Features
stringlengths 3
63
| Program type
stringclasses 10
values | Statewide or region-specific?
stringlengths 9
1.05k
| Federal operating authority
stringclasses 34
values | Program start date
stringlengths 8
10
| Waiver expiration date (if applicable)
stringdate 2021-12-27 00:00:00
2030-12-31 00:00:00
⌀ | If the program ended in 2020; indicate the end date
stringclasses 1
value | Populations enrolled: Low-income adults not covered under ACA Section VIII (excludes pregnant women and people with disabilities)
stringclasses 4
values | Populations enrolled: Low-income adults covered under ACA Section VIII (excludes pregnant women and people with disabilities)
stringclasses 4
values | Populations enrolled: Aged; Blind or Disabled Children or Adults
stringclasses 4
values | Populations enrolled: Non-Disabled Children (excludes children in foster care or receiving adoption assistance)
stringclasses 4
values | Populations enrolled: Individuals receiving Limited Benefits (excludes partial duals)
stringclasses 4
values | Populations enrolled: Full Duals
stringclasses 4
values | Populations enrolled: Children with Special Health Care Needs
stringclasses 4
values | Populations enrolled: American Indian/Alaska Native
stringclasses 3
values | Populations enrolled: Foster Care and Adoption Assistance Children
stringclasses 3
values | Populations enrolled: Enrollment choice period
stringclasses 6
values | Populations enrolled: Enrollment broker name (if applicable)
stringclasses 30
values | Populations enrolled: Notes on enrollment choice period
stringlengths 2
627
⌀ | Benefits covered: Inpatient hospital physical health
stringclasses 1
value | Benefits covered: Inpatient hospital behavioral health (MH and/or SUD)
stringclasses 1
value | Benefits covered: Outpatient hospital physical health
stringclasses 1
value | Benefits covered: Outpatient hospital behavioral health (MH and/or SUD)
stringclasses 1
value | Benefits covered: Partial hospitalization
stringclasses 1
value | Benefits covered: Physician
stringclasses 1
value | Benefits covered: Nurse practitioner
stringclasses 1
value | Benefits covered: Rural health clinics and FQHCs
stringclasses 1
value | Benefits covered: Clinic services
stringclasses 1
value | Benefits covered: Lab and x-ray
stringclasses 1
value | Benefits covered: Prescription drugs
stringclasses 1
value | Benefits covered: Prosthetic devices
stringclasses 1
value | Benefits covered: EPSDT
stringclasses 1
value | Benefits covered: Case management
stringclasses 1
value | Benefits covered: SSA Section 1945-authorized Health Home
stringclasses 1
value | Benefits covered: Home health services (services in home)
stringclasses 1
value | Benefits covered: Family planning
stringclasses 1
value | Benefits covered: Dental services (medical/surgical)
stringclasses 1
value | Benefits covered: Dental (preventative or corrective)
stringclasses 1
value | Benefits covered: Personal care (state plan option)
stringclasses 1
value | Benefits covered: HCBS waiver services
stringclasses 1
value | Benefits covered: Private duty nursing
stringclasses 1
value | Benefits covered: ICF-IDD
stringclasses 1
value | Benefits covered: Nursing facility services
stringclasses 1
value | Benefits covered: Hospice care
stringclasses 1
value | Benefits covered: Non-Emergency Medical Transportation
stringclasses 1
value | 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
stringclasses 1
value | Benefits covered: Other (e.g.; nurse midwife services; freestanding birth centers; podiatry; etc.)
stringlengths 1
720
⌀ | Quality assurance and improvement: HEDIS data required?
stringclasses 2
values | Quality assurance and improvement: CAHPS data required?
stringclasses 2
values | Quality assurance and improvement: Accreditation required?
