Medicaid Managed Care Enrollment and Program Characteristics

Winter 2020

Medicaid

Managed Care

Enrollment

and Program

Characteristics,

2018.

iii

CONTENTS

Medicaid Managed Care Enrollment and Program Characteristics, 2018 ............................................ 1

Errors and Corrections to the 2017 Report ........................................................................................... 2

Highlights ............................................................................................................................................. 10

Glossary .............................................................................................................................................. 11

Federal authorities (Waivers and State Plan Amendments) ............................................................... 11

Key Terms, Acronyms and Definitions ................................................................................................ 12

National Tables and Maps................................................................................................................... 16

Table 1. State Medicaid Managed Care Enrollment Data Summary, as of July 1, 2018 .................. 16

Table 2. State Managed Care Enrollment by Program Type, All Eligibles (Medicaid-only

and Medicare-Medicaid), as of July 1, 2018

................................................................................. 19

Table 3. Medicare-Medicaid Eligibles (Duals) Enrolled in Managed Care by Program

Type, as of July 1, 2018

................................................................................................................ 23

Table 4. Share of Medicaid Enrollees in Any Managed Care and in Comprehensive

Managed Care, as of July 1, 2018 ................................................................................................. 27

Map of State Comprehensive MCO Penetration as of July 1, 2018 ................................................. 30

Table 5. Enrollment by Program and Plan, as of 2018

.................................................................... 31

Table 6. Medicaid Managed Long Term Services and Supports (MLTSS) Program

Users or Enrollees, as of July 1, 2018

1.2

..................................................................................... 187

Map of State Counts of Users* of Managed Long-Term Services and Supports, as of

July 1, 2018 .................................................................................................................................. 191

Table 7 Number of Managed Care Programs Enrolling Certain Populations on a

Mandatory or Voluntary Basis, at any point in 2018 .................................................................... 192

Table 8. Number of Managed Care Program Types, by Quality Assurance

Requirements, Performance Incentives, and Provider Value-Based Purchasing

Status, at any point in 2018 ......................................................................................................... 193

State Tables ...................................................................................................................................... 194

Medicaid Managed Care Enrollment and Program Characteristics, 2018

Overview

This report is a production of the Division of Managed Care Programs (DMCP) in the

Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services, with

assistance from Mathematica Policy Research (contract # HHSM-500-2014-00034I/HHSM-500-

T0021).

The data and information presented in this report were collected directly from all states, the

District of Columbia, and US territories. Please see the Glossary for definitions of all terms and

acronyms used in this report.

• National tables provide summary data on Medicaid managed care: (1) enrollment at the state

and plan level, as of July 1, 2018, and (2) program features, including type of enrollment

(mandatory or voluntary) by population group enrolled, quality assurance requirements, and

use of performance incentives by managed care program type (see Glossary for definitions of

each type).

• State tables summarize the characteristics of each managed care program operating in each

state as of July 2018, including program type, geographic reach, federal operating authority,

start and end dates, beneficiary groups enrolled, services covered, quality assurance and

improvement provisions, and the names of participating plans or providers.

Data Limitations

Mathematica conducted quality assurance review and data validation on the enrollment data

and program features provided by state officials. While efforts were made to resolve apparent

errors, users of this report should be aware of some limitations. First, states may differ in how

they describe similar types of managed care programs; for example, some states listed the

benefits covered through primary care case management (PCCM) programs as all services that

are coordinated by primary care providers, while other states listed only case management. In

addition, states sometimes use different data systems to track the number of enrollees in each

type of managed care program or plan, and the number of unduplicated enrollees in any type of

managed care program, which may yield inconsistent results. In some cases, states reported

program or plan names that differ from those used in publicly available sources, including the

2017 edition of this report series. Questions regarding state-specific information in this report

should be directed to state/territorial Medicaid officials; contact information can be found on

state Medicaid agency websites in each state’s profile at this link:

http://medicaiddirectors.org/about/medicaid-directors/

If you have general questions concerning this report, please contact Alexis Gibson at

[email protected] or Angela Jones at [email protected].

Acknowledgements

We wish to extend special thanks to the many state officials who contributed their time and

assistance for this data collection. We also appreciate the contributions of the Mathematica team

that participated in this effort: Kelsey Cowen, Cyrus Jadun, Jenna Libersky, Danielle

Chelminsky, Burke Hays, Sean Kirk, William Mulhern, Natasha Reese-McLaughlin, Megan

Reilly, Alena Tourtellotte, and Erin Weir Lakhmani.

Errors and Corrections to the 2017 Report

In the course of collecting data for the 2018 version of this report, Mathematica uncovered

several errors in the data contained in the 2017 Medicaid Managed Care Enrollment Report,

released in Winter 2019. That report was reissued and its errors are listed below.

State/Domain Changes

Table 1: State Medicaid Managed Care Enrollment Data Summary, as of July 1, 2017

Georgia A footnote for Georgia has been added to the report that reads: “Georgia's Total Medicaid

Enrollment in Any Type of Managed Care does not include 1,556,221 NEMT enrollees; a

portion of these enrollees are simultaneously enrolled in other managed care programs.”

Indiana Total Medicaid enrollment in any type of managed care and total Medicaid enrollment in

comprehensive managed care were previously reported as 1,138,236. The corrected

figure for both enrollment in any type of managed care and enrollment in comprehensive

managed care is 1,138,368.

Nevada Medicaid enrollment in comprehensive MCOs under ACA Section VIII expansion was

previously reported as 190,510. The corrected figure is 183,853.

Oklahoma Total Medicaid enrollment in any type of managed care was previously reported as

653,362. The corrected figure is 652,952.

Texas Total Medicaid enrollment in comprehensive managed care was previously reported as

3,731,461. The corrected figure is 3,693,046.

All states As a result of these changes:

1. Total Medicaid enrollment in any type of managed care was previously reported as

65,796,616. The corrected figure is 65,796,338.

2. Medicaid enrollment in comprehensive managed care was previously reported as

55,601,033. The corrected figure is 55,562,750.

3. Medicaid enrollment in comprehensive MCOs under ACA Section VIII enrollment was

previously listed as 13,570,511. The corrected figure is 13,563,854.

Table 2. State Managed Care Enrollment by Program Type, All Eligibles (Medicaid-only and Medicare-

Medicaid), as of July 1, 2017

Georgia 1. Managed care enrollment in transportation programs was not previously reported. The

corrected figure is 1,556,221.

2. A footnote for Georgia has been added to the report that reads: “Georgia is unable to

provide separate counts of managed care and fee-for-service beneficiaries for their

NEMT program (which uses both payment models). As a result, enrollment counts

presented in this table include enrollees in both managed care and FFS.”

