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
|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Community Care of North Carolina | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1932(a) | 4/1/1991 | null | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | 90 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 | No | null | null | null | null | null | null | null | North Carolina Community Care | null | NC |
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Program of All Inclusive for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Buncombe; Henderson; Montgomery; Moore; Randolph; Gaston; Cleveland; Lincoln; Durham Wake; Granville; Mecklenburg; Cabarrus; Union; Stanley; Rowan; Davidson; Davie; Iredell; Catawba; Lincoln; Burke; Caldwell; Alexander; Guilford; Rockingham; Cumberland; Harnett; Robeson; Moore; Hoke; Alamance; Caswell; Chatham; Lee; Orange; Durham; New Hanover; Brunswick | PACE | 2/1/2008 | 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 | null | X | X | null | null | null | X | X | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Carolina Seniorcare; CarePartners PACE; Elderhaus; Inc; Life of St. Joseph of the Pines; Inc.; PACE at Home Inc.; PACE of the Southern Piedmont; PACE of the Triad; Piedmont Health Services; Inc.; Senior Total Life Care; Inc.; Staywell; Voans Senior Community Care of North Carolina | null | NC |
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1915(b)/(c) Medicaid Waiver for MH/DD/SA Services | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 1/1/2012 | 6/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | X | null | X | X | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | X | null | X | null | null | null | X | null | Yes | Yes | Yes | NCQA; JCAHO; CARF | Carolina Center for Medical Excellence | null | null | X | null | null | Alliance Behavioral Healthcare; Cardinal Innovations Healthcare Solutions; Eastpointe Human Services; Partners Behavioral Health Management; Sandhills Center for MH DD SA; Trillium Health Resources; Vaya Health | null | NC |
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EBCI Tribal Option | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1932(a) | 7/1/2021 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Mandatory | Pre-assigned | Maximus | 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 | null | null | null | null | null | null | null | EBCI Tribal Option | null | NC |
||
North Dakota Medicaid Expansion | Comprehensive MCO | Statewide | 1915(b);1937 Alt Benefit Plan | 1/1/2014 | 12/31/2021 | null | Mandatory | Mandatory | Pre-assigned | null | null | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | null | X | X | X | null | null | null | null | null | X | X | null | Up to 30 days SNF (within a 12 month period) and Vision Services | Yes | Yes | No | null | null | null | null | null | null | null | ND Medicaid Expansion MCO | null | ND |
|||||||
Multiple Primary Care Providers | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/10/1994 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | 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 | null | null | null | null | null | No | No | Yes | North Dakota | null | null | null | null | null | null | Primary Care Case Management (PCCM) | null | ND |
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Program of All-Inclusive Care for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Burleigh- 58501; 58502; 58503; 58504; 58558 Cass- 58047; 58078; 58102; 58103; 58104; 58105 Stark- 58601; 58602; 58630; 58652; 58655; 58656 Morton- 58554 Ward- 58701; 58702; 58703; 58722; 58785 | PACE | 8/1/2008 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | Participants voluntarily enroll in the PACE program; enrollment is on the first day of each month. | X | X | X | X | null | X | X | X | X | X | X | X | null | X | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | Program of All-inclusive Care for the Elderly | null | ND |
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Heritage Health | Comprehensive MCO | Statewide | 1915(b) | 1/1/2017 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | Automated Health Systems (AHS) | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | null | null | X | X | X | Podiatry; Hearing; Immunization; Speech Therapy; Physical Therapy; Vision; Chiropractic; Durable Medical Equipment (DME); Occupational Therapy; Freestanding birth center | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | null | null | X | X | UnitedHealthcare Community Plan of Nebraska; Healthy Blue; Nebraska Total Care | null | NE |
Program of All-Inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Nebraska Zip Codes: 68037; 68048; 68025; 68007; 68010; 68022; 68064; 68102; 68104; 68105; 68106; 68107; 68127; 68110; 68111; 68112; 68114; 68116; 68117; 68118; 68122; 68124; 68127; 68130; 68131; 68132; 68134; 68135; 68137; 68142; 68144; 68152; 68154; 68157; 68164; 68182; 68005; 68028; 68046; 68059; 68069; 68113; 68123; 68128; 68133; 68136; 68138; 68147; 68073; 68002; 68008; 68009; 68023; 68029; 68034; 68044; 68068 | PACE | 5/1/2013 | null | null | Voluntary | Voluntary | Voluntary | null | null | null | 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 | null | No | No | No | null | null | null | null | null | null | null | Immanuel Pathways | null | NE |
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Dental Benefit Manager | Dental only (PAHP) | Statewide | 1915(b) | 10/1/2017 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | 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 | X | X | null | null | null | null | null | null | null | null | null | No | No | Yes | URAC | Health Services Advisory Group | null | null | null | X | null | MCNA Nebraska | null | NE |
New Hampshire Medicaid Care Management | Comprehensive MCO | Statewide | 1915(b);1932(a) | 12/1/2013 | 3/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | 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 | null | X | X | X | Nurse midwife; non-nurse midwife; freestanding birth centers; podiatry; PT/OT/ST; ambulance; adult medical day care; DME; eyeglasses; full substance use disorder treatment | Yes | Yes | Yes | NCQA | HSAG | X | X | X | X | X | New Hampshire Healthy Families; Well Sense Health Plan; AmeriHealth Caritas of New Hampshire | The 1915(b) authority is only applicable to those members that cannot be mandated to participate in managed care. | NH |
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Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 7/1/2009 | null | null | Mandatory | Mandatory | Exempt | 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 | X | null | null | No | No | No | null | null | null | null | null | X | null | ModivCare | null | NJ |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | County or zip code specific; varies by plan. See individual plans. | PACE | 4/9/2009 | null | null | Exempt | null | null | null | null | X | X | X | X | X | X | X | null | 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 | AtlantiCare Life; Beacon of LIFE; Inspira LIFE; LIFE St. Francis; Lutheran Senior Life; Trinity Health LIFE NJ | null | NJ |
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FIDE SNP | Comprehensive MCO + MLTSS | Varies by MCO | 1115(a) (Medicaid demonstration waivers) | 1/1/2012 | 6/30/2022 | null | Exempt | null | Other | null | null | 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 | Assistive technology; audiology; chiropractic; durable medical equipment; hearing aid; immunization; medical day care; medical supplies; optical appliances; optometrist; organ transplants; orthotics; rehabilitation/specialized hospital; outpatient rehabilitation; non-routine podiatrist; post-acute care; preventive health; specialized hospital; vision | Yes | Yes | No | null | null | X | null | X | null | null | Amerivantage Dual Coordination (HMO D-SNP) Amerivantage Dual Secure (HMO POS); Aetna Assure Premier Plus (HMO SNP); Wellcare Liberty (HMO D-SNP); UnitedHealthcare Dual Complete ONE (HMO D-SNP); Horizon NJ TotalCare (HMO D-SNP) | null | NJ |
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NJ FamilyCare | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 9/1/1995 | 6/30/2022 | null | Exempt | null | 10 days | null | null | 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 | Assistive technology; audiology; chiropractic; durable medical equipment; hearing aid; immunization; medical day care; medical supplies; optical appliances; optometrist; organ transplants; orthotics; rehabilitation/specialized hospital; outpatient rehabilitation; non-routine podiatrist; post-acute care; preventive health; specialized hospital; vision | Yes | Yes | Yes | NCQA | null | X | null | X | null | null | Aetna Better Health NJ; Amerigroup New Jersey Inc; Horizon NJ Health; UnitedHealthcare Community Plan; WellCare of New Jersey | null | NJ |
