for medically necessary covered services; treatment for STDs; and vision services.,Yes,Yes,Yes,NCQA,Health Services Advisory Group (HSAG),X,X,X,X,X,Aetna Better Health of Michigan; Blue Cross Complete of Michigan; HAP Empowered; McLaren Health Plan; Meridian Health Plan of Michigan; Molina Healthcare of Michigan; Priority Health Choice; Total Health Care; UnitedHealthcare Community Plan; Upper Peninsula Health Plan,Due to a policy change; Medicare eligibles are excluded from Healthy Michigan Plan. In order to provide greater access and to support coordination of care for behavioral health services; the Michigan Department of Health and Human Services has removed the 20-visit maximum limitation for outpatient behavioral services (psychotherapy services). The restriction is lifted for both Fee-For-Service and Medicaid Health Plan beneficiaries effective for dates of service on or after October 1; 2017.,MI +Comprehensive Health Care Program,Comprehensive MCO,Statewide,1915(b),7/1/1997,12/31/2023,,Mandatory , ,Mandatory ,Mandatory ,Mandatory ,Voluntary ,Voluntary ,Voluntary,Mandatory,Other,Michigan Enrolls,New enrollees have up to 90 days to switch Medicaid Health Plans; otherwise there is a rolling open enrollment based on the last digit of the individuals case number.,X,,X,X,,X,X,X,X,X,X,X,X,X,,X,X,,,,,,,,,,X,Ambulance and other emergency medical transportation; certified midwife services; chiropractic services; DME and supplies; emergency services; end stage renal disease services; health education; hearing and speech services; hearing aids (under 21 years old); medically necessary weight reduction services; parenting and birthing classes; podiatry services; prosthetics and orthotics; tobacco cessation treatment; speech; language; physical; and occupational therapies; transplant services; transportation for medically necessary covered services; treatment for STDs; and vision services.,Yes,Yes,Yes,NCQA,Health Services Advisory Group (HSAG),X,X,X,X,X,Aetna Better Health of Michigan; Blue Cross Complete of Michigan; HAP Empowered; McLaren Health Plan; Meridian Health Plan of Michigan; Molina Healthcare of Michigan; Priority Health Choice; Total Health Care; UnitedHealthcare Community Plan; Upper Peninsula Health Plan,Due to a policy change; Medicare eligibles are excluded from Healthy Michigan Plan. In order to provide greater access and to support coordination of care for behavioral health services; the Michigan Department of Health and Human Services has removed the 20-visit maximum limitation for outpatient behavioral services (psychotherapy services). The restriction is lifted for both Fee-For-Service and Medicaid Health Plan beneficiaries effective for dates of service on or after October 1; 2017.,MI +Specialty Prepaid Inpatient Health Plans,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),10/1/1998,9/30/2024,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary , ,Voluntary,Mandatory,Other,,No lock-in period.,,X,,X,,,,,,,,,,,,,,,,,X,,,,,,,Assertive Community Treatment; Assessments; Assistive Technology; Behavior Management Review; Child Therapy; Clubhouse; Community Living Supports; Crisis Interventions; Crisis Residential Enhanced Pharmacy; Environmental Modifications.,No,No,No,,,,,,,,CMH Partnership of Southeast Michigan; Detroit Wayne Mental Health Authority; Lakeshore Regional Entity; Macomb County CMH Services; Mid-State Health Network; Northcare Network; Northern Michigan Regional Entity; Oakland County CMH Authority; Region 10 PIHP; Southwest MI Behavioral Health,7;607 beneficiaries received HCBS services as of 07/01/2021.,MI +Prepaid Medical Assistance Plan Plus (PMAP+),Comprehensive MCO + MLTSS,Statewide,1915(b);1932(a);1945 Health Homes,7/1/1985,12/31/2022,,Mandatory ,Mandatory , ,Mandatory , ,Voluntary ,Voluntary ,Mandatory,Mandatory,30 days,,,X,X,X,X,X,X,X,,X,X,,X,X,X,X,X,X,X,X,,,,,X,X,X,X,ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; EDBI; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Residential Mental Health Services (ITRS; Children's Crisis); Inpatient Detox; Inpatient Mental Health; Residential SUD Treatment,Yes,Yes,No,,,,X,,X,X,Blue Plus; Health Partners; Hennepin Health; Itasca Medical; Prime West Health; South Country Health Alliance; UCare,,MN +Minnesota Senior Care Plus (MSC+),Comprehensive MCO + MLTSS,Statewide,1915(b)/1915(c);1945 Health Homes,6/1/2005,6/30/2026,, , ,Mandatory , , ,Mandatory , ,Mandatory,Mandatory,30 days,,,X,X,X,X,X,X,X,,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,,ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SUD Treatment,Yes,Yes,No,,,,X,,X,X,Blue Plus; Health Partners; Itasca Medical Care; Medica; Prime West Health; South Country Alliance; UCare,,MN +Minnesota Senior Health Option (MSHO),Comprehensive MCO + MLTSS,Statewide,1915(a)/1915(c);1945 Health Homes,3/1/1997,6/30/2026,, , ,Voluntary , , ,Voluntary , ,Mandatory,Exempt,30 days,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,,X,X,X,,ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SUD Treatment,No,Yes,No,,,,X,,X,X,Blue Plus; Health Partners; Itasca Medical care; Medica; Prime West Health; South Country Health Alliance; UCare,,MN +Special Needs Basic Care (SNBC),Comprehensive MCO + MLTSS,Statewide,1915(a);1945 Health Homes,1/1/2008,,, , , , , ,Voluntary , ,Voluntary,Voluntary,30 days,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,,,X,,X,X,X,X,ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SUD Treatment,Yes,Yes,No,,,,X,,X,X,Health Partners; Hennepin Health; Medica; Prime West; South Country Health Alliance; UCare,,MN +MO HealthNet Managed Care/1915b,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers);1915(b),9/1/1995,6/30/2024,,Mandatory ,Mandatory ,Voluntary ,Mandatory , , ,Voluntary ,Mandatory,Mandatory,Other,WIPRO Infocrossing,Pregnant women have 7 days. 15 days for the rest of the population; however children in the care and custody of the State of Missouri are enrolled the same day.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,,X,X,X,Ambulatory Surgical Care; Asthma Education and In-Home Environmental Assessments; Comprehensive Day Rehabilitation; Durable Medical Equipment; Emergency; Hearing; Immunization; Inpatient Substance Use Disorders; Outpatient Substance Use Disorders; Obesity; Prenatal Case Management; Podiatry; Vision,Yes,Yes,Yes,NCQA,Primaris Holdings; Inc.,,,X,X,,Home State Health Eastern; Healthy Blue Eastern; UnitedHealthcare Eastern; Healthy Blue Western; Home State Health Western; UnitedHealthcare Western; Healthy Blue Central; Home State Health Central; UnitedHealthcare Central; Healthy Blue Southwestern; Home State Health Southwestern; UnitedHealthcare Southwestern,HCBS services within Missouri are limited and are therefore not covered under the 1915(c) waiver. Home health services provided through managed care are limited to 100 visits per year and are intended to be covered for a short term. Long-term home health services are provided outside of managed care.,MO +Non-Emergency Medical Transportation Program (NEMT),Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,10/1/2006,,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,,Medicaid State Plan,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Logisticare Solutions,,MO +Mississippi Coordinated Access Network (MississippiCAN),Comprehensive MCO,Statewide,1932(a),1/1/2011,,,Mandatory , ,Varies ,Mandatory , , ,Voluntary ,Voluntary,Voluntary,Other,Conduent Healthcare Solutions,Enrollment choice period open for 90 days,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,,,X,X,X,Vaccines; podiatry; chiropractic; vision and eyeglasses; etc,Yes,Yes,Yes,NCQA,The Carolinas Center for Medical Excellence (CCME),,,,X,X,Magnolia Health; UnitedHealthcare Community Plan; Molina Healthcare of Mississippi,Mississippi has a separate CHIP program. Personal care services are part of EPSDT services. The MississippiCAN program does not include Medicaid beneficiaries enrolled in Home and Community Based Waivers or residents of residential facilities; except Psychiatric Residential Treatment Facilities. Personal care services are defined as medically necessary personal care services for EPSDT-eligible beneficiaries who require assistance in order to safely perform the activities of daily living due to a diagnosed condition; disability; or injury. The delivery and receipt of these services must be medically necessary for the treatment of the beneficiary's condition; disability; or injury and exceed the level of care available through the home health benefit.,MS +Passport to Health,Primary Care Case Management (PCCM),Statewide,1915(b),1/1/1993,6/30/2024,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,Mandatory,N/A,Conduent,45 days,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,,,,,,,Passport to Health; Team Care,A member can only be enrolled in one PCCM at