State/Domain Changes

Indiana Managed care enrollment in PACE programs was not previously reported. The corrected

figure is 132.

Louisiana Managed care enrollment in BHO (PIHP and/or PAHP) programs was previously reported

as 114,982. The corrected figure is 117,429.

Rhode Island Managed care enrollment in transportation programs was previously reported as 309,034.

The corrected figure is 278,402.

Texas Managed care enrollment in comprehensive MCO (with or without MLTSS) programs was

previously reported as 3,730,231. The corrected figure is 3,691,816.

All states As a result of these changes:

1. Total Medicaid enrollment in comprehensive MCOs (with or without MLTSS) was

previously reported as 55,558,073. The corrected figure is 55,519,658.

2. Managed care enrollment in BHO (PIHP and/or PAHP) programs was previously

reported as 10,727,803. The corrected figure is 10,730,250.

3. Managed care enrollment in transportation programs was previously reported as

12,847,769. The corrected figure is 14,373,358.

4. Managed care enrollment in PACE programs was previously reported as 42,960. The

corrected figure is 43,092.

Table 3: Medicare-Medicaid Eligibles (Duals) Enrolled in Managed Care by Program Type, as of July 1, 2017

Georgia 1. Medicare-Medicaid eligible (dual) enrollment in transportation programs was not

previously reported. The corrected figure is 0.

2. A footnote for Georgia has been added to the report that reads: “Georgia is unable to

provide separate counts of Medicaid-only and dually eligible beneficiaries for their

NEMT program. As a result, Medicare-Medicaid beneficiary enrollment is reported here

as zero.”

3. A footnote for Georgia has been added to the report that reads: “The total number of

dually eligible beneficiaries reported for Georgia only includes beneficiaries in the

QMB, SLMB, and QI programs.”

Idaho Total Medicare-Medicaid dually eligible beneficiaries was previously reported as 27,517.

The corrected figure is 46,342 to account for partial duals.

Indiana Medicare-Medicaid eligible (dual) enrollment in PACE programs was not previously

reported. The corrected figure is 127.

Nevada Total Medicare-Medicaid dually eligible beneficiaries was previously reported as 67,365.

The corrected figure is 76,221.

Ohio Total Medicare-Medicaid dually eligible beneficiaries was previously reported as 108,460.

The corrected figure is 251,004.

Rhode Island 1. Medicare-Medicaid eligible (dual) enrollment in transportation programs was

previously reported as 36,877. The corrected figure is 0.

Texas 2. Medicare-Medicaid eligible (dual) enrollment in comprehensive MCO (with or without

MLTSS) programs was previously reported as 38,427. The corrected figure is

296,462.

State/Domain Changes

All states As a result of these changes:

1. Total Medicare-Medicaid dually eligible enrollment was previously reported as

10,132,041. The corrected figure is 10,302,266.

2. Medicare-Medicaid eligible (dual) enrollment in comprehensive MCO (with or without

MLTSS) programs was previously reported as 2,577,209. The corrected figure is

2,835,244.

3. Medicare-Medicaid eligible (dual) enrollment in transportation programs was previously

reported as 1,167,035. The corrected figure is 1,130,158.

4. Medicare-Medicaid eligible (dual) enrollment in PACE programs was previously

reported as 34,809. The corrected figure is 34,936.

Table 4: Share of Medicaid Enrollees in Any Managed Care and in Comprehensive Managed Care, as of July 1,

2017

Georgia A footnote for Georgia has been added to the report that reads: “Georgia's Total Medicaid

Enrollment in Any Type of Managed Care does not include 1,556,221 NEMT enrollees; a

portion of these enrollees are simultaneously enrolled in other managed care programs.”

Indiana 1. Total Medicaid enrollment in any type of managed care and total Medicaid enrollment

in comprehensive managed care were previously reported as 1,138,236. The corrected

figure for both enrollment in any type of managed care and enrollment in

comprehensive managed care is 1,138,368.

2. The percent of all Medicaid enrollees in any type of managed care and comprehensive

managed care was previously reported as 77.1%. The corrected figure is 77.2%.

Oklahoma Total Medicaid enrollment in any type of managed care was previously reported as

653,362. The corrected figure is 652,952.

Texas 1. Total Medicaid enrollment in comprehensive managed care was previously reported

as 3,731,461. The corrected figure is 3,693,046.

2. The percent of all Medicaid enrollees in comprehensive managed care was previously

reported as 92.4%. The corrected figure is 91.5%.

All states As a result of these changes:

1. The number of individuals enrolled in any type of managed care was previously

reported as 65,796,616. The corrected figure is 65,796,338.

2. The number of individuals enrolled in comprehensive managed care was previously

reported as 55,601,033. The corrected figure is 55,562,750.

3. The percent of all Medicaid enrollees enrolled in comprehensive managed care was

previously reported as 69.3%. The corrected figure is 69.2%.

Table 5: Enrollment by Program and Plan, as of July 1, 2017

Alabama The Maternity Program has been updated to the Maternity Care Program for consistency

with future reporting years.

Georgia 1. The NEMT program and its associated plans were previously omitted from the 2017

reports. The program and its associated plans are now shown in the corrected reports

with a Medicaid-only enrollment of 1,556,221, a dual enrollment of 0, and a total

enrollment of 1,556,221.

2. A footnote for Georgia has been added to the report that reads: “Georgia is unable to

provide separate counts of Medicaid-only and dually eligible beneficiaries for their

NEMT program. As a result, Medicaid-only and total enrollment counts presented in

this table include both Medicaid-only and Medicare-Medicaid beneficiaries.”

State/Domain Changes

Indiana The PACE program and its associated plans were previously omitted from the 2017

reports. The program and its associated plans are now shown in the corrected reports with

a Medicaid-only enrollment of 5, a dual enrollment of 127, and a total enrollment of 132.

Kentucky The parent organization for the NEMT - Human Services Transportation Delivery plan was

previously reported as Humana CareSource. The corrected parent organization is NEMT –

Human Service Transportation Delivery.

Louisiana 1. The Dental program has been updated to the Dental Benefit Management program for

consistency with future reporting years.

2. The Coordinated System of Care program and its associated plans were previously

omitted from the 2017 reports. The program and its associated plans are now shown in

the corrected reports with a Medicaid-only enrollment of 2,447, a dual enrollment of 0,

and a total enrollment of 2,447.

New Jersey The FIDE SNP program and its associated plans were previously omitted from the 2017

reports. The program and its associated plans are now shown in the corrected reports with

a Medicaid-only enrollment of 0, a dual enrollment of 26,565, and a total enrollment of

26,565.