stringclasses 4
values | Quality assurance and improvement: Accrediting organization
stringclasses 15
values | Quality assurance and improvement: EQRO contractor name (if applicable)
stringclasses 29
values | Performance incentives: Payment bonuses/differentials to reward plans
stringclasses 1
value | Performance incentives: Preferential auto-enrollment to reward plans
stringclasses 1
value | Performance incentives: Public reports comparing plan performance on key metrics
stringclasses 1
value | Performance incentives: Withholds tied to performance metrics
stringclasses 1
value | Performance incentives: MCOs/PHPs required or encouraged to pay providers for value/quality outcomes
stringclasses 1
value | Participating plans: Plans in Program
stringlengths 4
1.26k
| Notes: Program notes
stringlengths 30
1.48k
⌀ | State
stringlengths 2
2
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Integrated Care Network (ICN) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b);1915(b)/1915(c) | 10/1/2018 | 9/30/2023 | null | Voluntary | Voluntary | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | X | null | 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 |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Mobile and Baldwin Counties | PACE | 1/1/2012 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | 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 | null | X | X | X | null | null | X | null | X | null | X | X | X | null | X | null | X | X | X | null | Anything else that is determined to be medically necessary by the interdisciplinary team. | No | No | No | null | null | null | null | null | null | null | Mercy Life of Alabama | null | AL |
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Alabama Coordinated Health Network (ACHN) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b) | 10/1/2019 | 9/30/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | No | No | null | IPRO | X | null | X | null | null | Alabama Coordinated Health Network | 7 networks with one per region | AL |
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Arkansas Total Care | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c),1915(b)/1915(i) | 10/1/2017 | 3/31/2027 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | 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 | null | 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 | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | 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 |
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Empower Healthcare Solutions | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c) | 10/1/2017 | 3/31/2027 | null | 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 | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | 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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | Delta Dental Smiles | null | AR |
|
MCNA Insurance Company | Dental only (PAHP) | Statewide | 1915(b) | 1/1/2018 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | MCNA Dental | null | AR |
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Central Arkansas Development | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Central Arkansas Development | null | AR |
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Area Agency on Aging of Southeast | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Area Agency on Aging of Southeast | null | AR |
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Southeastrans, Inc | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | null | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Southeastrans, Inc | null | AR |
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PCCM | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2014 | null | null | Mandatory | Voluntary | Exempt | Voluntary | null | AFMC | null | X | X | X | X | X | null | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | X | null | null | null | null | null | Yes | Yes | No | null | null | X | null | X | X | X | Primary Care Case Management | null | AR |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 5/27/2008 | null | null | Voluntary | Exempt | null | null | null | null | X | null | X | null | null | null | null | null | X | X | X | X | null | X | null | X | null | null | X | X | X | null | null | X | X | X | null | null | No | No | No | null | null | null | null | null | null | null | PACE | PACE is incorporated into the AR Medicaid State Plan and is not under waiver authority. | AR |
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Arkansas Health & Wellness Solutions | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | 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 |
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Arkansas Blue Cross Blue Shield | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | 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 |
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QCA Health Plan, Inc | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | 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 |
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Qualchoice Life & Health Insurance | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2015 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | 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 |
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HMO Partners, Inc | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2021 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | 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 |
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Arizona Health Care Cost Containment System | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/13/1982 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | 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 | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | X | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | 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 | null | X | X | X | X | X | X | X | X | X | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | 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 | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | X | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE) | Yes | Yes | No | null | Health Services Advisory Group | X | null | X | null | 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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Voluntary | Voluntary | Other | Health Care Options/MAXIMUS | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | 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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Varies | Mandatory | Voluntary | Voluntary | Other | Health Care Options (Maximus) | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | 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 |
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Senior Care Action Network (SCAN) | Comprehensive MCO + MLTSS | Los Angeles, Riverside, San Bernardino | 1915(a) | 1/1/1996 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | null | X | X | X | X | X | X | X | X | X | X | null | X | null | X | null | null | null | null | null | null | X | X | X | X | null | 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) | null | null | null | null | null | SCAN Health Plan/Los Angeles; SCAN Health Plan Riverside/San Bernardino | null | CA |
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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 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | null | X | X | X | null | 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 | null | null | null | null | null | null | null | 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) | null | CA |