one time; they must choose either a Passport; CPC+ or Patient Centered Medical Home provider. The program-level counts of Passport to Health include people who also participate in the Tribal Health Improvement Plan.,MT +Comprehensive Primary Care Plus (CPC)+,Primary Care Case Management (PCCM),Statewide,1932(a),1/1/2018,,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , , ,Exempt,Mandatory,N/A,Conduent,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,Yes,No; but accreditation considered in plan selection criteria,,,X,,,,,Multiple Primary Care Providers,CPC+ is a subset of Passport to Health. The 1915(b) waiver authority for Passport to Health requires a large percentage of the Medicaid population to mandatorily choose a PCCM primary care provider. However; members have a choice of providers; including the option of choosing between a CPC+ provider or a Patient Centered Medical Home provider; and members can change providers on a monthly basis.,MT +Patient Centered Medical Home,Primary Care Case Management (PCCM),Statewide,1932(a),1/1/2016,,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , , ,Mandatory,Mandatory,N/A,Conduent,45 days,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,Yes,Yes,NCQA,,,,,,,Multiple Primary Care Providers,The Patient Centered Medical Home program is a subset of Passport to Health. The 1915(b) waiver authority for Passport to Health requires a large percentage of the Medicaid population to mandatorily choose a PCCM primary care provider. However; members have a choice of providers; including the option of choosing between a CPC+ provider or a Patient Centered Medical Home provider; and members can change providers on a monthly basis.,MT +Standard Plan,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),7/1/2021,10/31/2024,, ,Mandatory ,Mandatory ,Mandatory , , , ,Voluntary,Exempt,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,,X,,X,X,X,X,,Yes,Yes,No,,HSAG,,,X,,X,Healthy Blue of North Carolina; UnitedHealthcare; Carolina Complete Health; Wellcare; Amerihealth Caritas,,NC +Community Care of North Carolina,Primary Care Case Management Entity (PCCM Entity),Statewide,1932(a),4/1/1991,,,Mandatory , ,Mandatory ,Mandatory , ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,,90 days,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,Yes,No,,,,,,,,North Carolina Community Care,,NC +Program of All Inclusive for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Buncombe; Henderson; Montgomery; Moore; Randolph; Gaston; Cleveland; Lincoln; Durham Wake; Granville; Mecklenburg; Cabarrus; Union; Stanley; Rowan; Davidson; Davie; Iredell; Catawba; Lincoln; Burke; Caldwell; Alexander; Guilford; Rockingham; Cumberland; Harnett; Robeson; Moore; Hoke; Alamance; Caswell; Chatham; Lee; Orange; Durham; New Hanover; Brunswick,PACE,2/1/2008,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,,X,X,,,,X,X,,X,,,No,No,No,,,,,,,,Carolina Seniorcare; CarePartners PACE; Elderhaus; Inc; Life of St. Joseph of the Pines; Inc.; PACE at Home Inc.; PACE of the Southern Piedmont; PACE of the Triad; Piedmont Health Services; Inc.; Senior Total Life Care; Inc.; Staywell; Voans Senior Community Care of North Carolina,,NC +1915(b)/(c) Medicaid Waiver for MH/DD/SA Services,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b)/1915(c),1/1/2012,6/30/2024,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Voluntary,Mandatory,Pre-assigned,,,,X,,X,X,,,,,,,,X,X,,,,,,,X,,X,,,,X,,Yes,Yes,Yes,NCQA; JCAHO; CARF,Carolina Center for Medical Excellence,,,X,,,Alliance Behavioral Healthcare; Cardinal Innovations Healthcare Solutions; Eastpointe Human Services; Partners Behavioral Health Management; Sandhills Center for MH DD SA; Trillium Health Resources; Vaya Health,,NC +EBCI Tribal Option,Primary Care Case Management Entity (PCCM Entity),Statewide,1932(a),7/1/2021,,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Voluntary ,Mandatory,Mandatory,Pre-assigned,Maximus,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,Yes,Yes,No,,,,,,,,EBCI Tribal Option,,NC +North Dakota Medicaid Expansion,Comprehensive MCO,Statewide,1915(b);1937 Alt Benefit Plan,1/1/2014,12/31/2021,, , , , , , , ,Mandatory,Mandatory,Pre-assigned,,,X,X,X,X,X,X,X,X,X,X,X,X,X,,,,X,X,X,,,,,,X,X,,Up to 30 days SNF (within a 12 month period) and Vision Services,Yes,Yes,No,,,,,,,,ND Medicaid Expansion MCO,,ND +Multiple Primary Care Providers,Primary Care Case Management (PCCM),Statewide,1932(a),1/10/1994,,,Mandatory , , ,Mandatory ,Mandatory , , ,Mandatory,,N/A,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,Yes,North Dakota,,,,,,,Primary Care Case Management (PCCM),,ND +Program of All-Inclusive Care for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Burleigh- 58501; 58502; 58503; 58504; 58558 Cass- 58047; 58078; 58102; 58103; 58104; 58105 Stark- 58601; 58602; 58630; 58652; 58655; 58656 Morton- 58554 Ward- 58701; 58702; 58703; 58722; 58785,PACE,8/1/2008,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,Participants voluntarily enroll in the PACE program; enrollment is on the first day of each month.,X,X,X,X,,X,X,X,X,X,X,X,,X,,,,X,X,,,,,,,,,,No,No,No,,,,,,,,Program of All-inclusive Care for the Elderly,,ND +Heritage Health,Comprehensive MCO,Statewide,1915(b),1/1/2017,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,Automated Health Systems (AHS),,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,,,X,X,X,Podiatry; Hearing; Immunization; Speech Therapy; Physical Therapy; Vision; Chiropractic; Durable Medical Equipment (DME); Occupational Therapy; Freestanding birth center,Yes,Yes,Yes,NCQA,Health Services Advisory Group,,,,X,X,UnitedHealthcare Community Plan of Nebraska; Healthy Blue; Nebraska Total Care,,NE +Program of All-Inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),Nebraska Zip Codes: 68037; 68048; 68025; 68007; 68010; 68022; 68064; 68102; 68104; 68105; 68106; 68107; 68127; 68110; 68111; 68112; 68114; 68116; 68117; 68118; 68122; 68124; 68127; 68130; 68131; 68132; 68134; 68135; 68137; 68142; 68144; 68152; 68154; 68157; 68164; 68182; 68005; 68028; 68046; 68059; 68069; 68113; 68123; 68128; 68133; 68136; 68138; 68147; 68073; 68002; 68008; 68009; 68023; 68029; 68034; 68044; 68068,PACE,5/1/2013,,, , ,Voluntary , , , , ,Voluntary,Voluntary,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,,,No,No,No,,,,,,,,Immanuel Pathways,,NE +Dental Benefit Manager,Dental only (PAHP),Statewide,1915(b),10/1/2017,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,X,X,,,,,,,,,,No,No,Yes,URAC,Health Services Advisory Group,,,,X,,MCNA Nebraska,,NE +New Hampshire Medicaid Care Management,Comprehensive MCO,Statewide,1915(b);1932(a),12/1/2013,3/31/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,,X,,,X,X,X,Nurse midwife; non-nurse midwife; freestanding birth centers; podiatry; PT/OT/ST; ambulance; adult medical day care; DME; eyeglasses; full substance use disorder treatment,Yes,Yes,Yes,NCQA,HSAG,X,X,X,X,X,New Hampshire Healthy Families; Well Sense Health Plan; AmeriHealth Caritas of New Hampshire,The 1915(b) authority is only applicable to those members that cannot be mandated to participate in managed care.,NH +Non-Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,7/1/2009,,, , ,Mandatory , , ,Mandatory , ,Exempt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,X,,ModivCare,,NJ +PACE,Program of All-inclusive Care for the Elderly (PACE),County or zip code specific; varies by plan. See individual plans.,PACE,4/9/2009,,, , , , , , , ,Exempt,,N/A,,,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,X,X,X,X,,X,,X,X,X,,,No,No,No,,,,,,,,AtlantiCare Life; Beacon of LIFE; Inspira LIFE; LIFE St. Francis; Lutheran Senior Life; Trinity Health LIFE NJ,,NJ +FIDE SNP,Comprehensive MCO + MLTSS,Varies by MCO,1115(a) (Medicaid demonstration waivers),1/1/2012,6/30/2022,, , , , , , , ,Exempt,,Other,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Assistive technology; audiology; chiropractic; durable medical equipment; hearing aid; immunization; medical day care; medical supplies; optical appliances; optometrist; organ transplants; orthotics; rehabilitation/specialized hospital; outpatient rehabilitation; non-routine podiatrist; post-acute care; preventive health; specialized hospital; vision,Yes,Yes,No,,,X,,X,,,Amerivantage Dual Coordination (HMO D-SNP) Amerivantage Dual Secure (HMO POS); Aetna Assure Premier Plus (HMO SNP); Wellcare Liberty (HMO D-SNP); UnitedHealthcare Dual Complete ONE (HMO D-SNP); Horizon NJ TotalCare (HMO D-SNP),,NJ +NJ FamilyCare,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),9/1/1995,6/30/2022,, , , , , , , ,Exempt,,10 days,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Assistive technology; audiology; chiropractic; durable medical equipment; hearing aid; immunization; medical day care; medical supplies; optical appliances; optometrist; organ transplants; orthotics; rehabilitation/specialized hospital; outpatient rehabilitation; non-routine podiatrist; post-acute care; preventive health; specialized hospital; vision,Yes,Yes,Yes,NCQA,,X,,X,,,Aetna Better Health NJ; Amerigroup New Jersey Inc; Horizon NJ Health; UnitedHealthcare Community Plan; WellCare of New Jersey,,NJ +Centennial Care,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),1/1/2019,12/31/2023,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary,Mandatory,Other,,Members have 90 days to switch MCO's when initially enrolled and during recertification.