Rhode Island Medicaid-only, dually eligible, and total enrollment for the Transportation Broker program

were previously reported as 272,157; 36,877; and 309,034, respectively. The corrected

figures are 278,402; 0; and 278,402, respectively.

State/Domain Changes

Texas 1. Medicaid-only, dually eligible, and total enrollment for the STAR Health Superior Health

Plan was previously reported as 32,723; 12; and 32,735. The corrected figures are

32,735; 0; and 32,735, respectively.

2. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Amerigroup plan

was previously reported as 27,735; 0; 27,735. The corrected figures are 27,592; 143;

and 27,735, respectively.

3. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Superior Health

Plan was previously reported as 29,157; 0; and 29,157. The corrected figures are

28,967; 190; and 29,157, respectively.

4. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Aetna plan was

previously reported as 5,124; 0; and 5,124. The corrected figures are 5,074; 50; and

5,124, respectively.

5. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Community First

Health Plans plan was previously reported as 7,926; 0; and 7,926. The corrected

figures are 7,879; 47; 7,926, respectively.

6. Medicaid-only, dually eligible, and total enrollment for the STAR Kids United

Healthcare - Texas plan was previously reported as 30,364; 0; and 30,364. The

corrected figures are 30,208; 156; and 30,364, respectively.

7. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Texas Children’s

Health Plan was previously reported as 25,577; 0; and 25,577. The corrected figures

are 25,476; 101; and 25,577, respectively.

8. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Driscoll

Children’s Health Plan was previously reported as 10,611; 0; and 10,611. The

corrected figures are 10,565; 46; and 10,611, respectively.

9. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Cook Children’s

Health Plan was previously reported as 8,993; 0; and 8,993. The corrected figures are

8,952; 41; and 8,993, respectively.

10. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Blue Cross Blue

Shield plan was previously reported as 7,772; 0; and 7,772. The corrected figures are

7,735; 37; 7,772, respectively.

11. Medicaid-only, dually eligible, and total enrollment for the STAR Kids Children’s

Medical Center plan was previously reported as 9,688; 0; and 9,688. The corrected

figures are 9,658; 30; 9,688, respectively.

12. Medicaid-only, dually eligible, and total enrollment for the STAR+PLUS Amerigroup

plan was previously reported as 133,826; 13,053; and 146,879. The corrected figures

are 58,803; 75,023; and 133,826, respectively.

13. Medicaid-only, dually eligible, and total enrollment for the STAR+PLUS Cigna –

HealthSpring plan was previously reported as 50,149; 1,275; and 51,424. The

corrected figures are 19,706; 30,443; and 50,149, respectively.

14. Medicaid-only, dually eligible, and total enrollment for the STAR+PLUS Molina

Healthcare of Texas plan was previously reported as 87,652; 11,677; and 99,329. The

corrected figures are 35,012; 52,640; and 87,652, respectively.

15. Medicaid-only, dually eligible, and total enrollment for the STAR+PLUS Superior

Health Plan was previously reported as 139,417; 8,166; and 147,583. The corrected

figures are 65,115; 74,302; and 139,417, respectively.

16. Medicaid-only, dually eligible, and total enrollment for the STAR+PLUS United

Healthcare – Texas plan was previously reported as 115,686; 4,244; and 119,930. The

corrected figures are 52,473; 63,213; and 115,686, respectively.

State/Domain Changes

Table 6: Medicaid Managed Long Term Services and Supports (MLTSS) Program Users or Enrollees, as of July

1, 2017

Georgia A footnote for Georgia has been added to the report that reads: “Georgia's Total Medicaid

Enrollment in Any Type of Managed Care does not include 1,626,252 NEMT enrollees; a

portion of these enrollees are simultaneously enrolled in other managed care programs.”

Indiana Total Medicaid enrollment in any type of managed care was previously reported as

1,138,236. The corrected figure is 1,138,368.

Kansas A footnote for Kansas has been added to the report that reads: “Delaware, Idaho, Illinois,

Kansas, and Rhode Island report the number of enrollees in their MLTSS programs, some

of whom may not be using MLTSS. In previous years, they reported the number of users

of LTSS. The totals in this column do not include those six states because it is a count of

users, not enrollees.”

Ohio The number of enrollees using comprehensive managed care including LTSS was

previously reported as 45,135, which included users through Ohio’s FAI demonstration.

The corrected figure is 17,820 and does not include the state’s FAI demonstration.

Oklahoma Total Medicaid enrollment in any type of managed care was previously reported as

653,362. The corrected figure is 652,952.

All states As a result of these changes:

1. Total Medicaid enrollment in any type of managed care was previously reported as

65,796,616. The corrected figure is 65,796,338.

2. The number of enrollees using comprehensive managed care including LTSS was

previously reported as 871,052. The corrected figure is 814,450.

3. The percent of total managed care enrollees using comprehensive managed care

including LTSS was previously reported as 1.3%. The corrected figure is 1.2%

Table 7: Number of Managed Care Programs Enrolling Certain Populations on a Mandatory or Voluntary Basis,

at any point in 2017

The changes for Table 7 result from the errors and corrections described in Tables 1-6.

Comprehensive MCO with

or without MLTSS

1. The total number of comprehensive MCO programs with or without MLTSS has been

changed from 77 to 78.

2. The number of programs in which full duals are enrolled voluntarily has been changed

from 26 to 27.

3. The number of programs in which Native American/Alaskan Natives are exempt has

been changed from 12 to 13.

4. The number of programs in which foster care and adoption assistance children are

exempt has been changed from 26 to 27.

BHO (PIHP and/or PAHP) 1. The total number of BHO (PIHP and/or PAHP) programs has been changed from 14 to

15.

2. The number of programs in which children with special health care needs enrolled

voluntarily has been changed from 3 to 4.

State/Domain Changes

Transportation 1. The total number of transportation programs has been changed from 16 to 17.

2. The number of programs in which low-income adults are enrolled voluntarily has been

changed from 2 to 3.

3. The number of programs in which aged, blind, or disabled children or adults are

enrolled voluntarily has been changed from 2 to 3.

4. The number of programs in which non-disabled children (excluding children in foster

care or receiving adoption assistance) enrolled voluntarily has been changed from 2 to

5. The number of programs in which individuals receiving limited benefits are enrolled

voluntarily has been changed from 2 to 3.

6. The number of programs in which full duals are enrolled voluntarily has been changed

from 2 to 3.

7. The number of programs in which children with special health care needs are enrolled

voluntarily has been changed from 2 to 3.