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Centennial Care | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2019 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | Members have 90 days to switch MCO's when initially enrolled and during recertification. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | X | X | X | X | ambulatory; surgical; anesthesia; diagnostic imaging; imaging and therapeutic radiology services; dialysis; durable medical equipment and medical supplies; hearing and audiology; immunization; medical service providers; midwife; nutritional; occupational therapy; physical therapy; podiatry; pregnancy termination (state funded); prosthetics and orthotics; rehabilitation; reproductive health; school based; speech therapy; telehealth; transplant; transportation; vision; pediatricians; respite | Yes | Yes | Yes | NCQA | Island Peer Review Organization (IPRO) | null | X | X | X | X | Blue Cross Blue Shield of NM; Presbyterian Health Plan; Western Sky Community Care; Inc. | Native American/Alaska Native Enrollment would be mandatorily enrolled if dually eligible or receiving LTSS. | NM |
Program of All-inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Bernalillo; Sandoval; and Valencia counties | PACE | 7/1/2004 | null | null | Voluntary | Exempt | null | null | null | Disenrollment permitted every 30 days. | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | null | X | X | X | null | X | null | X | null | X | null | No | No | No | null | null | null | null | null | null | null | InnovAge New Mexico PACE dba Total Community Care | null | NM |
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Mandatory Health Maintenance Program (MCO) | Comprehensive MCO | Sufficiently populated Urban Zip Codes in Washoe and Clark counties; including: 88901; 88905; 89002; 89004; 89005; 89006; 89009; 89011; 89012; 89014; 89015; 89016; 89030; 89031; 89032; 89033; 89036; 89044; 89052; 89053; 89054; 89074; 89077; 89081; 89084; 89085; 89086; 89087; 89101; 89102; 89103; 89104; 89105; 89106; 89107; 89108; 89109; 89110; 89111; 89112; 89113; 89114; 89115; 89116; 89117; 89118; 89119; 89120; 89121; 89122; 89123; 89124; 89125; 89126; 89127; 89128; 89129; 89130; 89131; 89132; 89133; 89134; 89135; 89136; 89137; 89138; 89139; 89140; 89141; 89142; 89143; 89144; 89145; 89146; 89147; 89148; 89149; 89150; 89151; 89152; 89153; 89154; 89155; 89156; 89157; 89159; 89160; 89161; 89162; 89163; 89164; 89165; 89166; 89169; 89170; 89173; 89177; 89178; 89179; 89180; 89183; 89185; 89191; 89193; 89195; 89199; 89431; 89432; 89433; 89434; 89435; 89436; 89439; 89441; 89501; 89502; 89503; 89504; 89505; 89506; 89507; 89508; 89509; 89510; 89511; 89512; 89513; 89515; 89519; 89520; 89521; 89523; 89533; 89555; 89557; 89570; 89595; and 89599. | 1932(a) | 10/31/1988 | null | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Exempt | Other | Gainwell Technologies (GWT) | MCO selection is made by recipient at time of application. If no selection is made; recipient is auto-assigned based on the auto-assignment algorithm outlined in the State Plan. New recipients have a 90-day switch period in which to make a different MCO selection before being locked-in until the next open enrollment period. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | null | X | null | null | X | null | X | null | Yes | Yes | Yes | Any Nationally Recognized Accrediting Organization | Health Services Advisory Group (HSAG) | null | null | null | null | null | Anthem Blue Cross Blue Shield of Nevada; Health Plan of Nevada; SilverSummit Health Plan | Nursing Facility Services are covered by the MCO the first 180 days. Performance Incentives: For the year 2021; the State cancelled the Performance Incentives due to the COVID-19 pandemic. | NV |
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Dental Benefits Administrator (DBA) | Dental only (PAHP) | Sufficiently populated Urban Zip Codes in Washoe and Clark counties; including: 88901; 88905; 89002; 89004; 89005; 89006; 89009; 89011; 89012; 89014; 89015; 89016; 89030; 89031; 89032; 89033; 89036; 89044; 89052; 89053; 89054; 89074; 89077; 89081; 89084; 89085; 89086; 89087; 89101; 89102; 89103; 89104; 89105; 89106; 89107; 89108; 89109; 89110; 89111; 89112; 89113; 89114; 89115; 89116; 89117; 89118; 89119; 89120; 89121; 89122; 89123; 89124; 89125; 89126; 89127; 89128; 89129; 89130; 89131; 89132; 89133; 89134; 89135; 89136; 89137; 89138; 89139; 89140; 89141; 89142; 89143; 89144; 89145; 89146; 89147; 89148; 89149; 89150; 89151; 89152; 89153; 89154; 89155; 89156; 89157; 89159; 89160; 89161; 89162; 89163; 89164; 89165; 89166; 89169; 89170; 89173; 89177; 89178; 89179; 89180; 89183; 89185; 89191; 89193; 89195; 89199; 89431; 89432; 89433; 89434; 89435; 89436; 89439; 89441; 89501; 89502; 89503; 89504; 89505; 89506; 89507; 89508; 89509; 89510; 89511; 89512; 89513; 89515; 89519; 89520; 89521; 89523; 89533; 89555; 89557; 89570; 89595; and 89599. | 1915(b);1932(a) | 1/1/2018 | null | 12/31/2021 | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Exempt | Pre-assigned | Gainwell Technologies (GWT) | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | Any Nationally Recognized Accrediting Organization | Health Services Advisory Group (HSAG) | null | null | null | null | null | Liberty Dental Plan of Nevada | Enrollment: Recipients in Managed Care are automatically assigned to LIBERTY Dental as there is only one vendor. | NV |
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Non-Emergency Medical Transportation (NEMT) | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2003 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | 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 | X | null | null | null | null | Medical Transportation Management (MTM) | NV Check-Up is not eligible for NEMT. Enrollment: Recipients in Managed Care are automatically assigned to MTM as there is only one vendor. Performance Incentives ended June 30; 2021. | NV |
Medicaid Managed Care | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1945 Health Homes | 10/1/1997 | 3/31/2027 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Mandatory | 30 days | NY Medicaid Choice/Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | X | Nurse Midwife Services; Audiology; Vision Care; Foot Care Services; Occupational Therapy; Physical Therapy; & Speech Therapy | Yes | Yes | No | null | Island Peer Review Organization | X | X | X | null | X | Affinity Health Plan; AmidaCare Special Needs; Capital District Physician's Health Plan; Excellus; Fidelis Care; Health First; Health Now; HealthPlus; HIP Combined; Independent Health/Hudson Valley & WNY; MetroPlus Health Plan; MetroPlus Health Plan Special Needs; Molina HealthCare of New York; Inc.; MVP Health Plan; United HealthCare; VNS Choice Special Needs | Effective July 1; 2019; Partial Hospitalization is applicable to eligible children under age 21 as well as adults aged 21 and over. Fidelis Care covers emergency and non - emergency transportation in Rockland County only. MMC includes children's HCBS authorized under the State's 1915c Children's waiver and 1115 MRT Waiver. | NY |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 1/1/2001 | null | null | Voluntary | Exempt | Exempt | null | NY Medicaid Choice/Maximus | null | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | X | X | null | X | null | X | null | Podiatry; Physical Therapy; & Occupational Therapy | No | No | No | null | Island Peer Review Organization | null | null | null | null | null | ArchCare Senior Life; Catholic Health - Life; CenterLight (CCM); Complete Senior Care; Eddy Senior Care; Fallon Health Weinberg; Independent Living for Seniors; PACE CNY; Total Senior Care | Waiver Expiration Date not applicable; PACE is a joint state/federal program. Enrollment includes both full and partial dually eligibles; as well as qualified and specified low income (QMB/SLMB) Medicare Support programs; must be 55 years of age or older. PACE has a comprehensive mandate to cover all services deemed necessary by IDT. Covered Benefits include non-hospice palliative care. OG/GYN is mandated with a minimum age of 55 years. Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds. | NY |
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Health and Recovery Plans | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers);1945 Health Homes | 10/1/2015 | 3/31/2027 | null | Voluntary | Voluntary | Exempt | Exempt | 30 days | NY Medicaid Choice/Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | null | X | null | X | Nurse Midwife Services; Audiology; Vision Care; Foot Care Services; Occupational Therapy; Physical Therapy; & Speech Therapy | Yes | Yes | No | null | Island Peer Review Organization | X | X | X | null | X | Affinity Health Plan; Capital District Physician's Health Plan; Excellus Health Plan; Fidelis Care; HealthFirst; HealthPlus; HIP GNY; Independent Health Association; MetroPlus; Molina HealthCare of New York; MVP Health Plan; United HealthCare | The covered benefit partial hospitalization only applies to enrollees 21 years of age and older. CMS has approved HCBS within the HARP program under 1115(a) authority. | NY |