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Dental Managed Care/Los Angeles | Dental only (PAHP) | Los Angeles | 1115(a) (Medicaid demonstration waivers),1915(a) | 4/1/1998 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | 60 days | Health Care Operations (Maximus) | null | null | null | null | null | null | null | null | X | null | X | null | null | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | Yes | Yes | No, but accreditation considered in plan selection criteria | Private credentialling organizations approved by DHCS | Health Services Advisory Group | null | null | X | null | X | Health Net Dental Plan/Los Angeles; Access Dental Plan/Los Angeles; LIBERTY Dental Plan/Los Angeles | null | CA |
Dental Managed Care/Sacramento | Dental only (PAHP) | Sacramento | 1115(a) (Medicaid demonstration waivers) | 1/1/1995 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | 60 days | Health Care Operations (Maximus) | null | null | null | null | null | null | null | null | X | null | X | null | null | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | 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 | null | null | X | null | X | Health Net Dental Plan/Sacramento; Access Dental Plan/Sacramento; LIBERTY Dental Plan/Sacramento | null | 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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Varies | Mandatory | Voluntary | Voluntary | Other | Health Care Options/MAXIMUS | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | 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 |
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Positive Healthcare/Los Angeles | Comprehensive MCO | Los Angeles | 1915(a) | 4/1/2002 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group (HSAG) | null | null | null | null | 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 |
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Rady Children's Hospital San Diego (RCHSD) | Comprehensive MCO | San Diego | 1115(a) (Medicaid demonstration waivers) | 8/1/2018 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | null | X | X | null | 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) | null | null | null | null | null | 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 |
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Accountable Care Collaborative (ACC) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b) | 7/1/2018 | 6/30/2023 | null | 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 | null | 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 | null | Health Services Advisory Group, Inc. | X | null | 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 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | 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 | null | X | X | X | X | null | X | null | X | null | X | X | X | null | X | null | X | X | X | null | 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 | null | null | null | null | null | null | null | 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) | null | CO |
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Medicaid Managed Care Program | Comprehensive MCO | Statewide | 1932(a);1945 Health Homes | 4/1/1994 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Exempt | 30 days | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | null | null | X | X | X | Freestanding birth centers | Yes | Yes | Yes | NCQA | Qlarant | X | null | 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 |
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Child and Adolescent Supplemental Security Income Program | Comprehensive MCO | Statewide | 1915(a) | 1/1/1996 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | Enrollment is voluntary; else beneficiary stays in fee-for-service. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | Freestanding birth centers | Yes | Yes | Yes | NCQA | Qlarant | null | null | null | null | null | 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 |
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Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2007 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No; but accreditation considered in plan selection criteria | null | null | null | null | null | null | null | 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 |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 2/1/2013 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | X | X | X | X | null | Yes | Yes | No | null | null | null | null | null | null | null | Saint Francis Life | null | DE |
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Diamond State Health Plan & Diamond State Health Plan Plus | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1996 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | Automated Health Systems | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | X | X | null | 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 | null | X | null | X | Highmark Health Options of Delaware; AmeriHealth Caritas of Delaware | null | DE |
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ModivCare Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 7/1/2002 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | ModivCare | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | ModivCare Non-Emergency Medical Transportation | null | DE |
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Managed Medical Assistance Program | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 8/1/2014 | 6/30/2030 | null | 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 | null | null | X | X | null | null | null | null | X | null | 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 | null | X | null | 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 |
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Long-Term Care Program | MLTSS only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 8/1/2013 | 12/27/2021 | null | 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. | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | X | null | null | null | X | X | X | null | X | X | X | null | 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 | null | null | null | null | 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 |
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Dental | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 12/1/2018 | 6/30/2030 | null | 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. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | NCQA; Nationally recognized accrediting organizations | Health Services Advisory Group | X | null | null | X | null | 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 |
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Program of All- Inclusive Care for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 1/1/2003 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | Automated Health Systems | Continuous while slots are available. | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | null | X | null | null | X | X | X | null | All other FL Medicaid covered services and other services as determined by the multidisciplinary team. | No | No | No | null | null | null | null | null | null | null | 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 |
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Georgia Families | Comprehensive MCO | Statewide | 1932(a) | 6/1/2006 | null | null | Mandatory | Mandatory | Exempt | Exempt | 30 days | Maximus | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | null | X | X | X | null | null | null | X | null | null | null | null | null | Yes | Yes | Yes | NCQA; JCAHO; URAC | Health Services Advisory Group (HSAG) | null | X | null | null | null | 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 |