8. The number of programs in which foster care and adoption assistance children are

enrolled mandatorily has been changed from 12 to 13.

9. The number of programs in which Native American/Alaskan Natives are exempt has

been changed from 5 to 6.

PACE 1. The total number of PACE programs has been changed from 30 to 31.

2. The number of programs in which aged, blind, or disabled children or adults are

enrolled voluntarily has been changed from 23 to 24.

3. The number of programs in which full duals are enrolled voluntarily has been changed

from 29 to 30.

4. The number of programs in which partial duals are enrolled voluntarily has been

changed from 19 to 20.

5. The number of programs in which Native American/Alaskan Natives are enrolled

voluntarily has been changed from 21 to 22.

6. The number of programs in which foster care and adoption assistance children are

exempt has been changed from 20 to 21.

Table 8: Number of Managed Care Program Types, by Quality Assurance Requirements, Performance

Incentives, and Provider Value-Based Purchasing Status, at any point in 2017

The changes for Table 8 result from the errors and corrections described in Tables 1-6.

Comprehensive MCO with

or without MLTSS

1. The total number of comprehensive MCO programs with or without MLTSS has been

changed from 77 to 78.

2. The number of programs requiring HEDIS data has been changed from 70 to 71.

3. The number of programs requiring CAHPS data has been changed from 66 to 67.

4. The number of programs using an EQRO contractor has been changed from 72 to 73.

5. The number of programs using payment bonuses or differentials has been changed

from 32 to 33.

6. The number of programs using public reports comparing MCO performance on key

metrics has been changed from 42 to 43.

BHO (PIHP and/or PAHP) 1. The total number of BHO (PIHP and/or PAHP) programs has been changed from 14 to

15.

2. The number of programs requiring accreditation has been changed from 8 to 9.

Transportation The total number of transportation programs has been changed from 16 to 17.

PACE The total number of PACE programs has been changed from 30 to 31.

State/Domain Changes

State Tables

Alabama The Maternity Program has been updated to the Maternity Care Program for consistency

with future reporting years.

Georgia The NEMT program was previously omitted from the 2017 reports. The program is now

shown in the corrected report.

Indiana The PACE program was previously omitted from the 2017 reports. The program is now

shown in the corrected report.

Louisiana 1. The Dental program has been updated to the Dental Benefit Management program for

consistency with future reporting years.

2. The Coordinated System of Care program was previously omitted from the 2017

reports. The program is now shown in the corrected report.

New Jersey The FIDE SNP program was previously omitted from the 2017 reports. The program is

now shown in the corrected report.

New York HCBS waiver services were not previously reported as covered benefits under the

Medicaid Advantage Plus program. The benefits are included in the corrected 2017

reports.

Highlights

Data from the Medicaid Managed Care Data Collection System (MMCDCS) in 2018 and

previous years show the following trends:

• Medicaid enrollment in comprehensive MCOs increased by .7 percent – from 55.52

million in 2017 to 55.56 million in 2018, a smaller increase than in previous years. .

Comprehensive MCOs cover a broad range of Medicaid benefits, including acute,

primary and specialty care, and in some states, behavioral health and long-term services

and supports (LTSS) as well.

• The percentage of Medicaid beneficiaries enrolled in comprehensive managed care

plans as a result of the ACA Medicaid expansion increased for the third straight

year, although growth slowed in 2018. About 13.64 million low income adults eligible

for Medicaid under Section VIII of the ACA in 2018 were enrolled in comprehensive

MCOs, compared to 13.56 million in 2016 (a .54 percent increase). Enrollment in

comprehensive MCOs covered under Section VIII has more than tripled since 2014,

when just 4.8 million beneficiaries enrolled in such plans.

• Dual enrollment in comprehensive MCOs increased by 5.2 percent from 2017 to

2018. About 3 million dually eligible beneficiaries were enrolled in comprehensive

MCOs in 2018, an increase from about 2.8 million in 2017. Additionally, states expanded

the use of comprehensive MCOs for dually eligible beneficiaries. In 2018, about 29

percent of dually eligible beneficiaries were enrolled in comprehensive MCOs, compared

to about 28 percent in 2017.

• Use of Behavioral Health Organization (BHO) declined by 28.1 percent in 2018,

while use of Dental and MLTSS only programs continued to increase. 2018 marked

the fifth straight year of declined use in BHO programs. In 2018, about 9.7 percent of all

Medicaid beneficiaries were enrolled in BHO programs, down from 2013 enrollment of

17.0 percent. In contrast, enrollment in Dental and MLTSS only programs saw increased

enrollment similar to previous years. In 2018, about 10.4 percent of all Medicaid

beneficiaries were enrolled in Dental programs and .5 percent enrolled in MLTSS only

programs, up from 7.7 percent and .3 percent in 2014, respectively.

• Managed long-term services and supports (MLTSS) programs experienced growth.

Twenty-two states had managed LTSS (MLTSS) programs in operation as of July 1,

2018, consistent with the count in 2017

. As of July 1, 2018, there were over 1.3 million

(1,304,413) LTSS users, excluding a subset of 226,294 enrollees in Florida, Hawaii,

Idaho, Illinois, Kansas, and Pennsylvania, some of whom may not be LTSS users (these

states cannot report just LTSS users). 21 states reported LTSS users in both years, 14 of

which reported an increase in the number of LTSS users from 2017 to 2018.

The count of states in 2017 with MLTSS programs excludes South Carolina and Virginia whose only MLTSS

programs at that time were Medicare-Medicaid Financial Alignment demonstrations.

Glossary

Federal authorities (Waivers and State Plan Amendments)

1115(a) States can apply for a Section 1115 waiver to test experimental, pilot, or

demonstration projects that promote the objectives of the Medicaid and CHIP

programs.

1902(a)(70) NEMT States can use Section 1902(a)(70) statutory authority to amend their Medicaid state

plans to establish non‐emergency medical transportation (NEMT) brokerage

programs without regard to the statutory requirements for comparability, geographic

region served, and freedom of choice.

1905(t) States can use Section 1905(t) statutory authority to create voluntary primary care

case management (PCCM) managed care programs.

1915(a) States can use Section 1915(a) statutory authority to enter into a voluntary contract

with an entity to provide State plan services. Enrollment is voluntary.

1915(b) States can use Section 1915(b) waivers to mandate enrollment of special populations

into managed care delivery systems or otherwise limit beneficiaries’ choice of

providers.