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Medicaid Advantage Plus | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2007 | 3/31/2027 | null | Voluntary | Exempt | Exempt | 60 days | NY Medicaid Choice/Maximus | null | X | X | X | X | null | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | X | X | null | X | null | X | null | Podiatry | No | No | No | null | Island Peer Review Organization | null | null | null | null | null | AgeWell New York; Centers Plan; ElderPlan; ElderServe; Fidelis Legacy Plan; Hamaspik ; Inc; HealthFirst Health Plan; HealthPlus Advantage Plus; Senior Whole Health; Village Care; VNS Choice Plus | Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance; and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds. | NY |
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Medicaid Advantage | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 10/1/2006 | 3/31/2027 | null | Voluntary | Exempt | Exempt | 60 days | NY Medicaid Choice/Maximus | null | X | X | X | X | null | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | null | X | null | null | null | X | null | Podiatry; outpatient rehabilitation; hearing services; & vision care services | No | No | No | null | Island Peer Review Organization | null | null | null | null | null | Fidelis Legacy Plan; United HealthCare; WellCare | null | NY |
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Managed Long Term Care | MLTSS only (PIHP and/or PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1998 | 3/31/2027 | null | Mandatory | Exempt | Exempt | 60 days | NY Medicaid Choice/Maximus | null | null | null | null | null | null | X | X | null | X | null | null | null | null | X | null | X | null | X | X | X | X | X | null | X | X | X | null | null | No | No | No | null | Island Peer Review Organization | X | X | X | null | null | VNS Choice; Aetna Better Health; AgeWell New York; ArchCare Community Life; Centers Plan for Healthy Living; ElderPlan; ElderServe; ElderWood; Extended MLTC; Fallon Health Weinberg; Fidelis Care; Hamaspik Choice MLTC; Health Advantage/Elant Choice; HealthPlus; Icircle Care MLTC; Integra MLTC; Kalos Health Plan; MetroPlus; Montefiore HMO MLTC; Prime Health Choice; Senior Health Partners; Senior Network Health; Senior Whole Health; Village Care; VNA HomeCare Options | MLTC enrollees may elect hospice care; but a hospice enrollee cannot enroll in MLTC. Some; but not all; HCBS waiver services are covered by MLTC plans. Quality Incentive is a plan performance incentive. It is comprised of measures of satisfaction; quality; compliance; and efficiency which equate to points. A financial incentive payment is made to plans achieving a score at or above the thresholds. | NY |
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Ohio Medicaid Managed Care Program | Comprehensive MCO | Statewide | 1915(b);1932(a) | 7/21/2006 | 6/30/2027 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | Automated Health Systems; Inc. | Medicaid enrollees are pre-assigned to a plan with 90 days to change plans. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | null | X | X | X | X | Immunizations; nurse midwife services; freestanding birth centers; certified family nurse practitioner; certified pediatric nurse practitioner; physical therapy; speech therapy; occupational therapy; developmental therapy; chiropractic; podiatry; vision; durable medical equipment (DME) and medical supplies; ambulance; ambulette; care management; telemedicine; respite services for eligible children receiving SSI; services for members with a primary diagnosis of Autism Spectrum Disorder; screening and counseling for obesity. | Yes | Yes | Yes | NCQA | Island Peer Review Organization | null | X | X | X | X | Buckeye Health Plan; CareSource; Molina Healthcare of Ohio; Inc.; Paramount Advantage; UnitedHealthcare Community Plan of Ohio; Inc. | null | OH |
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MyCare Ohio Opt-Out Program | Comprehensive MCO + MLTSS | Central; Northwest; Northeast; Northeast Central; Southwest; West Central; East Central | 1915(b)/1915(c) | 5/1/2014 | 12/31/2023 | null | Mandatory | Voluntary | Mandatory | Other | Automated Health Systems; Inc. | MyCare Ohio Opt-Out enrollees are pre-assigned to a plan with 90 days to change plans. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | null | X | X | X | X | Immunizations; nurse midwife services; freestanding birth centers; care management; DME and medical supplies; vision; physical therapy; speech therapy; occupational therapy; developmental therapy; certified family nurse practitioner; certified pediatric nurse practitioner; ambulance; ambulette; podiatry; telemedicine; services for members with a primary diagnosis of autism spectrum disorder; screening and counseling for obesity. | Yes | Yes | Yes | NCQA | Island Peer Review Organization | null | null | X | X | X | CareSource; Molina Healthcare of Ohio; Inc.; UnitedHealthcare Community Plan of Ohio; Inc.; Aetna Better Health of Ohio; Buckeye Health Plan | null | OH |
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Ohio PACE | Program of All-inclusive Care for the Elderly (PACE) | Cuyahoga county | PACE | 11/1/2002 | null | null | Voluntary | Voluntary | Exempt | null | null | null | Ohio PACE operates under an open enrollment model. | X | X | null | X | null | X | X | null | null | X | null | null | null | null | null | X | null | X | X | null | X | X | null | X | X | X | null | null | No | No | No | null | null | null | null | null | null | null | McGregor PACE | null | OH |
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SoonerRide | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 6/1/2006 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Logisticare | 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 | SoonerRide | null | OK |
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SoonerCare Choice | Primary Care Case Management (PCCM) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1996 | 12/23/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | null | Maximus | Members are enrolled within 72 hours of application. | 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 | Telligen | null | null | null | null | null | SoonerCare Choice | null | OK |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | 73004; 73007; 73008; 73010; 73012; 73013; 73020; 73026; 73034; 73036; 73045; 73049; 73051; 73064; 73065; 73066; 73068; 73069; 73071; 73072; 73078; 73080; 73084; 73089; 73090; 73093; 73099; 73104; 73105; 73106; 73107; 73108; 73109; 73110; 73111; 73112; 73113; 73114; 73115; 73116; 73117; 73118; 73119; 73120; 73121; 73122; 73127; 73128; 73129; 73130; 73132; 73134; 73135; 73136; 73139; 73140; 73141; 73142; 73149; 73159; 73160; 73162; 73170; 74011; 74012; 74021; 74033; 74055; 74063; 74066; 74070; 74103; 74104; 74105; 74106; 74107; 74110; 74112; 74114; 74115; 74116; 74119; 74126; 74127; 74128; 74129; 74130; 74133; 74134; 74135; 74136; 74145; 74146; 74169; 74347; 74352; 74359; 74364; 74365; 74401; 74402; 74403; 74423; 74427; 74434; 74435; 74441; 74451; 74452; 74457; 74464; 74465; 74467; 74471; 74857; 74931; 74945; 74955; 74960; 74962; 74964; and 74965 | PACE | 8/1/2008 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | Enrollment process takes approximately 4-6 weeks. Members are enrolled throughout the entire month to be effective the first day of the following month. Members go through the PACE Organizations for the entire enrollment process. | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | null | X | null | X | null | X | null | Podiatry; speech therapy; disease management; hearing; institutional; occupational therapy; physical therapy; skilled nursing facility; vision; and medication assisted treatment | No | No | No | null | null | null | null | null | null | null | Life PACE; Valir PACE; Cherokee Elder Care (CEC) | null | OK |