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Georgia Families 360 | Comprehensive MCO | Statewide | 1932(a) | 3/3/2014 | null | null | Exempt | Mandatory | 30 days | Maximus | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | null | null | X | X | X | null | null | X | X | null | null | null | Podiatry; Nurse Midwife | Yes | Yes | Yes | NCQA; JCAHO | Health Services Advisory Group (HSAG) | X | null | null | null | null | 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 |
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Planning for Healthy Babies | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2011 | 12/31/2029 | null | Voluntary | Exempt | Exempt | Other | null | 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. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | CareSource Georgia; Peach State Health Plan; Amerigroup Community Care | null | GA |
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Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/7/1997 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Exempt | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | null | 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 | null | X | X | X | X | X | X | X | X | X | X | X | null | 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) | null | 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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | Tobacco Cessation; Vision Care Exams | Yes | Yes | Yes | NCQA | Health Services Advisory Group (HSAG) | null | null | 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 |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 8/1/2018 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | null | X | X | X | X | X | X | X | X | X | X | null | No | No | No | null | null | null | null | null | null | null | PACE | null | IA |
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Dental Wellness Plan | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan | 5/1/2014 | 12/31/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | Health Services Advisory Group (HSAG) | null | null | null | X | X | Delta Dental of Iowa; MCNA Dental Plans; Inc. | Delta Dental covers all of our Hawki (State CHIP) members | IA |
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Healthy Connections | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 10/1/2006 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No; but accreditation considered in plan selection criteria | NCQA | null | null | null | null | null | null | Multiple Primary Care Providers | NCQA is the accrediting organization for tier 3 of the Healthy Connections program. | ID |
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Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 9/1/2010 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | MTM (Medical Transportation Management) | null | ID |
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Idaho Behavioral Health Plan | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(i) | 9/1/2013 | 3/21/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Mandatory | null | null | null | null | null | null | X | null | X | X | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | null | null | null | null | Peer Support; Family Support | Yes | Yes | Yes | NCQA | null | X | null | X | X | X | United Healthcare/Optum Idaho | null | ID |
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Idaho Smiles | Dental only (PAHP) | Statewide | 1915(b) | 8/1/2008 | 6/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | Yes | No | NCQA; AAAHC | null | null | null | null | X | null | MCNA (Managed Care of North America; Inc.) | null | ID |
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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 | null | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | null | null | X | X | null | X | X | X | null | null | Medicaid Primary Services not covered by Medicare | No | No | Yes | NCQA | Telligen | null | null | X | X | X | Blue Cross of Idaho; Molina of Idaho | null | ID |
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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 | null | Mandatory | Voluntary | Exempt | Other | null | 90 days - Enrollment open for ninety days | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | null | null | X | X | X | X | X | X | null | null | Medicaid Primary Services not covered by Medicare | No | No | Yes | NCQA | Telligen | null | null | X | X | X | Blue Cross of Idaho; Molina of Idaho | null | ID |
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HealthChoice Illinois | Comprehensive MCO + MLTSS | Statewide | 1915(b);1932(a)/1915(c) | 1/1/2018 | 6/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | 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 | null | 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 |
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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 | null | Mandatory | Mandatory | Voluntary | Exempt | Pre-assigned | Maximus | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | X | null | X | null | non-medical behavioral health; telehealth | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | 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 |
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Healthy Indiana Plan | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 2/1/2015 | 12/31/2030 | null | 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 | null | X | X | X | X | null | null | null | null | X | X | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | 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 |
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Hoosier Care Connect | Comprehensive MCO | Statewide | 1915(b) | 4/1/2015 | 3/31/2023 | null | Mandatory | Voluntary | Voluntary | 60 days | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | X | X | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | 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 |
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Hoosier Healthwise | Comprehensive MCO | Statewide | 1932(a) | 1/1/2000 | null | null | 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 | null | X | X | X | X | null | null | null | null | X | null | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | 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 |
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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 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | null | X | null | X | X | X | null | null | No | No | No | null | null | null | null | null | null | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | 60 days | Gainwell Technologies | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | Yes | Yes | Yes | NCQA | Kansas Foundation for Medical Care | null | null | 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 |
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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 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | Gainwell Technologies | null | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | X | null | X | X | null | null | null | null | X | X | X | null | Adult day care; recreational therapy; meals; social services; social work counseling; etc. | No | No | No | null | null | null | null | null | null | null | Via Christi; Midland Care; Bluestem PACE; Inc. | null | KS |
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Kentucky Managed Care | Comprehensive MCO | Statewide | 1915(b) | 1/1/2021 | 12/25/2025 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | null | 90 | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | null | X | null | null | null | Yes | Yes | Yes | NCQA; URAC | Island Peer Review Organization | null | null | null | null | X | Aetna Better Health of Kentucky; Anthem BCBS; Humana; Passport by Molina; United Healthcare; Wellcare of Kentucky | null | KY |