1915(c) States can use Section 1915(c) waivers to provide long-term services and supports

(LTSS) in home and community settings rather than institutional settings. By using

1915(c) waivers concurrently with 1915(a), 1932(a), or 1915(b) authorities, states can

provide LTSS through managed care. Without a concurrent waiver allowing a state to

deliver these services through managed care, 1915(c) waiver services are paid fee-

for-service.

1915(i) States can use Section 1915(i) statutory authority to offer a variety of home and

community-based services through the state plan, regardless of whether enrollees

meet the institutional level of care. By using 1915(i) authority concurrently with

1915(a), 1932(a), or 1915(b) authorities, states can provide LTSS through managed

care.

1915(j) States can use Section 1915(j) statutory authority to offer self- directed personal

assistance services provided under the state plan and/or section 1915(c) waivers. By

using 1915(j) authority concurrently with 1915(a), 1932(a), or 1915(b) authorities,

states can provide LTSS through managed care.

1915(k) States can use Section 1915(k) statutory authority to provide home and community-

based attendant services and supports (the "Community First Choice Option") under

their state plan. By using 1915(k) authority concurrently with 1915(a), 1932(a), or

1915(b) authorities, states can provide LTSS through managed care.

1932(a) State can use Section 1932(a) statutory authority to mandate enrollment of Medicaid

beneficiaries in managed care entities without section 1915(b) or 1115 waiver

authority. However, certain groups are exempt from mandatory enrollment (for

example, Medicare-Medicaid dual enrollees, Native Americans and children with

special health care needs), and with exceptions for rural areas, the state must offer at

least two managed care options.

1937 Alternative Benefit

Plan

States can use Section 1937 statutory authority to provide alternative benefits tailored

to meet the needs of certain Medicaid population groups, target residents in certain

areas of the state, or provide services through specific delivery systems instead of

following the traditional Medicaid benefit plan. The Affordable Care Act of 2010

amended Section 1937 by requiring states to provide an alternative benefit package

to the newly eligible adult (Section VIII) Medicaid expansion population, which must

cover 10 essential health benefits described in ACA Section 1302(b).

1945 Health Homes States can use Section 1945 statutory authority to coordinate care for Medicaid

beneficiaries who have chronic conditions. Although Medicaid Health Homes are not

a managed care system, states can combine 1945 authority with a managed care

authority such as 1915(a), 1932(a), or 1915(b) to provide health home services

through managed care entities.

Key Terms, Acronyms and Definitions

Term Acronym Definition

Affordable Care Act ACA The Patient Protection and Affordable Care Act, is the federal law

that took full effect in 2014. Among other provisions, it authorized

states to expand Medicaid coverage to non-pregnant, childless,

low-income adults with household income up to 138 percent of the

federal poverty level, without a waiver or other special authority.

Behavioral Health

Organization

BHO A managed care entity specializing in behavioral health (mental

health and/or substance use disorder) services. Services are

covered on a prepaid basis.

Centers for Medicare &

Medicaid Services

CMS The federal agency that administers the Medicare and Medicaid

programs.

Comprehensive Managed

Care Organization

Compre-hensive

MCO

Comprehensive MCOs provide all acute, primary and specialty

medical services; some also cover behavioral health and long-term

services and supports. Entities that qualify as MCOs include Health

Maintenance Organizations (HMOs) and Health Insuring

Organizations (HIOs) in California.

Consumer Assessment of

Healthcare Providers and

Systems

CAHPS Surveys that ask consumers and patients about their experiences

with health care services and health plans. Some state Medicaid

agencies require health plans to submit data or results from

CAHPS surveys of managed care enrollees.

Dental Prepaid Ambulatory

Health Plan

A limited-benefit plan that only provides dental services.

Dual Eligibles (also

referred to as “Duals”, or

Medicare-Medicaid

Eligibles)

Individuals who are eligible for Medicare and either (1) eligible to

receive all state Medicaid benefits (“full duals”) or (2) the Medicaid

agency only pays for Medicare premiums and/or cost sharing

(“partial duals”).

Early and Periodic

Screening, Diagnostic and

Treatment

EPSDT States are required to cover the following services for all Medicaid-

eligible children under age 21: periodic screenings to identify

physical and mental conditions as well as vision, hearing, and

dental needs; and follow-up diagnostic and treatment services to

correct conditions identified during a screening.

External Quality Review

Organization

EQRO An organization that meets competence and independence

requirements and performs an external quality review of managed

care programs and plans.

Federally Qualified Health

Center

FQHC Federally Qualified Health Centers provide comprehensive health

services in underserved communities and must offer a sliding fee

scale. FQHCs receive grants under Section 330 of the Public

Health Service Act.

Fee-For-Service FFS A payment system in which the state reimburses providers directly

for each individual service rendered.

Healthcare Effectiveness

Data and Information Set

HEDIS A collection of performance measures and measurement

specifications which certain Medicaid managed care programs are

required to use and submit to the state. HEDIS measures and

definitions are produced by the National Committee for Quality

Assurance (NCQA).

Term Acronym Definition

Home and Community-

based Services

HCBS Long-term services and supports provided in homes or community

settings to Medicaid beneficiaries who are frail seniors, or with

mental illnesses, intellectual or developmental disabilities, and/or

physical disabilities in.

Intellectual /

Developmental Disabilities

IDD An individual with an intellectual or developmental disability has an

intellectual functioning level (IQ) below 70-75, limitations in

adaptive skills, and must have had the condition start before the

age of nineteen.

Intermediate Care

Facilities

ICF An optional Medicaid benefit to provide treatment in an institutional

care setting for individuals with intellectual disabilities.

Institution for Mental

Diseases

IMD Services furnished by a hospital, nursing facility, or other institution

of more than 16 beds that is primarily engaged in providing

diagnosis, treatment, or care of persons with mental diseases,

including medical attention, nursing care, and related services.

Whether an institution is an institution for mental diseases is

determined by its overall character as that of a facility established

and mai

ntained primarily for the care and treatment of individuals

with mental diseases, whether or not it is licensed as such. The

facility must be a hospital providing psychiatric or substance use

disorder inpatient care or a sub-acute facility providing psychi

atric

or substance use disorder crisis residential services, and length of

stay in the IMD must be for a short term stay of no more than 15

days during the period of the monthly capitation payment. The

provision of inpatient psychiatric or substance use disorder

treatment in an IMD must meet the requirements for in lieu of

services.

Long-term Services and

Supports

LTSS Long term services and supports assist individuals with activities of

daily living such as bathing, dressing and eating in institutional

settings, including nursing homes and ICFs-IDD, or in home and

community-based settings.