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OHP - Oregon Health Plan | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 2/1/1994 | 9/30/2022 | null | Mandatory | Mandatory | Voluntary | Voluntary | Mandatory | Voluntary | Mandatory | Voluntary | Voluntary | Pre-assigned | null | null | X | X | X | X | null | X | null | null | null | X | X | X | X | X | null | X | X | X | X | null | null | null | null | X | X | X | null | Hearing; immunization; vision | No | Yes | No | NCQA; URAC | HSAG (Health Services Advisory Group) | X | null | X | X | null | Advantage Dental Services; Capitol Dental Care; Inc.; Family Dental Care; AllCare Health Plan; Cascade Health Alliance; Columbia Pacific; Managed Dental Care of Oregon; ODS Community Health Inc.; Eastern Oregon CCO; HealthShare of Oregon; InterCommunity Health Network; Jackson Care Connect; PacificSource Community Solutions - Central Oregon; PacificSource Community Solutions - Columbia Gorge; Trillium Community Health Plan; Umpqua Health Alliance; Advanced Health; Yamhill Community Care; PacificSource Community Solutions - Lane (CCO); PacificSource Community Solutions - Marion Polk (CCO); Trillium Community Health Plan - Tri-County | As of 2011; Medicaid (known as Oregon Health Program (OHP) Plus); mandatorily enrolled most benefit groups; except childless adults; into fully-capitated MCOs; or offered primary care case managers in some counties where managed care was not available. The program covered acute; primary and specialty care; dental and behavioral health services were covered through separate prepaid health plans; many of which are operated by counties. Under this system; beneficiaries requiring physical; behavioral; dental; and transportation services could receive them from as many as four separate entities. On the Oregon Health Plan/Medicaid program; a person can be enrolled simultaneously in two or three plans. Note: Care Oregon Dental (DCO); Greater Oregon Behavioral Health; Inc. (MHO); PrimaryHealth of Josephine County (CCO); Willamette Dental Group (DCO); Willamette Valley Community Health (CCO); all had closed to enrollment prior to June 2020. | OR |
PACE | Program of All-inclusive Care for the Elderly (PACE) | Multnomah county; Washington county (97113; 97116; 97140; 97062; 97078; 97003; 97123; 97124; 97005; 97006; 97007; 97008; 97223; 97224; 97225; 97229 only); Clackamas county (97015; 97027; 97086; 97036; 97045; 97062; 97068; 97034; 97035; 97206; 97219; 97222; 97267; 97268; 97269 only); Clatsop county; Tillamook county (97130; 97131; 97147 only); Jackson county (97501; 97502; 97504; 97525; 97535; 97537 only); Josephine county (97526; 97527; 97543 only) | PACE | 1/1/1986 | null | null | Voluntary | Voluntary | null | null | null | Flexible enrollment eligibility - rolling enrollment to be effective on the 1st of the following month. | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | X | null | null | X | X | X | null | Medications (OTC and RX); mental health care; durable medical equipment; speech/physical/occupational/recreational therapeutic services; audiology/optical/podiatry specialty medical care; occupational and physical therapy and social services | No | No | No | NCQA | null | X | null | null | null | null | Providence Elder Place | null | OR |
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Medical Assistance Transportation Program | Non-Emergency Medical Transportation | Philadelphia | 1902(a)(70) NEMT | 11/1/2005 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Exempt | Voluntary | null | Modivcare (formerly LogistiCare) | 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 | null | PA |
Adult Community Autism Program | Other Prepaid Health Plan (PHP) (limited benefits) | Dauphin; Cumberland; Lancaster; and Chester counties | 1915(a) | 8/1/2009 | null | null | Voluntary | Exempt | Exempt | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | null | X | X | null | X | null | null | X | null | X | null | Podiatry; speech therapy; occupational therapy; language therapy; counseling; respite; and supported employment | No | No | No | null | Island Peer Review Organization (IPRO) | null | null | null | null | null | Adult Community Autism Program | null | PA |
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Behavioral Health Health Choices | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers);1915(b) | 1/1/1997 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | null | X | null | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | null | null | null | null | null | null | null | X | X | Psychiatric rehabilitation; peer support services; family based MH services; mobile MH treatment; MH crisis intervention services; SUD residential services; and SUD withdrawal management | Yes | No | Yes | NCQA; JCAHO; URAC | Island Peer Review Organization | X | null | X | X | X | Allegheny County HealthChoices; Beaver County HealthChoices; Behavioral Health Services of Somerset and Bedford Counties; Berks County HealthChoices; Blair County HealthChoices; Bucks County HealthChoices; Cambria County HealthChoices; Carbon-Monroe-Pike Joinder Board; Chester County HealthChoices; Capital Area Behavioral Health Collaborative; Delaware County HealthChoices; Erie County HealthChoices; Fayette County HealthChoices; Greene County (Commonwealth); Lehigh County HealthChoices; Lycoming-Clinton Joinder Board; Montgomery County HealthChoices; Community Care Behavioral Health Organization; Northampton County HealthChoices; Northeast Behavioral Health Care Consortium; Northwest Behavioral Health Partnership; Philadelphia County HealthChoices; Southwest Behavioral Health Management; Tuscarora Managed Care Alliance; York/Adams HealthChoices Joinder Governing Board | null | PA |
Physical Health HealthChoices | Comprehensive MCO | Statewide | 1915(b) | 2/1/1997 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | 15 days | Maximus | null | X | null | X | null | null | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | null | X | X | X | null | Nurse midwife services; freestanding birth centers; podiatry; chiropractic services; optometrists; renal dialysis centers; ambulatory surgical centers; medical supplies & equipment; and home health (visiting nurses) | Yes | Yes | Yes | NCQA | Island Peer Review Organization | X | null | X | X | X | Aetna Better Health; Gateway Health; Health Partners Plan; United Healthcare Community Plan; Inc; UPMC for You; Geisinger Health Plan; AmeriHealth Caritas/AmeriHealth Caritas Northeast; Keystone First | null | PA |
PA Living Independent for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Allegheny; Armstrong; Beaver; Bedford; Berks; Blair; Bucks; Butler; Cambria; Chester; Clarion; Clinton; Columbia; Crawford; Cumberland; Dauphin; Delaware; Elk; Erie; Fayette; Forest; Franklin; Fulton; Greene; Indiana; Jefferson; Juniata; Lackawanna; Lancaster; Lawrence; Lebanon; Lehigh; Luzerne; Lycoming; Mercer; Mifflin; Montgomery; Montour; Northampton; Northumberland; Perry; Philadelphia; Schuylkill; Snyder; Somerset; Union; Venango; Warren; Washington; Westmoreland; and York counties. | PACE | 7/24/1998 | null | null | Voluntary | Voluntary | Exempt | null | Maximus | open enrollment all year | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | null | null | X | X | X | X | X | null | X | X | X | null | PACE programs cover specialists of all disciplines as needed. | No | No | No | PACE Quality Assurance and Performance Improvement (QAPI) | null | null | null | null | null | null | Senior LIFE Greensburg H-2937; Senior LIFE Johnstown H-3925; Senior LIFE Altoona H- 5902; Senior LIFE York H- 0819; Senior LIFE Lehigh H- 5978; Senior LIFE Washington H-2992; SpiriTrust LIFE H-2537; LIFE NWPA H-4999; LIFE Geisinger H-2064; Mercy LIFE H-3919; Mercy LIFE West Philadelphia H-3908; LIFE St. Mary H-6551; Innovage LIFE H-9830; Albright LIFE H-9068; Community LIFE H- 3917; LIFE Pittsburgh H-3918; VieCare Butler H-3060; VieCare Beaver H- 7660; VieCare Armstrong H- 6118 | null | PA |
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Community HealthChoices | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c) | 1/1/2018 | 12/31/2024 | null | Mandatory | Mandatory | Mandatory | Exempt | 15 days | Maximus | null | X | null | X | null | null | X | X | X | X | X | X | X | null | X | null | X | X | X | X | null | X | null | X | X | X | X | null | Chiropractic services; maternity services; and podiatrist services. | Yes | Yes | Yes | NCQA | Island Peer Review Organization (IPRO) | null | null | null | null | null | UPMC Community HealthChoices; Pennsylvania Health & Wellness; AmeriHealth Caritas; Keystone First | null | PA |
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Comprehensive MCO | Comprehensive MCO | Statewide | 1932(a);1937 Alt Benefit Plan | 2/1/1994 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | X | X | X | X | X | X | null | X | X | X | X | X | X | null | null | null | X | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | No | null | null | null | null | null | X | X | Government Health Plan First Medical; Government Health Plan MMM Multi Health; Government Health Plan de Salud Menonita; Government Health Plan Triple S | null | PR |