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Kentucky Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1915(b) | 12/1/1998 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | NEMT Human Services Transportation Delivery | null | KY |
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Healthy Louisiana | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b) | 12/12/2015 | 6/30/2027 | null | Mandatory | Mandatory | Varies | Exempt | Mandatory | null | Maximus Health Services | null | null | X | null | X | X | X | X | X | X | null | null | null | X | X | null | null | null | null | null | X | X | null | null | null | null | X | X | null | Yes | Yes | Yes | NCQA | IPRO; Myers & Stauffer LC | null | null | 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 |
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Dental Benefit Management Program | Dental only (PAHP) | Statewide | 1915(b) | 7/1/2014 | 6/30/2026 | null | 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. | null | null | null | null | null | null | null | X | X | X | null | null | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | No | null | Myers & Stauffer LC | null | null | null | null | null | 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 |
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Coordinated System of Care | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 3/1/2012 | 6/30/2027 | null | Voluntary | Exempt | null | null | null | null | null | X | null | X | null | X | X | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | null | null | null | null | 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 | null | null | null | null | null | null | 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 |
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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 | null | null | Voluntary | Voluntary | null | null | null | null | X | X | X | X | null | X | X | X | X | null | null | null | null | X | null | X | null | X | X | X | X | X | null | X | X | X | null | All specialized services authorized by IDT; including podiatry. | No | No | No | null | null | null | null | null | null | null | PACE - Baton Rouge; PACE - Greater New Orleans; PACE - Lafayette | null | LA |
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Healthy Louisiana | Comprehensive MCO | Statewide | 1915(b);1932(a) | 2/1/2012 | 6/30/2027 | null | 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 | null | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | null | null | null | 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 | null | null | 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 |
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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 | null | 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. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | Innovative Resource Group; LLC D/B/A Kepro | X | null | 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 |
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Primary Care Clinician Program | Primary Care Case Management (PCCM) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1995 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | null | Maximus until 12/2/2022; Automated Health Systems 12/3/2022 - present | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | Innovative Resource Group; LLC D/B/A Kepro | null | null | null | null | null | 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 |
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Managed Care Organization | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/7/1998 | 9/30/2022 | null | 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 | null | X | X | X | null | null | null | X | null | null | 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 | null | X | X | X | Tufts Health Together; BMC HealthNet Plan | Private duty nursing is covered under capitation for SKSC population only. | MA |
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Accountable Care Partnership Plans | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 3/1/2018 | 9/30/2022 | null | 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 | null | X | X | X | null | null | null | null | null | 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 | null | 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 | null | MA |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Other | Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present | Daily | null | X | null | X | X | X | X | null | X | null | X | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | 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 | null | X | null | null | Massachusetts Behavioral Health Partnership | Full duals are only enrolled mandatorily if less than 21 years of age. | MA |
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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 | null | Voluntary | Voluntary | Voluntary | null | 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 | null | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | X | X | X | null | All MassHealth covered LTSS and all services described in the Commonwealth 1915(c) Frail Elder Waiver. | Yes | Yes | No | null | Innovative Resource Group; D/B/A Kepro | null | null | X | null | X | Boston Medical Center Healthnet Plan; Commonwealth Care Alliance; Navicare HMO; Senior Whole Health; Tufts Health Plan; United Healthcare | null | MA |
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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 | null | null | Voluntary | Voluntary | Voluntary | null | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | null | X | X | X | X | X | null | 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 | null | null | null | null | null | null | null | 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 |
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HealthChoice | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/1/1997 | 12/31/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Maryland Health Benefit Exchange | Individuals may apply for Medicaid and HealthChoice at any time. | X | null | X | null | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | null | X | X | null | null | 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 | null | X | null | 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 |
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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 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | null | X | null | null | X | X | X | X | X | X | X | X | X | null | X | null | null | null | X | null | X | null | X | null | null | null | 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 | null | null | null | null | null | null | null | Hopkins ElderPlus | null | MD |
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MaineCare | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 5/1/1999 | null | null | Mandatory | Mandatory | Voluntary | Voluntary | null | null | 28 Days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | No | No | null | null | X | null | X | null | null | Multiple Primary Care Providers | null | ME |
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NET | Non-Emergency Medical Transportation | Statewide | 1915(b) | 8/1/2011 | 3/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Modivcare; Penquis CAP; MidCoast Connector | null | ME |