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,X,X,X,X,ambulatory; surgical; anesthesia; diagnostic imaging; imaging and therapeutic radiology services; dialysis; durable medical equipment and medical supplies; hearing and audiology; immunization; medical service providers; midwife; nutritional; occupational therapy; physical therapy; podiatry; pregnancy termination (state funded); prosthetics and orthotics; rehabilitation; reproductive health; school based; speech therapy; telehealth; transplant; transportation; vision; pediatricians; respite,Yes,Yes,Yes,NCQA,Island Peer Review Organization (IPRO),,X,X,X,X,Blue Cross Blue Shield of NM; Presbyterian Health Plan; Western Sky Community Care; Inc.,Native American/Alaska Native Enrollment would be mandatorily enrolled if dually eligible or receiving LTSS.,NM +Program of All-inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),Bernalillo; Sandoval; and Valencia counties,PACE,7/1/2004,,, , , , , ,Voluntary , ,Exempt,,N/A,,Disenrollment permitted every 30 days.,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,,X,X,X,,X,,X,,X,, ,No,No,No,,,,,,,,InnovAge New Mexico PACE dba Total Community Care,,NM +Mandatory Health Maintenance Program (MCO),Comprehensive MCO,Sufficiently populated Urban Zip Codes in Washoe and Clark counties; including: 88901; 88905; 89002; 89004; 89005; 89006; 89009; 89011; 89012; 89014; 89015; 89016; 89030; 89031; 89032; 89033; 89036; 89044; 89052; 89053; 89054; 89074; 89077; 89081; 89084; 89085; 89086; 89087; 89101; 89102; 89103; 89104; 89105; 89106; 89107; 89108; 89109; 89110; 89111; 89112; 89113; 89114; 89115; 89116; 89117; 89118; 89119; 89120; 89121; 89122; 89123; 89124; 89125; 89126; 89127; 89128; 89129; 89130; 89131; 89132; 89133; 89134; 89135; 89136; 89137; 89138; 89139; 89140; 89141; 89142; 89143; 89144; 89145; 89146; 89147; 89148; 89149; 89150; 89151; 89152; 89153; 89154; 89155; 89156; 89157; 89159; 89160; 89161; 89162; 89163; 89164; 89165; 89166; 89169; 89170; 89173; 89177; 89178; 89179; 89180; 89183; 89185; 89191; 89193; 89195; 89199; 89431; 89432; 89433; 89434; 89435; 89436; 89439; 89441; 89501; 89502; 89503; 89504; 89505; 89506; 89507; 89508; 89509; 89510; 89511; 89512; 89513; 89515; 89519; 89520; 89521; 89523; 89533; 89555; 89557; 89570; 89595; and 89599.,1932(a),10/31/1988,,,Mandatory ,Mandatory , ,Mandatory , , ,Voluntary ,Voluntary,Exempt,Other,Gainwell Technologies (GWT),MCO selection is made by recipient at time of application. If no selection is made; recipient is auto-assigned based on the auto-assignment algorithm outlined in the State Plan. New recipients have a 90-day switch period in which to make a different MCO selection before being locked-in until the next open enrollment period.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,X,,X,,,X,,X,,Yes,Yes,Yes,Any Nationally Recognized Accrediting Organization,Health Services Advisory Group (HSAG),,,,,,Anthem Blue Cross Blue Shield of Nevada; Health Plan of Nevada; SilverSummit Health Plan,Nursing Facility Services are covered by the MCO the first 180 days. Performance Incentives: For the year 2021; the State cancelled the Performance Incentives due to the COVID-19 pandemic.,NV +Dental Benefits Administrator (DBA),Dental only (PAHP),Sufficiently populated Urban Zip Codes in Washoe and Clark counties; including: 88901; 88905; 89002; 89004; 89005; 89006; 89009; 89011; 89012; 89014; 89015; 89016; 89030; 89031; 89032; 89033; 89036; 89044; 89052; 89053; 89054; 89074; 89077; 89081; 89084; 89085; 89086; 89087; 89101; 89102; 89103; 89104; 89105; 89106; 89107; 89108; 89109; 89110; 89111; 89112; 89113; 89114; 89115; 89116; 89117; 89118; 89119; 89120; 89121; 89122; 89123; 89124; 89125; 89126; 89127; 89128; 89129; 89130; 89131; 89132; 89133; 89134; 89135; 89136; 89137; 89138; 89139; 89140; 89141; 89142; 89143; 89144; 89145; 89146; 89147; 89148; 89149; 89150; 89151; 89152; 89153; 89154; 89155; 89156; 89157; 89159; 89160; 89161; 89162; 89163; 89164; 89165; 89166; 89169; 89170; 89173; 89177; 89178; 89179; 89180; 89183; 89185; 89191; 89193; 89195; 89199; 89431; 89432; 89433; 89434; 89435; 89436; 89439; 89441; 89501; 89502; 89503; 89504; 89505; 89506; 89507; 89508; 89509; 89510; 89511; 89512; 89513; 89515; 89519; 89520; 89521; 89523; 89533; 89555; 89557; 89570; 89595; and 89599.,1915(b);1932(a),1/1/2018,,12/31/2021,Mandatory ,Mandatory , ,Mandatory , , ,Voluntary ,Voluntary,Exempt,Pre-assigned,Gainwell Technologies (GWT),,,,,,,,,,,,,,X,,,,,X,X,,,,,,,,,,Yes,Yes,Yes,Any Nationally Recognized Accrediting Organization,Health Services Advisory Group (HSAG),,,,,,Liberty Dental Plan of Nevada,Enrollment: Recipients in Managed Care are automatically assigned to LIBERTY Dental as there is only one vendor.,NV +Non-Emergency Medical Transportation (NEMT),Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,10/1/2003,,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary ,Mandatory,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,X,,,,,Medical Transportation Management (MTM),NV Check-Up is not eligible for NEMT. Enrollment: Recipients in Managed Care are automatically assigned to MTM as there is only one vendor. Performance Incentives ended June 30; 2021.,NV +Medicaid Managed Care,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1945 Health Homes,10/1/1997,3/31/2027,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Exempt,Mandatory,30 days,NY Medicaid Choice/Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,X,Nurse Midwife Services; Audiology; Vision Care; Foot Care Services; Occupational Therapy; Physical Therapy; & Speech Therapy,Yes,Yes,No,,Island Peer Review Organization,X,X,X,,X,Affinity Health Plan; AmidaCare Special Needs; Capital District Physician's Health Plan; Excellus; Fidelis Care; Health First; Health Now; HealthPlus; HIP Combined; Independent Health/Hudson Valley & WNY; MetroPlus Health Plan; MetroPlus Health Plan Special Needs; Molina HealthCare of New York; Inc.; MVP Health Plan; United HealthCare; VNS Choice Special Needs,Effective July 1; 2019; Partial Hospitalization is applicable to eligible children under age 21 as well as adults aged 21 and over. Fidelis Care covers emergency and non - emergency transportation in Rockland County only. MMC includes children's HCBS authorized under the State's 1915c Children's waiver and 1115 MRT Waiver.,NY +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,1/1/2001,,, , , , , ,Voluntary , ,Exempt,Exempt,N/A,NY Medicaid Choice/Maximus,,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,X,X,,X,,X,,Podiatry; Physical Therapy; & Occupational Therapy,No,No,No,,Island Peer Review Organization,,,,,,ArchCare Senior Life; Catholic Health - Life; CenterLight (CCM); Complete Senior Care; Eddy Senior Care; Fallon Health Weinberg; Independent Living for Seniors; PACE CNY; Total Senior Care,Waiver Expiration Date not applicable; PACE is a joint state/federal program. Enrollment includes both full and partial dually eligibles; as well as qualified and specified low income (QMB/SLMB) Medicare Support programs; must be 55 years of age or older. PACE has a comprehensive mandate to cover all services deemed necessary by IDT. Covered Benefits include non-hospice palliative care. OG/GYN is mandated with a minimum age of 55 years. Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds.,NY +Health and Recovery Plans,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers);1945 Health Homes,10/1/2015,3/31/2027,,Voluntary ,Voluntary , , , , , ,Exempt,Exempt,30 days,NY Medicaid Choice/Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,,,X,,X,Nurse Midwife Services; Audiology; Vision Care; Foot Care Services; Occupational Therapy; Physical Therapy; & Speech Therapy,Yes,Yes,No,,Island Peer Review Organization,X,X,X,,X,Affinity Health Plan; Capital District Physician's Health Plan; Excellus Health Plan; Fidelis Care; HealthFirst; HealthPlus; HIP GNY; Independent Health Association; MetroPlus; Molina HealthCare of New York; MVP Health Plan; United HealthCare,The covered benefit partial hospitalization only applies to enrollees 21 years of age and older. CMS has approved HCBS within the HARP program under 1115(a) authority.,NY +Medicaid Advantage Plus,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),1/1/2007,3/31/2027,, , , , , ,Voluntary , ,Exempt,Exempt,60 days,NY Medicaid Choice/Maximus,,X,X,X,X,,X,X,,X,X,X,X,,X,,X,,X,X,X,X,X,,X,,X,,Podiatry,No,No,No,,Island Peer Review Organization,,,,,,AgeWell New York; Centers Plan; ElderPlan; ElderServe; Fidelis Legacy Plan; Hamaspik ; Inc; HealthFirst Health Plan; HealthPlus Advantage Plus; Senior Whole Health; Village Care; VNS Choice Plus,Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance; and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds.,NY +Medicaid Advantage,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),10/1/2006,3/31/2027,, , , , , ,Voluntary , ,Exempt,Exempt,60 days,NY Medicaid Choice/Maximus,,X,X,X,X,,X,X,,X,X,X,X,,X,,X,,X,X,X,,X,,,,X,,Podiatry; outpatient rehabilitation; hearing services; & vision care services,No,No,No,,Island Peer Review Organization,,,,,,Fidelis Legacy Plan; United HealthCare; WellCare,,NY +Managed Long Term Care,MLTSS only (PIHP and/or PAHP),Statewide,1115(a) (Medicaid demonstration waivers),1/1/1998,3/31/2027,, , , , , ,Mandatory , ,Exempt,Exempt,60 days,NY Medicaid Choice/Maximus,,,,,,,X,X,,X,,,,,X,,X,,X,X,X,X,X,,X,X,X,,,No,No,No,,Island Peer Review Organization,X,X,X,,,VNS Choice; Aetna Better Health; AgeWell New York; ArchCare Community Life; Centers Plan for Healthy Living; ElderPlan; ElderServe; ElderWood; Extended MLTC; Fallon Health Weinberg; Fidelis Care; Hamaspik Choice MLTC; Health Advantage/Elant Choice; HealthPlus; Icircle Care MLTC; Integra MLTC; Kalos Health Plan; MetroPlus; Montefiore HMO MLTC; Prime Health Choice; Senior Health Partners; Senior Network Health; Senior Whole Health; Village Care; VNA HomeCare Options,MLTC enrollees may elect hospice care; but a hospice enrollee cannot enroll in MLTC. Some; but not all; HCBS waiver services are covered by MLTC plans. Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance; and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds.,NY +Ohio Medicaid Managed Care Program,Comprehensive MCO,Statewide,1915(b);1932(a),7/21/2006,6/30/2027,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Voluntary,Mandatory,Other,Automated Health Systems; Inc.,Medicaid enrollees are pre-assigned to a plan with 90 days to change plans.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,,X,X,X,X,Immunizations; nurse midwife services; freestanding birth centers; certified family nurse practitioner; certified pediatric nurse practitioner; physical therapy; speech therapy; occupational therapy; developmental therapy; chiropractic; podiatry; vision; durable medical equipment (DME) and medical supplies; ambulance; ambulette; care management; telemedicine; respite services for eligible children receiving SSI; services for members with a primary diagnosis of Autism Spectrum Disorder; screening and counseling for obesity.,Yes,Yes,Yes,NCQA,Island Peer Review Organization,,X,X,X,X,Buckeye Health Plan; CareSource; Molina Healthcare of Ohio; Inc.; Paramount Advantage; UnitedHealthcare Community Plan of Ohio; Inc.,,OH +MyCare Ohio Opt-Out Program,Comprehensive MCO + MLTSS,Central; Northwest; Northeast; Northeast Central; Southwest; West Central; East Central,1915(b)/1915(c),5/1/2014,12/31/2023,, , , , , ,Mandatory , ,Voluntary,Mandatory,Other,Automated Health Systems; Inc.,MyCare Ohio Opt-Out enrollees are pre-assigned to a plan with 90 days to change plans.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,,X,X,X,X,Immunizations; nurse midwife services; freestanding birth centers; care management; DME and medical supplies; vision; physical therapy; speech therapy; occupational therapy; developmental therapy; certified family nurse practitioner; certified pediatric nurse practitioner; ambulance; ambulette; podiatry; telemedicine; services for members with a primary diagnosis of autism spectrum disorder; screening and counseling for obesity.,Yes,Yes,Yes,NCQA,Island Peer Review Organization,,,X,X,X,CareSource; Molina Healthcare of Ohio; Inc.; UnitedHealthcare Community Plan of Ohio; Inc.; Aetna Better Health of Ohio; Buckeye Health Plan,,OH +Ohio PACE,Program of All-inclusive Care for the Elderly (PACE),Cuyahoga county,PACE,11/1/2002,,, , ,Voluntary , , ,Voluntary , ,Exempt,,N/A,,Ohio PACE operates under an open enrollment model.,X,X,,X,,X,X,,,X,,,,,,X,,X,X,,X,X,,X,X,X,,,No,No,No,,,,,,,,McGregor PACE,,OH +SoonerRide,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,6/1/2006,,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory , ,Mandatory,Mandatory,,Logisticare,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,SoonerRide,,OK +SoonerCare Choice,Primary Care Case Management (PCCM),Statewide,1115(a) (Medicaid demonstration waivers),1/1/1996,12/23/2023,,Mandatory , ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Voluntary,Voluntary,N/A,Maximus,Members are enrolled within 72 hours of application.,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,Telligen,,,,,,SoonerCare Choice,,OK +PACE,Program of All-inclusive Care for the Elderly (PACE),73004; 73007; 73008; 73010; 73012; 73013; 73020; 73026; 73034; 73036; 73045; 73049; 73051; 73064; 73065; 73066; 73068; 73069; 73071; 73072; 73078; 73080; 73084; 73089; 73090; 73093; 73099; 73104; 73105; 73106; 73107; 73108; 73109; 73110; 73111; 73112; 73113; 73114; 73115; 73116; 73117; 73118; 73119; 73120; 73121; 73122; 73127; 73128; 73129; 73130; 73132; 73134; 73135; 73136; 73139; 73140; 73141; 73142; 73149; 73159; 73160; 73162; 73170; 74011; 74012; 74021; 74033; 74055; 74063; 74066; 74070; 74103; 74104; 74105; 74106; 74107; 74110; 74112; 74114; 74115; 74116; 74119; 74126; 74127; 74128; 74129; 74130; 74133; 74134; 74135; 74136; 74145; 74146; 74169; 74347; 74352; 74359; 74364; 74365; 74401; 74402; 74403; 74423; 74427; 74434; 74435; 74441; 74451; 74452; 74457; 74464; 74465; 74467; 74471; 74857; 74931; 74945; 74955; 74960; 74962; 74964; and 74965,PACE,8/1/2008,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,Enrollment process takes approximately 4-6 weeks. Members are enrolled throughout the entire month to be effective the first day of the following month. Members go through the PACE Organizations for the entire enrollment process.,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,,X,,X,,X,,Podiatry; speech therapy; disease management; hearing; institutional; occupational therapy; physical therapy; skilled nursing facility; vision; and medication assisted treatment,No,No,No,,,,,,,,Life PACE; Valir PACE; Cherokee Elder Care (CEC),,OK +OHP - Oregon Health Plan,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),2/1/1994,9/30/2022,,Mandatory ,Mandatory ,Voluntary ,Voluntary ,Mandatory ,Voluntary ,Mandatory ,Voluntary,Voluntary,Pre-assigned,,,X,X,X,X,,X,,,,X,X,X,X,X,,X,X,X,X,,,,,X,X,X,,Hearing; immunization; vision,No,Yes,No,NCQA; URAC,HSAG (Health Services Advisory Group),X,,X,X,,Advantage Dental Services; Capitol Dental Care; Inc.; Family Dental Care; AllCare Health Plan; Cascade Health Alliance; Columbia Pacific; Managed Dental Care of Oregon; ODS Community Health Inc.; Eastern Oregon CCO; HealthShare of Oregon; InterCommunity Health Network; Jackson Care Connect; PacificSource Community Solutions - Central Oregon; PacificSource Community Solutions - Columbia Gorge; Trillium Community Health Plan; Umpqua Health Alliance; Advanced Health; Yamhill Community Care; PacificSource Community Solutions - Lane (CCO); PacificSource Community Solutions - Marion Polk (CCO); Trillium Community Health Plan - Tri-County,As of 2011; Medicaid (known as Oregon Health Program (OHP) Plus); mandatorily enrolled most benefit groups; except childless adults; into fully-capitated MCOs; or offered primary care case managers in some counties where managed care was not available. The program covered acute; primary and specialty care; dental and behavioral health services were covered through separate prepaid health plans; many of which are operated by counties. Under this system; beneficiaries requiring physical; behavioral; dental; and transportation services could receive them from as many as four separate entities. On the Oregon Health Plan/Medicaid program; a person can be enrolled simultaneously in two or three plans. Note: Care Oregon Dental (DCO); Greater Oregon Behavioral Health; Inc. (MHO); PrimaryHealth of Josephine County (CCO); Willamette Dental Group (DCO); Willamette Valley Community Health (CCO); all had closed to enrollment prior to June 2020.,OR +PACE,Program of All-inclusive Care for the Elderly (PACE),Multnomah county; Washington county (97113; 97116; 97140; 97062; 97078; 97003; 97123; 97124; 97005; 97006; 97007; 97008; 97223; 97224; 97225; 97229 only); Clackamas county (97015; 97027; 97086; 97036; 97045; 97062; 97068; 97034; 97035; 97206; 97219; 97222; 97267; 97268; 97269 only); Clatsop county; Tillamook county (97130; 97131; 97147 only); Jackson county (97501; 97502; 97504; 97525; 97535; 97537 only); Josephine county (97526; 97527; 97543 only),PACE,1/1/1986,,, , , , , ,Voluntary , ,Voluntary,,N/A,,Flexible enrollment eligibility - rolling enrollment to be effective on the 1st of the following month.,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,X,,,X,X,X,,Medications (OTC and RX); mental health care; durable medical equipment; speech/physical/occupational/recreational therapeutic services; audiology/optical/podiatry specialty medical care; occupational and physical therapy and social services,No,No,No,NCQA,,X,,,,,Providence Elder Place,,OR +Medical Assistance Transportation Program,Non-Emergency Medical Transportation,Philadelphia,1902(a)(70) NEMT,11/1/2005,,,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Voluntary ,Exempt,Voluntary,,Modivcare (formerly LogistiCare),,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Modivcare,,PA +Adult Community Autism Program,Other Prepaid Health Plan (PHP) (limited benefits),Dauphin; Cumberland; Lancaster; and Chester counties,1915(a),8/1/2009,,, , , , , ,Voluntary , ,Exempt,Exempt,,,,,,,,,X,X,,,,,,,,,,,X,X,,X,,,X,,X,,Podiatry; speech therapy; occupational therapy; language therapy; counseling; respite; and supported employment,No,No,No,,Island Peer Review Organization (IPRO),,,,,,Adult Community Autism Program,,PA +Behavioral Health Health Choices,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1115(a) (Medicaid demonstration waivers);1915(b),1/1/1997,9/30/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,,X,,X,X,X,X,X,X,X,X,,X,X,,,,,,,,,,,,X,X,Psychiatric rehabilitation; peer support services; family based MH services; mobile MH treatment; MH crisis intervention services; SUD residential services; and SUD withdrawal management,Yes,No,Yes,NCQA; JCAHO; URAC,Island Peer Review Organization,X,,X,X,X,Allegheny County HealthChoices; Beaver County HealthChoices; Behavioral Health Services of Somerset and Bedford Counties; Berks County HealthChoices; Blair County HealthChoices; Bucks County HealthChoices; Cambria County HealthChoices; Carbon-Monroe-Pike Joinder Board; Chester County HealthChoices; Capital Area Behavioral Health Collaborative; Delaware County HealthChoices; Erie County HealthChoices; Fayette County HealthChoices; Greene County (Commonwealth); Lehigh County HealthChoices; Lycoming-Clinton Joinder Board; Montgomery County HealthChoices; Community Care Behavioral Health Organization; Northampton County HealthChoices; Northeast Behavioral Health Care Consortium; Northwest Behavioral Health Partnership; Philadelphia County HealthChoices; Southwest Behavioral Health Management; Tuscarora Managed Care Alliance; York/Adams HealthChoices Joinder Governing Board,,PA +Physical Health HealthChoices,Comprehensive MCO,Statewide,1915(b),2/1/1997,12/31/2022,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,15 days,Maximus,,X,,X,,,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,,X,X,X,,Nurse midwife services; freestanding birth centers; podiatry; chiropractic services; optometrists; renal dialysis centers; ambulatory surgical centers; medical supplies & equipment; and home health (visiting nurses),Yes,Yes,Yes,NCQA,Island Peer Review Organization,X,,X,X,X,Aetna Better Health; Gateway Health; Health Partners Plan; United Healthcare Community Plan; Inc; UPMC for You; Geisinger Health Plan; AmeriHealth Caritas/AmeriHealth Caritas Northeast; Keystone First,,PA +PA Living Independent for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Allegheny; Armstrong; Beaver; Bedford; Berks; Blair; Bucks; Butler; Cambria; Chester; Clarion; Clinton; Columbia; Crawford; Cumberland; Dauphin; Delaware; Elk; Erie; Fayette; Forest; Franklin; Fulton; Greene; Indiana; Jefferson; Juniata; Lackawanna; Lancaster; Lawrence; Lebanon; Lehigh; Luzerne; Lycoming; Mercer; Mifflin; Montgomery; Montour; Northampton; Northumberland; Perry; Philadelphia; Schuylkill; Snyder; Somerset; Union; Venango; Warren; Washington; Westmoreland; and York counties.,PACE,7/24/1998,,, , , , , ,Voluntary , ,Voluntary,Exempt,N/A,Maximus,open enrollment all year,X,X,X,X,X,X,X,,X,X,X,X,,X,,,,X,X,X,X,X,,X,X,X,,PACE programs cover specialists of all disciplines as needed.,No,No,No,PACE Quality Assurance and Performance Improvement (QAPI),,,,,,,Senior LIFE Greensburg H-2937; Senior LIFE Johnstown H-3925; Senior LIFE Altoona H- 5902; Senior LIFE York H- 0819; Senior LIFE Lehigh H- 5978; Senior LIFE Washington H-2992; SpiriTrust LIFE H-2537; LIFE NWPA H-4999; LIFE Geisinger H-2064; Mercy LIFE H-3919; Mercy LIFE West Philadelphia H-3908; LIFE St. Mary H-6551; Innovage LIFE H-9830; Albright LIFE H-9068; Community LIFE H- 3917; LIFE Pittsburgh H-3918; VieCare Butler H-3060; VieCare Beaver H- 7660; VieCare Armstrong H- 6118,,PA +Community HealthChoices,Comprehensive MCO + MLTSS,Statewide,1915(b)/1915(c),1/1/2018,12/31/2024,, , ,Mandatory , , ,Mandatory , ,Mandatory,Exempt,15 days,Maximus,,X,,X,,,X,X,X,X,X,X,X,,X,,X,X,X,X,,X,,X,X,X,X,,Chiropractic services; maternity services; and podiatrist services.,Yes,Yes,Yes,NCQA,Island Peer Review Organization (IPRO),,,,,,UPMC Community HealthChoices; Pennsylvania Health & Wellness; AmeriHealth Caritas; Keystone First,,PA +Comprehensive MCO,Comprehensive MCO,Statewide,1932(a);1937 Alt Benefit Plan,2/1/1994,,,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,X,X,X,X,X,X,,X,X,X,X,X,X,,,,X,X,X,,,,,,,,,,Yes,Yes,No,,,,,,X,X,Government Health Plan First Medical; Government Health Plan MMM Multi Health; Government Health Plan de Salud Menonita; Government Health Plan Triple S,,PR +Comprehensive MAO - Medicare Platino,Comprehensive MCO,Statewide,,1/1/2006,,, , , , , ,Voluntary , ,Voluntary,,Other,,No specific time,X,X,X,X,X,X,,X,X,X,X,X,,,,,,X,X,X,,,,,,,,,Yes,Yes,No,,,,,,,X,Medicare Platino - MMM Healthcare; Medicare Platino - MSC Advantage; Medicare Platino - HUMANA; Medicare Platino - Triple S Advantage,,PR +RIte Smiles Dental Program,Dental only (PAHP),Statewide,1115(a) (Medicaid demonstration waivers),5/1/2006,12/31/2023,,Mandatory ,Mandatory ,Mandatory , , , , ,Mandatory,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,X,,,,,,,,,,Yes,Yes,Yes,URAC,,,,X,,X,UnitedHealthcare Dental of Rhode Island,,RI +RI Medicaid PACE Program,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,11/1/2005,,, , , , , ,Voluntary , ,Voluntary,,N/A,,90 days,X,X,X,X,X,X,X,,X,X,X,X,,,,X,,X,X,,,X,,X,,X,,,No,No,No,,,,,X,,X,PACE Organization of Rhode Island,,RI +RIte Care; Rhody Health Partners and Medicaid Expansion,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),8/1/1994,12/23/2023,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory,Mandatory,Other,Gainwell Technologies,90 Days,X,X,X,,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,,X,X,,X,Doulas and value add services,Yes,Yes,Yes,NCQA,IPRO,X,X,X,X,X,Neighborhood Health Plan of Rhode Island; United HealthCare of Rhode Island Community Plan; Tufts Health Public Plans,,RI +Rhode Island Non-Emergency Medical Transportation Program,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,5/1/2014,,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Exempt,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,Yes,URAC,,,,X,X,,Medical Transportation Management; Inc.,,RI +South Carolina Managed Care Organizations,Comprehensive MCO,Statewide,1932(a),9/1/1996,,,Mandatory , ,Mandatory ,Mandatory , , ,Voluntary ,Voluntary,Voluntary,Other,Maximus,90 days,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,X,,,,,,,,,,X,Nurse midwife; birth centers; chiropractic services; therapy services (speech; hearing; language; etc.); and vision.,Yes,Yes,Yes,NCQA,Carolina Center for Medical Excellence,X,X,X,X,X,Select Health of South Carolina; Absolute Total Care; Inc.; Molina Healthcare of South Carolina; BlueChoice Healthplan Medicaid,The States MCO withhold program was temporarily suspended for CY 2020 due to the COVID pandemic. The State has since reinstituted the withhold for CY2021. The State currently does operate a financial alignment demonstration model. As indicated in the instructions we have only included these members in the total Medicaid enrollment for the entire state and this model is not reflected in any other program on this report. Wellcare members were transitioned to Absolute Total Care effective 4/1/2021; following the 1/23/2020 acquisition of Wellcare Health Plans; Inc. by Centene Corporation on 1/23/2020.,SC +South Carolina Medical Homes Network,Primary Care Case Management (PCCM),Statewide,1932(a),8/1/2007,,,Voluntary , ,Voluntary ,Voluntary , , ,Voluntary ,Voluntary,Voluntary,N/A,,90 days,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,Carolina Center for Medical Excellence,,,,,,South Carolina Solutions,,SC +South Carolina Program for All Inclusive Care for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Lexington County; Richland County; Orangeburg County; Greenville County; Anderson County; Pickens County; Bamberg County; Calhoun County,PACE,1/1/1990,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,,X,X,X,X,,,X,,,,,No,No,No,,,,,,,,Prisma