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Comprehensive MAO - Medicare Platino | Comprehensive MCO | Statewide | null | 1/1/2006 | null | null | Voluntary | Voluntary | null | Other | null | No specific time | X | X | X | X | X | X | null | X | X | X | X | X | null | null | null | null | null | X | X | X | null | null | null | null | null | null | null | null | Yes | Yes | No | null | null | null | null | null | null | X | Medicare Platino - MMM Healthcare; Medicare Platino - MSC Advantage; Medicare Platino - HUMANA; Medicare Platino - Triple S Advantage | null | PR |
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RIte Smiles Dental Program | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 5/1/2006 | 12/31/2023 | null | 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 | X | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | URAC | null | null | null | X | null | X | UnitedHealthcare Dental of Rhode Island | null | RI |
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RI Medicaid PACE Program | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 11/1/2005 | null | null | Voluntary | Voluntary | null | null | null | 90 days | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | X | null | X | X | null | null | X | null | X | null | X | null | null | No | No | No | null | null | null | null | X | null | X | PACE Organization of Rhode Island | null | RI |
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RIte Care; Rhody Health Partners and Medicaid Expansion | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 8/1/1994 | 12/23/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Gainwell Technologies | 90 Days | X | X | X | null | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | null | X | X | null | X | Doulas and value add services | Yes | Yes | Yes | NCQA | IPRO | X | X | X | X | X | Neighborhood Health Plan of Rhode Island; United HealthCare of Rhode Island Community Plan; Tufts Health Public Plans | null | RI |
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Rhode Island Non-Emergency Medical Transportation Program | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 5/1/2014 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | 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 | X | null | null | No | No | Yes | URAC | null | null | null | X | X | null | Medical Transportation Management; Inc. | null | RI |
South Carolina Managed Care Organizations | Comprehensive MCO | Statewide | 1932(a) | 9/1/1996 | null | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Voluntary | Other | Maximus | 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | null | null | null | null | null | X | Nurse midwife; birth centers; chiropractic services; therapy services (speech; hearing; language; etc.); and vision. | Yes | Yes | Yes | NCQA | Carolina Center for Medical Excellence | X | X | X | X | X | Select Health of South Carolina; Absolute Total Care; Inc.; Molina Healthcare of South Carolina; BlueChoice Healthplan Medicaid | The States MCO withhold program was temporarily suspended for CY 2020 due to the COVID pandemic. The State has since reinstituted the withhold for CY2021. The State currently does operate a financial alignment demonstration model. As indicated in the instructions we have only included these members in the total Medicaid enrollment for the entire state and this model is not reflected in any other program on this report. Wellcare members were transitioned to Absolute Total Care effective 4/1/2021; following the 1/23/2020 acquisition of Wellcare Health Plans; Inc. by Centene Corporation on 1/23/2020. | SC |
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South Carolina Medical Homes Network | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 8/1/2007 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | 90 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 | Carolina Center for Medical Excellence | null | null | null | null | null | South Carolina Solutions | null | SC |
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South Carolina Program for All Inclusive Care for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Lexington County; Richland County; Orangeburg County; Greenville County; Anderson County; Pickens County; Bamberg County; Calhoun County | PACE | 1/1/1990 | 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 | null | X | X | X | X | null | null | X | null | null | null | null | No | No | No | null | null | null | null | null | null | null | Prisma Health SeniorCare PACE - Midlands; Orangeburg Senior Helping Center; Prisma Health SeniorCare PACE - Upstate | There is no parent organization. | SC |
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South Carolina Non Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 5/1/2007 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Mandatory | Other | null | Recipient chooses to use transportation services based on identifying the need to access service providers. | 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 | X | null | X | null | null | Modivcare formerly Logisticare | null | SC |
PRIME | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 10/2/2002 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | 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 | null | null | null | null | null | null | null | Multiple Primary Care Providers | Disabled Children under age 19 are exempt from the PCCM program. | SD |
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TennCare III | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1945 Health Homes | 1/8/2021 | 12/31/2030 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Voluntary | Pre-assigned | null | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | X | TennCare covers freestanding birth centers; podiatrists' services; and other services as indicated in Tennessee's approved Medicaid State Plan (where limitations imposed on each service are identified). | Yes | Yes | Yes | NCQA | Qsource | X | null | X | X | X | Amerigroup; DentaQuest USA Insurance Company; OptumRx; UnitedHealthcare Community Plan; Volunteer State Health Plan (BlueCare); Volunteer State Health Plan (TennCare Select) | On 1/8/21; a new iteration of Tennessee's Medicaid program referred to as "TennCare III" began. The preceding iteration of the program (referred to as "TennCare II") had been in place since 2002. While Tennessee intended to extend TennCare II; the state chose to restructure the TennCare demonstration; ending TennCare II on 1/7/21 instead of on 6/30/2021 as originally intended. | TN |
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Program of All-Inclusive Care for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Hamilton county | PACE | 4/7/1999 | null | null | Voluntary | Voluntary | Exempt | null | null | null | null | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | X | X | null | X | X | X | null | Podiatry; nutrition counseling; recreational therapy and social activities; spiritual care; transportation and escort to and from the PACE center; audiology and hearing aids; optometry and eyeglasses; and medical equipment and supplies are additional services covered by Tennessee's PACE program. | No | No | No | null | null | null | null | null | null | null | Alexian Brothers Community Services | A segment of Tennessee's PACE population qualifies for coverage solely by virtue of the TennCare III Demonstration (Tennessee's 1115 Medicaid demonstration waiver) and not via Tennessee's Medicaid State Plan. TennCare III has a demonstration-only population referred to as the "PACE Carryover Group"; which consists of individuals who were enrolled in a PACE program as of 6/30/2012; but who upon redetermination no longer qualify for enrollment due solely to the state's modification of its nursing facility level of care criteria. | TN |
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STAR HEALTH | Comprehensive MCO + MLTSS | Statewide | 1915(a);1915(b)/1915(c) | 4/1/2008 | 8/31/2027 | null | Voluntary | Voluntary | Mandatory | Other | MAXIMUS | Members are auto-enrolled by the enrollment broker | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | null | null | X | X | Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services. | Yes | Yes | Yes | NCQA; URAC | Institute for Child Health Policy | null | X | X | null | X | Superior Health Plan | Enrollment in the STAR Health Program is voluntary for the following population categories: 1) Children and young adults in DFPS conservatorship; 2) Emancipated minors or members age 18-22 who voluntarily agree to continue in foster placement; 3) Young adults age 18-21 who have exited care and are participating in the Medicaid for Transitional Foster Care Youth (MTFCY) or Former Foster Care Children (FFCC) program. 4) An infant born to a mother who is enrolled in STAR Health; 5) Children through age 17 and young adults aged 18 through the month of their 21st birthday who are receiving Supplemental Security Income (SSI) or who were receiving Supplemental Income before becoming eligible for AA or PCA; and Children through age 17 and young adults aged 18 through the month of their 21st who are enrolled in a 1915(c ) Medicaid Waiver and AA or PCA. Additional Notes: STAR Health members may receive HCBS through state plan HCBS such as Community First Choice and Personal Care Services; they also can receive Medically Dependent Children's Program services under the MDCP 1915 (c ) waiver delivered through the STAR Health managed care program. STAR Health is operated under the state plan by contract with a managed care organization. Children and youth in Foster Care Medicaid are mandatorily enrolled in this program; this is allowed by the fact that the Texas Department of Family and Protective Services serves as the conservator for these members and chooses enrollment. | TX |