Managed Long Term

Services and Supports

MLTSS The delivery of LTSS, such as nursing home care and home and

community-based services, through capitated Medicaid managed

care programs. MLTSS programs can either provide LTSS in

addition to medical care through comprehensive MCOs, or they can

provide only LTSS benefits through PIHPs or PAHPs, referred to as

MLTSS-only programs.

Medicaid A health care program providing coverage for eligible low-income

adults, children, pregnant women, elderly adults and people with

disabilities. Medicaid is jointly administered and funded by states

and the federal government, according to federal rules.

Medicaid Managed Care Medicaid managed care provides for the delivery of Medicaid

health benefits and additional services through contracted

arrangements between state Medicaid agencies and managed care

entities, such as MCOs, that accept a set per member per month

(capitation) payment for these services, or with providers

responsible for coordinating a defined set of services.

Medicaid State Plan An agreement between a state and the federal government

describing how that state administers its Medicaid program,

including eligible individuals, services covered, reimbursement

methodologies, and administrative activities.

Term Acronym Definition

Medicaid State Plan

Amendment

SPA When a state is planning to make a change to its Medicaid program

policies or operational approach, states submit SPAs to CMS for

review and approval.

Medicaid Waivers Statutory authorities under which the Secretary of Health and

Human Services, upon the request of a state, may allow the state

to receive federal Medicaid matching funds for its expenditures

when the benefits or populations covered, or other program

features deviate from requirements or limitations of the federal

Medicaid statute.

Medicare A health care program for individuals ages 65 and older, and

individuals under age 65 with certain disabilities. Medicare is

administered and funded by the federal government.

Mental Health MH An individual’s psychological and emotional state. Mental disorders

affect how individuals relate to each other and make choices, and

may include changes in thinking, mood, and/or behavior.

Non-Emergency Medical

Transportation

NEMT A program that covers transportation to and from medically

necessary health care services.

Other Prepaid Health

Plans

PHP Prepaid ambulatory or inpatient health plans that cover a limited set

of benefits, such as behavioral health, long term care, dental, or

transportation benefits.

Prepaid Ambulatory Health

Plan

PAHP An entity that provides medical services to enrollees under contract

with the State agency and on the basis of prepaid capitation

payments or other payment arrangements that do not use State

plan payment rates. A PAHP does not provide or arrange for the

provision of any inpatient hospital or institutional services for its

enrollees.

Prepaid Inpatient Health

Plan

PIHP An entity that provides medical services to enrollees under contract

with the State agency and on the basis of prepaid capitation

payments or other payment arrangements that do not use State

plan payment rates. A PIHP provides, arranges for, or otherwise

has responsibility for, the provision of any inpatient hospital or

institutional services for its enrollees.

Presumptive Eligibility The option available to states to extend limited Medicaid coverage

at the point a provider determines that an individual’s income does

not exceed the eligibility threshold until a formal determination of

eligibility is made.

Primary Care Case

Management

PCCM A managed care arrangement in which primary care providers

contract with the state to provide a core set of case management

services to the enrollees assigned to them and to serve as the

enrollees’ home for medical care, in exchange for a small

administrative fee. All other services are reimbursed on a FFS

basis. Primary Care Providers (PCPs) can include primary care

physicians, clinics, group practices and nurse practitioners, among

others.

Term Acronym Definition

Primary Care Case

Management entity

PCCM entity In addition to providing primary care case management services for

the State, a PCCM entity is an organization that provides any of the

following functions: (1) Provision of intensive telephonic or face-to-

face case management, including operation of a nurse triage

advice line; (2) Development of enrollee care plans; (3) Execution

of contracts with and/or oversight resp

onsibilities for the activities of

FFS providers in the FFS program; (4) Provision of payments to

FFS providers on behalf of the State; (5) Provision of enrollee

outreach and education activities; (6) Operation of a customer

service call center; (7) Review of provider claims, utilization and

practice patterns to conduct provider profiling and/or practice

improvement; (8) Implementation of quality improvement activities

including administering enrollee satisfaction surveys or collecting

data necessary for per

formance measurement of providers; (9)

Coordination with behavioral health systems/providers; and/or (10)

Coordination with long-term services and supports systems/

providers.

Program for All-inclusive

Care for the Elderly

PACE A program that provides prepaid, capitated comprehensive medical

and social services in an adult day health center, as well as in-

home and referral services according to a participant’s needs. To

qualify, individuals must: (1) be 55 years of age or older, (2) meet a

nursing home level of care, and (3) live in a PACE organization

service area.

Section VIII Section VIII of the Affordable Care Act (ACA) authorized the

expansion of Medicaid coverage to non-pregnant, childless, low-

income adults with household income up to 138 percent of the

federal poverty level, who could previously be covered only under a

waiver or other special authority.

Substance Use Disorder SUD Individuals with an SUD recurrently use alcohol and/or drugs. As a

result, they experience significant clinical and functional impairment

that may include: health issues, disability and failure to meet

responsibilities.

Transportation Prepaid

Ambulatory Health Plan

NEMT PAHP A prepaid ambulatory health plan covering transportation services

only.