Health SeniorCare PACE - Midlands; Orangeburg Senior Helping Center; Prisma Health SeniorCare PACE - Upstate,There is no parent organization.,SC +South Carolina Non Emergency Medical Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,5/1/2007,,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Voluntary ,Mandatory,Mandatory,Other,,Recipient chooses to use transportation services based on identifying the need to access service providers.,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,X,,X,,,Modivcare formerly Logisticare,,SC +PRIME,Primary Care Case Management (PCCM),Statewide,1932(a),10/2/2002,,, , ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory,Exempt,N/A,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,,,,,,,Multiple Primary Care Providers,Disabled Children under age 19 are exempt from the PCCM program.,SD +TennCare III,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1945 Health Homes,1/8/2021,12/31/2030,,Mandatory , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Exempt,Voluntary,Pre-assigned,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,X,TennCare covers freestanding birth centers; podiatrists' services; and other services as indicated in Tennessee's approved Medicaid State Plan (where limitations imposed on each service are identified).,Yes,Yes,Yes,NCQA,Qsource,X,,X,X,X,Amerigroup; DentaQuest USA Insurance Company; OptumRx; UnitedHealthcare Community Plan; Volunteer State Health Plan (BlueCare); Volunteer State Health Plan (TennCare Select),"On 1/8/21; a new iteration of Tennessee's Medicaid program referred to as ""TennCare III"" began. The preceding iteration of the program (referred to as ""TennCare II"") had been in place since 2002. While Tennessee intended to extend TennCare II; the state chose to restructure the TennCare demonstration; ending TennCare II on 1/7/21 instead of on 6/30/2021 as originally intended.",TN +Program of All-Inclusive Care for the Elderly,Program of All-inclusive Care for the Elderly (PACE),Hamilton county,PACE,4/7/1999,,, , ,Voluntary , , ,Voluntary , ,Exempt,,N/A,,,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,X,X,,X,X,X,,Podiatry; nutrition counseling; recreational therapy and social activities; spiritual care; transportation and escort to and from the PACE center; audiology and hearing aids; optometry and eyeglasses; and medical equipment and supplies are additional services covered by Tennessee's PACE program.,No,No,No,,,,,,,,Alexian Brothers Community Services,"A segment of Tennessee's PACE population qualifies for coverage solely by virtue of the TennCare III Demonstration (Tennessee's 1115 Medicaid demonstration waiver) and not via Tennessee's Medicaid State Plan. TennCare III has a demonstration-only population referred to as the ""PACE Carryover Group""; which consists of individuals who were enrolled in a PACE program as of 6/30/2012; but who upon redetermination no longer qualify for enrollment due solely to the state's modification of its nursing facility level of care criteria.",TN +STAR HEALTH,Comprehensive MCO + MLTSS,Statewide,1915(a);1915(b)/1915(c),4/1/2008,8/31/2027,, , , , , ,Voluntary , ,Voluntary,Mandatory,Other,MAXIMUS,Members are auto-enrolled by the enrollment broker,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,,,X,X,Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services.,Yes,Yes,Yes,NCQA; URAC,Institute for Child Health Policy,,X,X,,X,Superior Health Plan,Enrollment in the STAR Health Program is voluntary for the following population categories: 1) Children and young adults in DFPS conservatorship; 2) Emancipated minors or members age 18-22 who voluntarily agree to continue in foster placement; 3) Young adults age 18-21 who have exited care and are participating in the Medicaid for Transitional Foster Care Youth (MTFCY) or Former Foster Care Children (FFCC) program. 4) An infant born to a mother who is enrolled in STAR Health; 5) Children through age 17 and young adults aged 18 through the month of their 21st birthday who are receiving Supplemental Security Income (SSI) or who were receiving Supplemental Income before becoming eligible for AA or PCA; and Children through age 17 and young adults aged 18 through the month of their 21st who are enrolled in a 1915(c ) Medicaid Waiver and AA or PCA. Additional Notes: STAR Health members may receive HCBS through state plan HCBS such as Community First Choice and Personal Care Services; they also can receive Medically Dependent Children's Program services under the MDCP 1915 (c ) waiver delivered through the STAR Health managed care program. STAR Health is operated under the state plan by contract with a managed care organization. Children and youth in Foster Care Medicaid are mandatorily enrolled in this program; this is allowed by the fact that the Texas Department of Family and Protective Services serves as the conservator for these members and chooses enrollment.,TX +STAR Kids,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1915(b)/1915(c);1945 Health Homes,11/1/2016,9/30/2030,, , ,Mandatory , , ,Mandatory ,Mandatory ,Voluntary,Mandatory,15 days,MAXIMUS,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,,,X,,Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services,Yes,Yes,Yes,NCQA; URAC,Institute for Child Health Policy,X,X,X,,X,Amerigroup Insurance Company; Superior HealthPlan; Inc.; Aetna Better Health of Texas; Inc.; Community First Health Plans; Inc.; UnitedHealthcare Insurance Company; dba United Healthcare; Texas Children's Health Plan; Inc.; Driscoll Children's Health Plan; Cook Children's Health Plan; Health Care Service Corporation DBA Blue Cross and Blue Shield of Texas (BCBSTX),Foster Care and Adoption Assistance choose between STAR Kids and STAR Health,TX +STAR+PLUS,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers),12/11/2011,9/30/2030,, , ,Mandatory , , ,Mandatory , ,Voluntary,,15 days,MAXIMUS,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,,,X,,X,X,Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services; emergency and non-emergency ambulance; audiology and hearing aids; behavioral health services; prenatal care; birthing services; cancer screening; diagnostic and treatment; chiropractic services; dialysis; durable medical equipment; early childhood intervention; emergency services; laboratory; mastectomy; breast reconstruction; and related; radiology; therapies; organ transplant; telemedicine; community-based long term services and supports including habilitation; emergency response services (ERC) and support management,Yes,Yes,Yes,NCQA; URAC,Institute for Child Health Policy,X,X,X,,X,Amerigroup Texas; Inc.; Superior HealthPlan; Inc.; UnitedHealthcare Insurance Company; dba United Healthcare Community Plan; Molina Healthcare of Texas; Inc.; HealthSpring Life & Health Insurance Co.; Inc.,,TX +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,6/1/2001,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,,X,X,X,X,X,,X,X,X,,Adult day care/adult foster care; nursing; physical therapy; occupational therapy; recreational therapy; meals and nutrition counseling; social work/social services; medical supplies/adaptive aids and minor home modifications; transportation to and from medical appointments; audiology; dentistry; optometry; podiatry; speech therapy; respite care; medical care provided by a PACE physician familiar with the history; needs; and preferences of each participant,No,No,No,,,,,,,,Bienvivir Senior Health Services (El Paso); Silver Star Health Network (Lubbock); The Basic at Jan Werner (Amarillo),,TX +Children's Medicaid Dental Services,Dental only (PAHP),Statewide,1115(a) (Medicaid demonstration waivers),12/11/2011,9/30/2022,, , ,Mandatory ,Mandatory , , , ,Voluntary,Exempt,15 days,MAXIMUS,,,,,,,,,,,,,,X,,,,,X,X,,,,,,,,,,Yes,Yes,Yes,URAC,Institute for Child Health Policy,X,,X,,X,MCNA Insurance Company; DentaQuest USA Insurance Company; Inc.,,TX +STAR,Comprehensive MCO,Statewide,1115(a) (Medicaid demonstration waivers),12/11/2011,9/30/2022,,Mandatory , ,Mandatory ,Mandatory , , ,Mandatory ,Voluntary,Mandatory,15 days,MAXIMUS,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,,,X,,,,,X,Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services.,Yes,Yes,No; but accreditation considered in plan selection criteria,NCQA; URAC,Institute for Child Health Policy,X,X,X,,X,Amerigroup Texas; Inc.; Superior Health Plan; Inc.; El Paso Health Plans; Inc.; dba El Paso Health; Aetna Better Health of Texas; Inc.; Community First Health Plans; Inc.; Seton Health Plan; Inc. dba Dell Children's Health Plan; UnitedHealthcare Insurance Company; dba United Healthcare Community Plan; Texas Children's Health Plan; Inc.; Molina Healthcare of Texas; Inc.; Driscoll Children's Health Plan; Parkland Community Health Plan; inc.; Cook Children's Health Plan; Community Health Choice Texas; Inc.; Health Care Service Corp. (dba Blue Cross Blue Shield); SHA.LLC; dba FirstCare Health Plans; Scott & White Health Plan,,TX +Utah Medicaid Integrated Care,Comprehensive MCO,Salt Lake; Utah; Davis; Weber and Washington counties.,1115(a) (Medicaid demonstration waivers),1/1/2020,6/30/2027,,Mandatory , , , , , , ,Mandatory,Exempt,Other,,15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,,X,,,,,X,,,X,,X,Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical center.,Yes,Yes,No,,Health Services Advisory Group,,,,,,Healthy U Integrated; Molina Integrated; Health Choice Integrated; SelectHealth Integrated,Medicaid integration pilot program set up for Medicaid Expansion Adults in Salt Lake; Utah; Davis; Weber and Washington counties. Enrollment is mandatory for eligible individuals. Enrollees will be provided with both physical and behavioral health services. They will not enroll in a separate Prepaid Mental Health Plan. Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Utah Medicaid Integrated Care; they may not also be enrolled in Choice of Health Care Delivery program; and vice-versa.,UT +UNI HOME,Comprehensive MCO,Statewide,1915(a),7/1/2011,6/30/2025,, , ,Voluntary , , ,Voluntary ,Voluntary ,Voluntary,Voluntary,Other,,No enrollment period. There is a waiting list for the program. Enrollees apply. If there is room; they are enrolled.,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,,,X,,,Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical centers.,Yes,Yes,No,,Health Service Advisory Group,,,,,,HOME,Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Choice of Health Care Delivery; they may not also be enrolled in UNI HOME; and vice-versa.,UT +Transportation,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,7/12/2001,,, , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,,,,,,Modivcare,AI/AN members enrolled in the Traditional Medicaid program are enrolled in Transportation; with the exception of those who are enrolled in a Nursing Home specific Medicaid program. Specific American Indian/Alaska Native populations are exempted from enrollment with the contracted Transportation provider by race; and zip code and/or county code. However; they are provided transportation through other means. Pregnant women are also provided transportation services. The enrollment tab did not have a category that included pregnant women.,UT +Choice of Health Care Delivery,Comprehensive MCO,Statewide,1915(b),3/23/1983,6/30/2027,,Varies ,Varies ,Varies ,Varies ,Varies ,Varies ,Varies ,Mandatory,Mandatory,Other,,15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period.,X,,X,,X,X,X,X,X,X,X,X,X,X,,X,X,,,,,X,,,X,,,Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical center.,Yes,Yes,No,,Health Services Advisory Group,,,,,,Healthy U; Molina; Health Choice; SelectHealth,Each of the enrollment subgroups can be voluntarily or mandatorily enrolled; depending on the county where they reside. 13 counties have mandatory enrollment; and 16 have voluntary enrollment. Mandatory enrollment is required in the following 13 counties: Box Elder; Cache; Davis; Iron; Morgan; Rich; Salt Lake; Summit; Tooele; Utah; Wasatch; Washington; and Weber. All other counties are voluntary enrollment in the plans. Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Choice of Health Care Delivery; they may not also be enrolled in UNI HOME; and vice-versa.,UT +Prepaid Mental Health,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Based on State counties and some multi-county partnerships.,1915(b),7/1/1991,6/30/2027,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,,,,X,,X,X,X,X,,X,X,,,X,X,,,,,,,,,,,,,X,Comprehensive continuum of outpatient behavioral health services.,Yes,Yes,No,,Health Services Advisory Group,,,,,,Bear River Mental Health; Central Utah Counseling Center; Davis Behavioral Health; Four Corners Community Behavioral Health; Healthy U Behavioral Health; Northeastern Counseling Center; Salt Lake County Division of Behavioral Health Services; Southwest Behavioral Health Center; Wasatch Behavioral Health; Weber Human Services; United Behavioral Health,,UT +Dental,Dental only (PAHP),Statewide,1915(b),9/1/2013,12/31/2023,, , ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory,Mandatory,Other,,15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period.,,,,,,,,,,,,,,,,,,,X,,,,,,,,,,Yes,Yes,No,,Health Services Advisory Group,,,,,,Premier Access; MCNA Dental,Pregnant women are an enrollment group covered by Dental. Only Foster Care children are exempt from Dental PAHP enrollment. Those qualifying for subsidized adoption are mandatorily enrolled in a Dental PAHP.,UT +Medallion 4.0,Comprehensive MCO,Statewide,1915(b),8/1/2018,6/30/2023,,Mandatory ,Mandatory , ,Mandatory , , ,Mandatory ,Mandatory,Mandatory,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,,X,,,,X,X,,Yes,Yes,Yes,NCQA,Health Services Advisory Group,,,X,X,X,Molina Healthcare of Virginia; Optima Family Care; United Healthcare of the Mid-Atlantic; Virginia Premier Health Plan; Anthem Healthkeepers Plus; Aetna Better Health of Virginia,,VA +Commonwealth Coordinated Care (CCC) Plus,Comprehensive MCO + MLTSS,Statewide,1915(b)/1915(c),8/1/2017,9/30/2022,,Mandatory ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,Pre-assigned,Maximus,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,,X,X,X,X,,Yes,Yes,Yes,NCQA,Health Services Advisory Group,,,X,X,X,Aetna Better Health of Virginia; Anthem Healthkeepers Plus; Molina Healthcare of Virginia; Optima Health Community Care; United Healthcare; Virginia Premier Elite Plus,,VA +PACE,Program of All-inclusive Care for the Elderly (PACE),Big Stone Gap; Cedar Bluff; Charlottesville; Farmville; Gretna; Lynchburg; Newport News; Norfolk; Portsmouth; Richmond; Roanoke; Salem,PACE,2/5/2009,,, , , , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,,X,X,X,X,,X,,X,,X,X,X,,X,,X,X,X,,,No,No,No,,,,,,,,AllCare for Seniors; Centra PACE - Farmville; Centra PACE - Gretna; Centra PACE - Lynchburg; InnovAge Virginia PACE Roanoke Valley; LLC; InnovAge Virginia PACE Charlottesville; LLC; InnovAge Virginia PACE Peninsula; InnovAge Virginia PACE Richmond; Mountain Empire PACE; Sentara Senior Community Care - Norfolk; Sentara Senior Community Care - Portsmouth,,VA +Global Commitment to Health Demonstration,Comprehensive MCO + MLTSS,Statewide,1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1945 Health Homes,10/1/2015,12/31/2027,,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory ,Mandatory , ,Mandatory,Mandatory,Pre-assigned,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,Nurse midwives; chiropractic; PT/OT/SP; tobacco cessation counseling; optometrist services; high tech nursing services; optician services; naturopathic physician services; and behavioral health services.,Yes,No,No,,Health Services Advisory Group,X,,,X,,Department of Vermont Health Access,Health homes provide coordinated; systemic; whole person care to Vermont Medicaid beneficiaries who receive medication assisted therapy (MAT) for opioid dependency.,VT +Behavioral Health Services Only (BHSO),Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Statewide,1915(b),4/1/2016,9/30/2022,, ,Mandatory ,Mandatory ,Mandatory , ,Mandatory , ,Voluntary,Voluntary,Other,,Enrollment open continuously,,X,,X,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,Yes,NCQA,Comagine Health,,,,,,Amerigroup; Community Health Plan of Washington; Coordinated Care of Washington; Molina Health Care; United Health Care,Clients with factors that disqualify them for Integrated Health Care and need Behavioral Health Services will fall under this service.,WA +PCCM,Primary Care Case Management (PCCM),Clallam; Grays Harbor; King; Snohomish; Whatcom; Okanogan; Ferry; Stevens; Lincoln; Spokane; Benton; and Yakima counties,1932(a),7/1/1995,,, ,Voluntary ,Voluntary , , , ,Voluntary ,Voluntary,Voluntary,N/A,,Enrollment open continuously,,,,,,,,,,,,,,X,,,,,,,,,,,,,,,No,No,No,,,,,,,,Multiple Primary Care Providers,WA State HCA pays a capitated rate of $3 per member per month to Primary Care Case Management (PCCM) entities to provide PCCM services to American Indian and Alaska Native Medicaid beneficiaries who opt out of the managed care program and who enroll in the PCCM program with a contracted PCCM entity. Only the Indian Health Service (IHS); tribes; and urban Indian health programs may contract with HCA to serve as PCCM entities. All other Medicaid covered services are available to the Medicaid beneficiaries through the Medicaid fee-for-service program. IHS administers this program in three Service Units: Colvill Service Unit; Wellpinit Service Unit; and Yakama Service Unit. Two FQHCs participate in this program: Seattle Indian Health Board and NATIVE Project of Spokane. Seven tribes participate in this program: Confederated Tribes of