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STAR Kids | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1915(b)/1915(c);1945 Health Homes | 11/1/2016 | 9/30/2030 | null | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | 15 days | MAXIMUS | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | null | X | null | Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services | Yes | Yes | Yes | NCQA; URAC | Institute for Child Health Policy | X | X | X | null | X | Amerigroup Insurance Company; Superior HealthPlan; Inc.; Aetna Better Health of Texas; Inc.; Community First Health Plans; Inc.; UnitedHealthcare Insurance Company; dba United Healthcare; Texas Children's Health Plan; Inc.; Driscoll Children's Health Plan; Cook Children's Health Plan; Health Care Service Corporation DBA Blue Cross and Blue Shield of Texas (BCBSTX) | Foster Care and Adoption Assistance choose between STAR Kids and STAR Health | TX |
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STAR+PLUS | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 12/11/2011 | 9/30/2030 | null | Mandatory | Mandatory | Voluntary | null | 15 days | MAXIMUS | null | X | X | 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 | Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services; emergency and non-emergency ambulance; audiology and hearing aids; behavioral health services; prenatal care; birthing services; cancer screening; diagnostic and treatment; chiropractic services; dialysis; durable medical equipment; early childhood intervention; emergency services; laboratory; mastectomy; breast reconstruction; and related; radiology; therapies; organ transplant; telemedicine; community-based long term services and supports including habilitation; emergency response services (ERC) and support management | Yes | Yes | Yes | NCQA; URAC | Institute for Child Health Policy | X | X | X | null | X | Amerigroup Texas; Inc.; Superior HealthPlan; Inc.; UnitedHealthcare Insurance Company; dba United Healthcare Community Plan; Molina Healthcare of Texas; Inc.; HealthSpring Life & Health Insurance Co.; Inc. | null | TX |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 6/1/2001 | 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 | null | X | X | X | X | X | null | X | X | X | null | Adult day care/adult foster care; nursing; physical therapy; occupational therapy; recreational therapy; meals and nutrition counseling; social work/social services; medical supplies/adaptive aids and minor home modifications; transportation to and from medical appointments; audiology; dentistry; optometry; podiatry; speech therapy; respite care; medical care provided by a PACE physician familiar with the history; needs; and preferences of each participant | No | No | No | null | null | null | null | null | null | null | Bienvivir Senior Health Services (El Paso); Silver Star Health Network (Lubbock); The Basic at Jan Werner (Amarillo) | null | TX |
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Children's Medicaid Dental Services | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 12/11/2011 | 9/30/2022 | null | Mandatory | Mandatory | Voluntary | Exempt | 15 days | MAXIMUS | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | URAC | Institute for Child Health Policy | X | null | X | null | X | MCNA Insurance Company; DentaQuest USA Insurance Company; Inc. | null | TX |
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STAR | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 12/11/2011 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | 15 days | MAXIMUS | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | X | null | null | null | null | X | Diagnostic services; podiatrist services; medical supplies; non-prescription drugs; eye glasses; preventive services; nurse midwife services; and pediatric or family nurse practitioner services. | Yes | Yes | No; but accreditation considered in plan selection criteria | NCQA; URAC | Institute for Child Health Policy | X | X | X | null | X | Amerigroup Texas; Inc.; Superior Health Plan; Inc.; El Paso Health Plans; Inc.; dba El Paso Health; Aetna Better Health of Texas; Inc.; Community First Health Plans; Inc.; Seton Health Plan; Inc. dba Dell Children's Health Plan; UnitedHealthcare Insurance Company; dba United Healthcare Community Plan; Texas Children's Health Plan; Inc.; Molina Healthcare of Texas; Inc.; Driscoll Children's Health Plan; Parkland Community Health Plan; inc.; Cook Children's Health Plan; Community Health Choice Texas; Inc.; Health Care Service Corp. (dba Blue Cross Blue Shield); SHA.LLC; dba FirstCare Health Plans; Scott & White Health Plan | null | TX |
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Utah Medicaid Integrated Care | Comprehensive MCO | Salt Lake; Utah; Davis; Weber and Washington counties. | 1115(a) (Medicaid demonstration waivers) | 1/1/2020 | 6/30/2027 | null | Mandatory | Mandatory | Exempt | Other | null | 15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | null | null | null | null | X | null | null | X | null | X | Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical center. | Yes | Yes | No | null | Health Services Advisory Group | null | null | null | null | null | Healthy U Integrated; Molina Integrated; Health Choice Integrated; SelectHealth Integrated | Medicaid integration pilot program set up for Medicaid Expansion Adults in Salt Lake; Utah; Davis; Weber and Washington counties. Enrollment is mandatory for eligible individuals. Enrollees will be provided with both physical and behavioral health services. They will not enroll in a separate Prepaid Mental Health Plan. Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Utah Medicaid Integrated Care; they may not also be enrolled in Choice of Health Care Delivery program; and vice-versa. | UT |
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UNI HOME | Comprehensive MCO | Statewide | 1915(a) | 7/1/2011 | 6/30/2025 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | No enrollment period. There is a waiting list for the program. Enrollees apply. If there is room; they are enrolled. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | null | null | X | null | null | Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical centers. | Yes | Yes | No | null | Health Service Advisory Group | null | null | null | null | null | HOME | Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Choice of Health Care Delivery; they may not also be enrolled in UNI HOME; and vice-versa. | UT |
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Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 7/12/2001 | null | 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 | AI/AN members enrolled in the Traditional Medicaid program are enrolled in Transportation; with the exception of those who are enrolled in a Nursing Home specific Medicaid program. Specific American Indian/Alaska Native populations are exempted from enrollment with the contracted Transportation provider by race; and zip code and/or county code. However; they are provided transportation through other means. Pregnant women are also provided transportation services. The enrollment tab did not have a category that included pregnant women. | UT |
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Choice of Health Care Delivery | Comprehensive MCO | Statewide | 1915(b) | 3/23/1983 | 6/30/2027 | null | Varies | Varies | Varies | Varies | Varies | Varies | Varies | Mandatory | Mandatory | Other | null | 15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period. | X | null | X | null | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | null | null | X | null | null | Vision; podiatry; dialysis; durable medical equipment; inpatient medical detox; nurse midwife services; free standing birth centers; ambulatory surgical center. | Yes | Yes | No | null | Health Services Advisory Group | null | null | null | null | null | Healthy U; Molina; Health Choice; SelectHealth | Each of the enrollment subgroups can be voluntarily or mandatorily enrolled; depending on the county where they reside. 13 counties have mandatory enrollment; and 16 have voluntary enrollment. Mandatory enrollment is required in the following 13 counties: Box Elder; Cache; Davis; Iron; Morgan; Rich; Salt Lake; Summit; Tooele; Utah; Wasatch; Washington; and Weber. All other counties are voluntary enrollment in the plans. Individuals may only enroll in one MCO program. For example; if an individual is enrolled under the Choice of Health Care Delivery; they may not also be enrolled in UNI HOME; and vice-versa. | UT |