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MI Choice | MLTSS only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 10/1/2003 | 9/30/2023 | null | Voluntary | Voluntary | Voluntary | Exempt | Other | null | Enrollments and disenrollments are allowed at any time. Enrollments are always voluntary for qualified individuals. Must meet NFLOC to qualify. | null | null | null | X | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | X | X | null | null | null | 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 | null | null | null | null | null | null | null | 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 |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 11/1/2003 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | X | X | X | null | null | null | null | null | X | X | X | null | X | null | X | null | X | X | X | X | null | null | X | null | X | null | Transportation | No | No | No | null | null | null | null | null | null | null | 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 |
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Healthy Kids Dental | Dental only (PAHP) | Statewide | 1915(b) | 4/1/2009 | 12/31/2022 | null | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | 90 days for new enrollees. For all other enrollees; they are able to switch plans one time per year. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | X | null | 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 |
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Healthy Michigan Plan | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 4/1/2014 | 12/31/2023 | null | 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 | null | X | X | null | X | X | X | X | X | X | X | X | X | null | null | X | X | X | null | null | null | null | X | X | X | null | 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 |
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Comprehensive Health Care Program | Comprehensive MCO | Statewide | 1915(b) | 7/1/1997 | 12/31/2023 | null | 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 | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | null | null | null | null | null | 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 |
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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 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Mandatory | Other | null | No lock-in period. | null | X | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | 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 | null | null | null | null | null | null | null | 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 |
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Prepaid Medical Assistance Plan Plus (PMAP+) | Comprehensive MCO + MLTSS | Statewide | 1915(b);1932(a);1945 Health Homes | 7/1/1985 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Mandatory | Mandatory | 30 days | null | null | X | X | X | X | X | X | X | null | X | X | null | X | X | X | X | X | X | X | X | null | null | null | null | 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 | null | null | null | X | null | X | X | Blue Plus; Health Partners; Hennepin Health; Itasca Medical; Prime West Health; South Country Health Alliance; UCare | null | MN |
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Minnesota Senior Care Plus (MSC+) | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c);1945 Health Homes | 6/1/2005 | 6/30/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | 30 days | null | null | X | X | X | X | X | X | X | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | 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 | null | null | null | X | null | X | X | Blue Plus; Health Partners; Itasca Medical Care; Medica; Prime West Health; South Country Alliance; UCare | null | MN |
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Minnesota Senior Health Option (MSHO) | Comprehensive MCO + MLTSS | Statewide | 1915(a)/1915(c);1945 Health Homes | 3/1/1997 | 6/30/2026 | null | Voluntary | Voluntary | Mandatory | Exempt | 30 days | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | 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 | null | null | null | X | null | X | X | Blue Plus; Health Partners; Itasca Medical care; Medica; Prime West Health; South Country Health Alliance; UCare | null | MN |
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Special Needs Basic Care (SNBC) | Comprehensive MCO + MLTSS | Statewide | 1915(a);1945 Health Homes | 1/1/2008 | null | null | Voluntary | Voluntary | Voluntary | 30 days | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | null | null | X | null | 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 | null | null | null | X | null | X | X | Health Partners; Hennepin Health; Medica; Prime West; South Country Health Alliance; UCare | null | MN |
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MO HealthNet Managed Care/1915b | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers);1915(b) | 9/1/1995 | 6/30/2024 | null | 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 | null | X | X | X | X | X | X | X | null | null | 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. | null | null | X | X | null | 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 |
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Non-Emergency Medical Transportation Program (NEMT) | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2006 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Medicaid State Plan | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Logisticare Solutions | null | MO |
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Mississippi Coordinated Access Network (MississippiCAN) | Comprehensive MCO | Statewide | 1932(a) | 1/1/2011 | null | null | 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 | null | X | X | X | X | X | null | X | null | null | X | X | X | Vaccines; podiatry; chiropractic; vision and eyeglasses; etc | Yes | Yes | Yes | NCQA | The Carolinas Center for Medical Excellence (CCME) | null | null | null | 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 |
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Passport to Health | Primary Care Case Management (PCCM) | Statewide | 1915(b) | 1/1/1993 | 6/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Conduent | 45 days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | 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 |
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Comprehensive Primary Care Plus (CPC)+ | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2018 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Mandatory | null | Conduent | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | Yes | No; but accreditation considered in plan selection criteria | null | null | X | null | null | null | null | 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 |
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Patient Centered Medical Home | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2016 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Conduent | 45 days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | NCQA | null | null | null | null | null | null | 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 |
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Standard Plan | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/1/2021 | 10/31/2024 | null | Mandatory | Mandatory | Mandatory | Voluntary | Exempt | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | null | X | null | X | X | X | X | null | Yes | Yes | No | null | HSAG | null | null | X | null | X | Healthy Blue of North Carolina; UnitedHealthcare; Carolina Complete Health; Wellcare; Amerihealth Caritas | null | NC |
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