National Tables and Maps

Table 1. State Medicaid Managed Care Enrollment Data Summary, as of July 1, 2018

State or Territory Total Medicaid Enrollees

Total Medicaid Enrollment in

Any Type of Managed Care

Medicaid Enrollment in

Comprehensive Managed Care

Medicaid Enrollment in

Comprehensive MCOs Under

ACA Section VIII Expansion

TOTALS 79,898,701 66,107,287 55,605,461 13,637,012

Alabama 1,019,417 638,221 174 0

Alaska

198,417 0 0 0

American Samoa n/a n/a n/a n/a

Arizona 1,849,465 1,560,593 1,560,593 383,615

Arkansas 979,619 871,262 258 0

California 13,140,347 10,670,306 10,661,382 3,144,393

Colorado

1,302,808 1,171,171 122,207 47,361

Connecticut

928,800 0 0 0

Delaware 236,760 208,802 199,887 57,851

District of Columbia 264,984 189,363 189,363 65,150

Florida 3,885,169 3,178,981 3,027,995 0

Georgia

2,074,310 1,485,250 1,445,804 0

Guam n/a n/a n/a n/a

Hawaii 355,873 351,685 351,685 23,714

Idaho 300,252 272,979 3,799 0

Illinois 3,110,093 2,176,902 2,145,760 476,583

Indiana 1,457,544 1,126,425 1,126,425 344,386

Iowa 626,011 580,507 564,926 166,755

Kansas 417,140 358,225 358,225 0

Kentucky 1,385,239 1,259,525 1,259,525 459,092

State or Territory Total Medicaid Enrollees

Total Medicaid Enrollment in

Any Type of Managed Care

Medicaid Enrollment in

Comprehensive Managed Care

Medicaid Enrollment in

Comprehensive MCOs Under

ACA Section VIII Expansion

Louisiana 1,640,075 1,504,540 1,385,242 473,308

Maine 270,243 234,327 0 0

Maryland 1,401,781 1,169,708 1,169,708 291,852

Massachusetts 1,865,755 1,211,485 750,573 180,657

Michigan 4,623,834 4,608,988 2,379,554 554,203

Minnesota 1,122,672 892,137 892,137 184,105

Mississippi 683,577 441,782 441,782 0

Missouri 971,143 954,603 712,335 0

Montana 291,890 215,475 0 0

Nebraska 250,056 249,024 249,022 0

Nevada 666,561 588,111 457,782 187,715

New Hampshire 200,850 133,829 133,829 9,046

New Jersey 1,668,451 1,569,344 1,569,344 523,347

New Mexico 842,138 666,050 666,050 224,743

New York 6,153,799 4,764,261 4,552,993 3,337,546

North Carolina 2,178,225 1,581,469 2,112 0

North Dakota 93,042 48,957 19,696 19,515

Northern Mariana

Islands

n/a n/a n/a n/a

Ohio 2,915,546 2,450,031 2,450,031 606,662

Oklahoma 880,954 649,023 466 0

Oregon 1,062,787 847,570 847,570 386,277

Pennsylvania 2,897,085 2,627,563 2,359,277 723,410

Puerto Rico

1,505,610 1,505,610 1,505,610 0

Rhode Island 313,095 302,407 248,278 73,323

State or Territory Total Medicaid Enrollees

Total Medicaid Enrollment in

Any Type of Managed Care

Medicaid Enrollment in

Comprehensive Managed Care

Medicaid Enrollment in

Comprehensive MCOs Under

ACA Section VIII Expansion

South Carolina 1,195,703 1,195,703 745,911 0

South Dakota 123,890 92,184 0 0

Tennessee 1,510,045 1,386,664 1,386,664 0

Texas 3,981,912 3,845,916 3,695,426 0

Utah 275,511 271,137 226,893 0

Vermont 174,682 123,310 123,310 48,637

Virgin Islands n/a n/a n/a n/a

Virginia 1,063,122 875,351 875,351 0

Washington 1,781,048 1,781,048 1,574,163 491,177

West Virginia 505,528 407,193 407,193 152,589

Wisconsin 1,197,453 811,920 759,015 0

Wyoming 58,390 370 136 0

1. Total Medicaid Enrollees represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and Medicare-

Medicaid ("dual") enrollees receiving full Medicaid benefits or Medicaid cost sharing.

2. Total Medicaid Enrollment in Any Type of Managed Care represents an unduplicated count of beneficiaries enrolled in any Medicaid managed care program,

including comprehensive MCOs, limited benefit plans such as prepaid inpatient and ambulatory health plans, primary care case management (PCCM) programs,

and PCCM entities.

3. Medicaid Enrollment in Comprehensive Managed Care represents an unduplicated count of Medicaid beneficiaries enrolled in a managed care plan that

provides comprehensive benefits (acute, primary care, specialty, and any other), or PACE program. It excludes beneficiaries who are enrolled in a Financial

Alignment Demonstration Medicare-Medicaid Plan as their only form of managed care.

4. Medicaid Enrollment in Comprehensive MCOs under ACA Section VIII Expansion is a subset of the total reported in column C, and includes individuals who are

enrolled in comprehensive MCOs and are low-income adults, with or without dependent children, eligible for Medicaid under ACA Section VIII.

5. Alaska was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected through the

Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-4Q-

Medicaid-MBES-Enrollment/qjmt-6zzy.

6. Colorado reported plan level enrollment as 0 for plans that had less than 30 beneficiaries. As a result, reported Medicaid Enrollment in Comprehensive

Managed Care may be lower than actual enrollment.

7. Connecticut was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected

through the Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-

4Q-Medicaid-MBES-Enrollment/qjmt-6zzy.

8. Georgia's Total Medicaid Enrollment in Any Type of Managed Care does not include 1,626,252 NEMT enrollees; a portion of these enrollees are simultaneously

enrolled in other managed care programs.

9. Puerto Rico provides expanded Medicaid to 421,577 low-income, childless adults under an authority other than ACA Section VIII.

Note: "n/a" indicates that a state or territory was not able to report data.`

Table 2. State Managed Care Enrollment by Program Type, All Eligibles (Medicaid-only and Medicare-

Medicaid), as of July 1, 2018

State or

Territory

Total

Medicaid

Enrollees

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

TOTALS 79,898,701 55,558,458 2,583,532 2,910,656 403,798 7,717,977 8,292,589 15,204,939 48,395 66,486

Alabama

1,019,417 -- 611,251 -- -- -- -- -- 174 22,844

Alaska

198,417 -- -- -- -- -- -- -- -- --

American Samoa n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Arizona 1,849,465 1,560,593 -- -- -- -- -- -- -- --