Prepaid Mental Health | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Based on State counties and some multi-county partnerships. | 1915(b) | 7/1/1991 | 6/30/2027 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | null | X | null | X | X | X | X | null | X | X | null | null | X | X | null | null | null | null | null | null | null | null | null | null | null | null | X | Comprehensive continuum of outpatient behavioral health services. | Yes | Yes | No | null | Health Services Advisory Group | null | null | null | null | null | Bear River Mental Health; Central Utah Counseling Center; Davis Behavioral Health; Four Corners Community Behavioral Health; Healthy U Behavioral Health; Northeastern Counseling Center; Salt Lake County Division of Behavioral Health Services; Southwest Behavioral Health Center; Wasatch Behavioral Health; Weber Human Services; United Behavioral Health | null | UT |
Dental | Dental only (PAHP) | Statewide | 1915(b) | 9/1/2013 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | null | 15-45 days. Enrollment choice date will vary depending on when the Enrollment file transaction takes place. In addition; the Enrollee will be able to change to another plan within the first 90 days of enrollment in the plan and during an annual open enrollment period. | 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 | Yes | Yes | No | null | Health Services Advisory Group | null | null | null | null | null | Premier Access; MCNA Dental | Pregnant women are an enrollment group covered by Dental. Only Foster Care children are exempt from Dental PAHP enrollment. Those qualifying for subsidized adoption are mandatorily enrolled in a Dental PAHP. | UT |
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Medallion 4.0 | Comprehensive MCO | Statewide | 1915(b) | 8/1/2018 | 6/30/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | 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 | null | X | null | null | null | X | X | null | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | null | X | X | X | Molina Healthcare of Virginia; Optima Family Care; United Healthcare of the Mid-Atlantic; Virginia Premier Health Plan; Anthem Healthkeepers Plus; Aetna Better Health of Virginia | null | VA |
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Commonwealth Coordinated Care (CCC) Plus | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c) | 8/1/2017 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | 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 | null | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | null | X | X | X | Aetna Better Health of Virginia; Anthem Healthkeepers Plus; Molina Healthcare of Virginia; Optima Health Community Care; United Healthcare; Virginia Premier Elite Plus | null | VA |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Big Stone Gap; Cedar Bluff; Charlottesville; Farmville; Gretna; Lynchburg; Newport News; Norfolk; Portsmouth; Richmond; Roanoke; Salem | PACE | 2/5/2009 | null | null | Voluntary | Voluntary | Exempt | null | null | null | 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 | null | No | No | No | null | null | null | null | null | null | null | AllCare for Seniors; Centra PACE - Farmville; Centra PACE - Gretna; Centra PACE - Lynchburg; InnovAge Virginia PACE Roanoke Valley; LLC; InnovAge Virginia PACE Charlottesville; LLC; InnovAge Virginia PACE Peninsula; InnovAge Virginia PACE Richmond; Mountain Empire PACE; Sentara Senior Community Care - Norfolk; Sentara Senior Community Care - Portsmouth | null | VA |
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Global Commitment to Health Demonstration | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1945 Health Homes | 10/1/2015 | 12/31/2027 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | Nurse midwives; chiropractic; PT/OT/SP; tobacco cessation counseling; optometrist services; high tech nursing services; optician services; naturopathic physician services; and behavioral health services. | Yes | No | No | null | Health Services Advisory Group | X | null | null | X | null | Department of Vermont Health Access | Health homes provide coordinated; systemic; whole person care to Vermont Medicaid beneficiaries who receive medication assisted therapy (MAT) for opioid dependency. | VT |
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Behavioral Health Services Only (BHSO) | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b) | 4/1/2016 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Other | null | Enrollment open continuously | null | X | null | X | 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 | Yes | NCQA | Comagine Health | null | null | null | null | null | Amerigroup; Community Health Plan of Washington; Coordinated Care of Washington; Molina Health Care; United Health Care | Clients with factors that disqualify them for Integrated Health Care and need Behavioral Health Services will fall under this service. | WA |
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PCCM | Primary Care Case Management (PCCM) | Clallam; Grays Harbor; King; Snohomish; Whatcom; Okanogan; Ferry; Stevens; Lincoln; Spokane; Benton; and Yakima counties | 1932(a) | 7/1/1995 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | Enrollment open continuously | 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 | Multiple Primary Care Providers | WA State HCA pays a capitated rate of $3 per member per month to Primary Care Case Management (PCCM) entities to provide PCCM services to American Indian and Alaska Native Medicaid beneficiaries who opt out of the managed care program and who enroll in the PCCM program with a contracted PCCM entity. Only the Indian Health Service (IHS); tribes; and urban Indian health programs may contract with HCA to serve as PCCM entities. All other Medicaid covered services are available to the Medicaid beneficiaries through the Medicaid fee-for-service program. IHS administers this program in three Service Units: Colvill Service Unit; Wellpinit Service Unit; and Yakama Service Unit. Two FQHCs participate in this program: Seattle Indian Health Board and NATIVE Project of Spokane. Seven tribes participate in this program: Confederated Tribes of the Colville Indian Reservation (through the Lake Roosevelt Community Health Centers for the half of the reservation that is outside of the IHS Colville Service Unit service area); Lower Elwha Klallam Tribe; Lummi Nation; Nooksack Tribe; Puyallap Tribe; Quinault Indian Nation; and Shoalwater Bay Tribe. | WA |
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Fully Integrated Managed Care (FIMC) | Comprehensive MCO | Adams; Asotin; Benton; Chelan; Clallam; Clark; Columbia; Cowlitz; Douglas; Ferry; Franklin; Garfield; Grant; Grays Harbor; Island; Jefferson; King; Kitsap; Kittitas; Klickitat; Lewis; Lincoln; Mason; Okanogan; Pacific; Pend Oreille; Pierce; San Juan; Skagit; Skamania; Snohomish; Spokane; Stevens; Thurston; Wahkiakum; Walla Walla; Whatcom; Whitman; and Yakima counties | 1932(a);1945 Health Homes | 4/1/2016 | null | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Other | null | Enrollment open continuously | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | null | X | null | X | X | null | X | Yes | Yes | Yes | NCQA | Comagine Health | null | X | X | X | X | Amerigroup; Coordinated Care of Washington; Community Health Plan; Molina Health Care of Washington; United Health Care | Nursing home care under managed care coverage is for rehabilitation care only; custodial care is covered under FFS and not a benefit under managed care coverage. | WA |
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PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 1/1/1997 | 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 | null | X | X | X | X | X | null | X | X | X | null | Comfort Care and Podiatry | No | No | No | null | null | null | null | null | null | null | PACE | The enrollment data does not include services received under a PACE program. There are two PACE providers: Providence Elder Place (located in King and Spokane County) and International Community Health Services (located in King County). | WA |