the Colville Indian Reservation (through the Lake Roosevelt Community Health Centers for the half of the reservation that is outside of the IHS Colville Service Unit service area); Lower Elwha Klallam Tribe; Lummi Nation; Nooksack Tribe; Puyallap Tribe; Quinault Indian Nation; and Shoalwater Bay Tribe.,WA +Fully Integrated Managed Care (FIMC),Comprehensive MCO,Adams; Asotin; Benton; Chelan; Clallam; Clark; Columbia; Cowlitz; Douglas; Ferry; Franklin; Garfield; Grant; Grays Harbor; Island; Jefferson; King; Kitsap; Kittitas; Klickitat; Lewis; Lincoln; Mason; Okanogan; Pacific; Pend Oreille; Pierce; San Juan; Skagit; Skamania; Snohomish; Spokane; Stevens; Thurston; Wahkiakum; Walla Walla; Whatcom; Whitman; and Yakima counties,1932(a);1945 Health Homes,4/1/2016,,, ,Mandatory ,Mandatory ,Mandatory , , , ,Voluntary,Voluntary,Other,,Enrollment open continuously,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,,,X,,X,X,,X, ,Yes,Yes,Yes,NCQA,Comagine Health,,X,X,X,X,Amerigroup; Coordinated Care of Washington; Community Health Plan; Molina Health Care of Washington; United Health Care,Nursing home care under managed care coverage is for rehabilitation care only; custodial care is covered under FFS and not a benefit under managed care coverage.,WA +PACE,Program of All-inclusive Care for the Elderly (PACE),Statewide,PACE,1/1/1997,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,,X,X,X,,Comfort Care and Podiatry,No,No,No,,,,,,,,PACE,The enrollment data does not include services received under a PACE program. There are two PACE providers: Providence Elder Place (located in King and Spokane County) and International Community Health Services (located in King County).,WA +NEMT,Non-Emergency Medical Transportation,Statewide,1902(a)(70) NEMT,10/1/2008,,, ,Mandatory ,Mandatory , ,Mandatory ,Mandatory ,Mandatory ,Mandatory,Mandatory,,Regional brokers based on county of residents,,,,,,,,,,,,,,,,,,,,,,,,,,,X,,,No,No,No,,,X,,,,,Multiple Transportation Brokers,NEMT is provided for anyone with Medicaid coverage that meet the requirement of having no other transportation resources available to them.,WA +Apple Health/Healthy Options Health Home Program,Other Prepaid Health Plan (PHP) (limited benefits),Statewide,1945 Health Homes,7/1/2013,,,Voluntary ,Voluntary ,Voluntary , , ,Voluntary ,Voluntary ,Voluntary,Voluntary,Pre-assigned,,,,,,,,,,,,,,,,,X,,,,,,,,,,,,,,No,No,No,,,,,,,,Multiple Sites,Washington delivers optional Health Home Medicaid/Medical Benefit both via the Fee-For -Service system and through MCOs. For individuals in Comprehensive MCOs; the MCOs are at risk for health home services plus a broad array of benefits. For individuals in PCCMs; the MCOs administer health home services separately from the PCCM program.,WA +BadgerCare Plus,Comprehensive MCO,Statewide,1932(a),2/1/2008,,,Mandatory ,Mandatory , ,Mandatory , ,Voluntary , ,Voluntary,Exempt,Other,Maximus,90 days open enrollment period,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,X,X,,X,,X,X,,X,Prosthetic devices; nurse midwife services; podiatry; chiropractic (varies by plan); and dental (varies by geographic region).,Yes,No,No,,MetaStar,X,,X,X,X,Anthem Blue Cross Blue Shield; Childrens Community Health plan; Dean Health Plan; Inc.; Group Health Cooperative of Eau Claire; Group Health Cooperative of South Central Wisconsin; Independent Care (ICARE) Health Plan; MercyCare Insurance Company; MHS Health Wisconsin; Molina Healthcare of Wisconsin; My Choice Wisconsin Health Plan Inc.; Network Health Plan; Quartz; Security Health Plan of Wisconsin; United Healthcare Community Plan,BadgerCare Plus does not serve dually eligible individuals but there may be a limited number of months where a BadgerCare Plus member with Medicare remains enrolled in managed care. In addition; PHE polices throughout 2021 kept BadgerCare Plus members with Medicare enrolled in managed care when they would have otherwise been disenrolled.,WI +SSI Managed Care,Comprehensive MCO,Statewide,1932(a),4/1/2005,,, , ,Mandatory , , ,Voluntary , ,Voluntary,Exempt,Other,MAXIMUS,90 days open enrollment period,X,X,X,X,X,X,X,X,X,X,,,X,X,,X,X,X,X,X,,X,,X,X,,X,Prosthetic devices; nurse midwife services; podiatry; chiropractic (varies by plan); and dental (varies by geographic region).,Yes,No,No,,MetaStar; Inc.,X,,X,X,X,Managed Health Services Insurance Corporation; My Choice Wisconsin Health Plan Inc.; Anthem Blue Cross Blue Shield; Molina Healthcare of Wisconsin; United Healthcare Community Plan; Group Health Cooperative of Eau Claire; Network Health Plan; Independent Care (ICARE) Health Plan,,WI +WrapAround Milwaukee,Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Milwaukee County,1915(a),3/1/1997,,, , , , , , ,Voluntary ,Voluntary,Voluntary,Other,,Voluntary enrollment can occur at any time,,X,,X,X,,,,X,,,,,X,,,,,,,,,,,,,X,,No,No,No,,MetaStar; Inc.,,,,,,WrapAround Milwaukee,,WI +Children Come First (CCF),Behavioral Health Organization (BHO) only (PIHP and/or PAHP),Dane County,1915(a),4/1/1993,,, , , , , , ,Voluntary ,Voluntary,Voluntary,Other,,Enrollment may occur at any time,,X,,X,X,,,,X,,,,,X,,,,,,,,,,,,,,,No,No,No,,MetaStar; Inc.,,,,,,Children Come First,,WI +Program of All-inclusive Care for the Elderly (PACE),Program of All-inclusive Care for the Elderly (PACE),Milwaukee; Waukesha; Kenosha; and Racine Counties,PACE,11/1/1990,,, , ,Voluntary , , ,Voluntary , ,Voluntary,Exempt,N/A,,Open enrollment,X,X,X,X,X,X,X,X,X,X,X,X,,X,,X,X,X,X,X,X,X,X,X,,X,,Ambulatory surgical center; audiology; chiropractic; community mental health services; durable medical equipment and medical supplies; occupational therapy; physical therapy; podiatry; respiratory care for ventilator dependent persons; speech & language pathology; vision care.,No,No,No,,MetaStar Inc,,,,,,Community Care; Inc.,,WI +Wisconsin Partnership Program,Comprehensive MCO + MLTSS,Calumet; Columbia; Dane; Dodge; Jefferson; Kenosha; Milwaukee. Outagamie; Ozaukee; Racine; Sauk; Washington; Waukesha; and Waupaca Counties,1932(a)/1915(c),12/1/1995,12/31/2024,, , ,Mandatory , , ,Voluntary , ,Voluntary,Exempt,Other,,Open enrollment,X,X,X,X,X,X,X,X,X,X,X,X,X,X,,X,X,X,X,X,X,X,X,X,X,X,X,Ambulatory surgical center; audiology; chiropractic; community mental health services; durable medical equipment and medical supplies; nurse-midwife; occupational therapy; physical therapy; podiatry; prenatal care coordination; respiratory care for ventilator dependent persons; school-based services; speech & language pathology; vision care.,No,No,No,,MetaStar Inc,X,,,X,,Independent Care (ICARE) Health Plan; My Choice Wisconsin Health Plan Inc.; Community Health Care Plan,,WI +Family Care,MLTSS only (PIHP and/or PAHP),Ashland; Barron; Bayfield; Brown; Buffalo; Burnett; Calumet; Chippewa; Clark; Columbia; Crawford; Dodge; Door; Douglas; Dunn; Eau Claire; Florence; Forest; Fond du Lac; Grant; Green; Green Lake; Iowa; Iron; Jackson; Jefferson; Juneau; Kenosha; Kewaunee; La Crosse; Lafayette; Langlade; Lincoln; Manitowoc; Marathon; Marinette; Marquette; Menominee; Milwaukee; Monroe; Oconto; Oneida; Outagamie; Ozaukee; Pepin; Pierce; Polk; Portage; Price; Racine; Richland; Rock; Rusk; St. Croix; Sauk; Sawyer; Shawano; Sheboygan; Taylor; Trempealeau; Vernon; Vilas; Walworth; Washburn; Washington; Waukesha; Waupaca; Waushara; Winnebago; and Wood Counties,1915(b)/1915(c),2/1/2000,12/31/2024,, , ,Mandatory , , ,Mandatory , ,Mandatory,Exempt,Other,,Open enrollment,,,,X,X,,,,,,,,,X,,X,,,,X,X,X,X,X,,X,,Community mental health services; durable medical equipment and medical supplies; occupational therapy; physical therapy; respiratory care for ventilator dependent persons; speech & language pathology.,No,No,No,,MetaStar; Inc,X,,,X,,Community Care Inc.; Lakeland Care Inc.; My Choice Wisconsin; Inclusa Inc.,,WI +Care4Kids,Other Prepaid Health Plan (PHP) (limited benefits),Kenosha; Milwaukee; Ozaukee; Racine; Washington; and Washington Counties,1937 Alt Benefit Plan,1/1/2014,,, , , , , , ,Voluntary ,Voluntary,Voluntary,Other,MAXIMUS,Open enrollment period as long as child remains in out of home care and resides in eligible placement setting/county,X,X,X,X,X,X,X,X,X,X,,,X,X,,X,X,X,X,X,,X,,X,X,,,Prosthetic devices; nurse midwife services; and podiatry,Yes,No,No,,MetaStar; Inc.,,,,,,Children's Hospital of Wisconsin,,WI +Mountain Health Trust,Comprehensive MCO,Statewide,1915(b),1/1/1996,6/30/2023,,Mandatory ,Mandatory ,Mandatory ,Mandatory , , ,Mandatory ,Mandatory,,60 days,Maximus US,,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,X,X,,X,,,X,,,,Yes,Yes,Yes,NCQA,Qlarant,,,X,,X,Aetna Better Health of WV; The Health Plan of WV; Unicare of WV,,WV +Mountain Health Promise,Comprehensive MCO,Statewide,1915(b),3/1/2021,6/30/2023,, , , , , , , ,Exempt,Voluntary,Pre-assigned,,,X,X,X,X,X,X,X,X,X,X,,X,X,X,,X,X,X,X,X,X,X,,,X,,,,Yes,Yes,Yes,NCQA,Qlarant,,,,,,Aetna Better Health of WV,,WV