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NEMT | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2008 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Regional brokers based on county of residents | 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 | X | null | null | null | null | Multiple Transportation Brokers | NEMT is provided for anyone with Medicaid coverage that meet the requirement of having no other transportation resources available to them. | WA |
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Apple Health/Healthy Options Health Home Program | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1945 Health Homes | 7/1/2013 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Pre-assigned | 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 | No | No | No | null | null | null | null | null | null | null | Multiple Sites | Washington delivers optional Health Home Medicaid/Medical Benefit both via the Fee-For -Service system and through MCOs. For individuals in Comprehensive MCOs; the MCOs are at risk for health home services plus a broad array of benefits. For individuals in PCCMs; the MCOs administer health home services separately from the PCCM program. | WA |
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BadgerCare Plus | Comprehensive MCO | Statewide | 1932(a) | 2/1/2008 | null | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Exempt | Other | Maximus | 90 days open enrollment period | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | X | X | null | X | null | X | X | null | X | Prosthetic devices; nurse midwife services; podiatry; chiropractic (varies by plan); and dental (varies by geographic region). | Yes | No | No | null | MetaStar | X | null | X | X | X | Anthem Blue Cross Blue Shield; Childrens Community Health plan; Dean Health Plan; Inc.; Group Health Cooperative of Eau Claire; Group Health Cooperative of South Central Wisconsin; Independent Care (ICARE) Health Plan; MercyCare Insurance Company; MHS Health Wisconsin; Molina Healthcare of Wisconsin; My Choice Wisconsin Health Plan Inc.; Network Health Plan; Quartz; Security Health Plan of Wisconsin; United Healthcare Community Plan | BadgerCare Plus does not serve dually eligible individuals but there may be a limited number of months where a BadgerCare Plus member with Medicare remains enrolled in managed care. In addition; PHE polices throughout 2021 kept BadgerCare Plus members with Medicare enrolled in managed care when they would have otherwise been disenrolled. | WI |
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SSI Managed Care | Comprehensive MCO | Statewide | 1932(a) | 4/1/2005 | null | null | Mandatory | Voluntary | Voluntary | Exempt | Other | MAXIMUS | 90 days open enrollment period | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | X | X | X | X | X | null | X | null | X | X | null | X | Prosthetic devices; nurse midwife services; podiatry; chiropractic (varies by plan); and dental (varies by geographic region). | Yes | No | No | null | MetaStar; Inc. | X | null | X | X | X | Managed Health Services Insurance Corporation; My Choice Wisconsin Health Plan Inc.; Anthem Blue Cross Blue Shield; Molina Healthcare of Wisconsin; United Healthcare Community Plan; Group Health Cooperative of Eau Claire; Network Health Plan; Independent Care (ICARE) Health Plan | null | WI |
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WrapAround Milwaukee | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Milwaukee County | 1915(a) | 3/1/1997 | null | null | Voluntary | Voluntary | Voluntary | Other | null | Voluntary enrollment can occur at any time | null | X | null | X | X | null | null | null | X | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | X | null | No | No | No | null | MetaStar; Inc. | null | null | null | null | null | WrapAround Milwaukee | null | WI |
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Children Come First (CCF) | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Dane County | 1915(a) | 4/1/1993 | null | null | Voluntary | Voluntary | Voluntary | Other | null | Enrollment may occur at any time | null | X | null | X | X | null | null | null | X | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | MetaStar; Inc. | null | null | null | null | null | Children Come First | null | WI |
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Program of All-inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Milwaukee; Waukesha; Kenosha; and Racine Counties | PACE | 11/1/1990 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | Open enrollment | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | X | null | X | null | Ambulatory surgical center; audiology; chiropractic; community mental health services; durable medical equipment and medical supplies; occupational therapy; physical therapy; podiatry; respiratory care for ventilator dependent persons; speech & language pathology; vision care. | No | No | No | null | MetaStar Inc | null | null | null | null | null | Community Care; Inc. | null | WI |
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Wisconsin Partnership Program | Comprehensive MCO + MLTSS | Calumet; Columbia; Dane; Dodge; Jefferson; Kenosha; Milwaukee. Outagamie; Ozaukee; Racine; Sauk; Washington; Waukesha; and Waupaca Counties | 1932(a)/1915(c) | 12/1/1995 | 12/31/2024 | null | Mandatory | Voluntary | Voluntary | Exempt | Other | null | Open enrollment | 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 | Ambulatory surgical center; audiology; chiropractic; community mental health services; durable medical equipment and medical supplies; nurse-midwife; occupational therapy; physical therapy; podiatry; prenatal care coordination; respiratory care for ventilator dependent persons; school-based services; speech & language pathology; vision care. | No | No | No | null | MetaStar Inc | X | null | null | X | null | Independent Care (ICARE) Health Plan; My Choice Wisconsin Health Plan Inc.; Community Health Care Plan | null | WI |
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Family Care | MLTSS only (PIHP and/or PAHP) | Ashland; Barron; Bayfield; Brown; Buffalo; Burnett; Calumet; Chippewa; Clark; Columbia; Crawford; Dodge; Door; Douglas; Dunn; Eau Claire; Florence; Forest; Fond du Lac; Grant; Green; Green Lake; Iowa; Iron; Jackson; Jefferson; Juneau; Kenosha; Kewaunee; La Crosse; Lafayette; Langlade; Lincoln; Manitowoc; Marathon; Marinette; Marquette; Menominee; Milwaukee; Monroe; Oconto; Oneida; Outagamie; Ozaukee; Pepin; Pierce; Polk; Portage; Price; Racine; Richland; Rock; Rusk; St. Croix; Sauk; Sawyer; Shawano; Sheboygan; Taylor; Trempealeau; Vernon; Vilas; Walworth; Washburn; Washington; Waukesha; Waupaca; Waushara; Winnebago; and Wood Counties | 1915(b)/1915(c) | 2/1/2000 | 12/31/2024 | null | Mandatory | Mandatory | Mandatory | Exempt | Other | null | Open enrollment | null | null | null | X | X | null | null | null | null | null | null | null | null | X | null | X | null | null | null | X | X | X | X | X | null | X | null | Community mental health services; durable medical equipment and medical supplies; occupational therapy; physical therapy; respiratory care for ventilator dependent persons; speech & language pathology. | No | No | No | null | MetaStar; Inc | X | null | null | X | null | Community Care Inc.; Lakeland Care Inc.; My Choice Wisconsin; Inclusa Inc. | null | WI |
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Care4Kids | Other Prepaid Health Plan (PHP) (limited benefits) | Kenosha; Milwaukee; Ozaukee; Racine; Washington; and Washington Counties | 1937 Alt Benefit Plan | 1/1/2014 | null | null | Voluntary | Voluntary | Voluntary | Other | MAXIMUS | Open enrollment period as long as child remains in out of home care and resides in eligible placement setting/county | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | X | X | X | X | X | null | X | null | X | X | null | null | Prosthetic devices; nurse midwife services; and podiatry | Yes | No | No | null | MetaStar; Inc. | null | null | null | null | null | Children's Hospital of Wisconsin | null | WI |
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Mountain Health Trust | Comprehensive MCO | Statewide | 1915(b) | 1/1/1996 | 6/30/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | 60 days | Maximus US | null | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | X | X | null | X | null | null | X | null | null | null | Yes | Yes | Yes | NCQA | Qlarant | null | null | X | null | X | Aetna Better Health of WV; The Health Plan of WV; Unicare of WV | null | WV |
||
Mountain Health Promise | Comprehensive MCO | Statewide | 1915(b) | 3/1/2021 | 6/30/2023 | null | Exempt | Voluntary | Pre-assigned | null | null | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | X | X | X | X | X | null | null | X | null | null | null | Yes | Yes | Yes | NCQA | Qlarant | null | null | null | null | null | Aetna Better Health of WV | null | WV |
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