Arkansas 979,619 -- 445,284 29,078 -- -- 576,970 579,996 258 --

California 13,140,347 10,653,598 -- -- -- 32 845,796 -- 7,784 670

Colorado

1,302,808 118,408 -- 1,048,881 -- 0 -- -- 3,799 --

Connecticut

928,800 -- -- -- -- -- -- -- -- --

Delaware 236,760 199,645 -- -- -- -- -- 208,802 242 --

District of

Columbia

264,984 189,363 -- -- -- -- -- 54,594 -- --

Florida 3,885,169 3,026,316 -- -- 101,524 -- -- -- 1,679 --

Georgia

2,074,310 1,445,804 -- -- -- -- -- 1,623,252 -- 39,446

Guam n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Hawaii

355,873 351,685 -- -- -- -- -- -- -- --

Idaho 300,252 3,799 254,791 -- -- 269,240 272,979 272,979 -- --

Illinois 3,110,093 2,145,760 -- -- 31,143 -- -- -- -- --

Indiana 1,457,544 1,126,133 -- -- -- -- -- -- 292 --

Iowa 626,011 564,492 -- -- -- -- 302,681 15,581 434 --

Kansas 417,140 357,683 -- -- -- -- -- -- 542 --

State or

Territory

Total

Medicaid

Enrollees

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

Kentucky 1,385,239 1,259,525 -- -- -- -- -- 1,232,903 -- --

Louisiana 1,640,075 1,384,784 -- -- -- 118,107 1,503,192 -- 458 --

Maine 270,243 -- 141,777 -- -- -- -- 234,327 -- --

Maryland 1,401,781 1,169,603 -- -- -- -- -- -- 105 --

Massachusetts 1,865,755 746,051 119,512 339,350 -- 528,106 -- -- 4,522 --

Michigan

4,623,834 2,377,009 -- -- 11,295 2,276,353 969,152 -- 2,545 --

Minnesota 1,122,672 892,137 -- -- -- -- -- -- -- --

Mississippi 683,577 441,782 -- -- -- -- -- -- -- --

Missouri 971,143 712,335 -- -- -- -- -- 242,268 -- --

Montana 291,890 -- 215,475 -- -- -- -- -- -- --

Nebraska 250,056 248,832 -- -- -- -- 247,580 -- 190 --

Nevada

666,561 457,782 -- -- -- -- 457,782 588,111 -- --

New Hampshire 200,850 133,829 -- -- -- -- -- -- -- --

New Jersey 1,668,451 1,568,277 -- -- -- -- -- 1,561,266 1,067 --

New Mexico 842,138 665,250 -- -- -- -- -- -- 800 --

New York 6,153,799 4,547,299 -- -- 211,268 -- -- -- 5,694 --

North Carolina 2,178,225 -- -- 1,493,347 -- 1,578,977 -- -- 2,112 --

North Dakota 93,042 19,515 48,957 -- -- -- -- -- 181 0

Northern Mariana

Islands

n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Ohio 2,915,546 2,449,577 -- -- -- -- -- -- 454 --

Oklahoma 880,954 -- 648,557 -- -- -- -- 648,557 466 --

Oregon

1,062,787 847,570 -- -- -- -- -- -- 1,392 --

Pennsylvania 2,897,085 2,352,627 -- -- -- 896,466 -- 622,053 6,650 151

State or

Territory

Total

Medicaid

Enrollees

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

Puerto Rico 1,505,610 1,505,610 -- -- -- -- -- -- -- --

Rhode Island 313,095 247,983 -- -- -- -- 111,315 267,396 295 --

South Carolina 1,195,703 745,469 558 -- -- -- -- 1,195,703 442 --

South Dakota 123,890 -- 92,184 -- -- -- -- -- -- --

Tennessee

1,510,045 1,386,383 -- -- -- -- -- -- 281 --

Texas 3,981,912 3,694,211 -- -- -- -- 2,879,944 3,844,572 1,215 --

Utah 275,511 226,893 -- -- -- 268,452 125,198 231,531 -- --

Vermont 174,682 123,310 -- -- -- -- -- -- -- --

Virgin Islands n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Virginia 1,063,122 872,408 -- -- -- -- -- -- 2,943 --

Washington 1,781,048 1,573,493 5,186 -- -- 1,781,048 -- 1,781,048 670 --

West Virginia

505,528 407,193 -- -- -- -- -- -- -- --

Wisconsin 1,197,453 758,442 -- -- 48,568 1,196 -- -- 573 3,141

Wyoming 58,390 -- -- -- -- -- -- -- 136 234

1. Because Medicaid beneficiaries may be enrolled concurrently in more than one type of managed care program (e.g., a Comprehensive MCO and a BHO), users

should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual number of

Medicaid enrollees.

2. Total Medicaid Enrollees represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and Medicare-

Medicaid ("dual") enrollees receiving full Medicaid benefits or Medicaid cost sharing.

3. Comprehensive MCOs cover acute, primary, and specialty medical care services; they may also cover behavioral health, long-term services and supports, and

other benefits in some states. Limited benefit managed care programs, including PCCM, PCCM entity, MLTSS only, BHO, Dental, Transportation, and Other cover

a narrower set of services.

4. Beneficiaries can simultaneously enroll in Alabama's two PCCM programs: Patient 1st and Health Homes. The de-duplicated Patient 1st enrollment is 380,285.

5. Alaska was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected through the

Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-4Q-

Medicaid-MBES-Enrollment/qjmt-6zzy.

6. Colorado reported plan level enrollment as 0 for plans that had less than 30 beneficiaries. As a result, reported PACE program-level enrollment may be lower

than actual enrollment.

7. Connecticut was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected

through the Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-

4Q-Medicaid-MBES-Enrollment/qjmt-6zzy.

8. Georgia is unable to provide separate counts of managed care and fee-for-service beneficiaries for their NEMT program (which uses both payment models). As

a result, enrollment counts presented in this table include enrollees in both managed care and FFS.

9. Hawaii's enrollment in comprehensive MCOs includes 4,470 beneficiaries who enrolled in an MCO plus Ohana Community Care Service for behavioral health

services.

10. Michigan has two programs that provide HCBS waiver services under capitation: MI Choice and the Specialty Prepaid Inpatient Health Plan (SPIHP). In this

table, MI Choice is reported as an MLTSS program and SPIHP is reported as a BHO. In Table 6, both programs are considered in the count of LTSS users.

11. Oregon’s enrollment in comprehensive MCOs includes beneficiaries in (1) Coordinated Care Organizations (CCOs); (2) Dental Care Organizations (DCOs), or

(3) a Mental Health Organization. CCO enrollees receive physical, dental and mental health services and may be enrolled in more than one plan type

simultaneously. Plan-level enrollment is found in Report 5.

12. Tennessee’s enrollment in comprehensive MCOs includes 1,241,360 beneficiaries who are also enrolled in an MCO plus Magellan Health Services for

pharmacy benefits and 802,783 beneficiaries who are also enrolled in an MCO plus DentaQuest USA Insurance Company for dental services.

Note: "n/a" indicates that a state or territory was not able to report data. "--" indicates states that do not operate programs of the given type. 0 signifies that a state

operated a program of this type in 2018, but it ended before July 1 or began after that date.

Table 3. Medicare-Medicaid Eligibles (Duals) Enrolled in Managed Care by Program Type, as of July 1, 2018

State or Territory

Total Medicare-

Medicaid dually

eligible

beneficiaries

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

TOTALS 10,290,613 2,981,554 115,388 222,913 364,682 417,918 331,798 1,089,256 39,005 400

Alabama 213,678 -- 0 -- -- -- -- -- 149 0

Alaska n/a -- -- -- -- -- -- -- -- --

American Samoa n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Arizona 220,474 149,900 -- -- -- -- -- -- -- --

Arkansas 134,914 -- 589 2,763 -- -- 53,473 67,099 248 --

California 1,343,891 962,791 -- -- -- 0 53,499 -- 6,068 339

Colorado

120,127 7,858 -- 68,703 -- 0 -- -- 3,646 --

Connecticut n/a -- -- -- -- -- -- -- -- --

Delaware 30,631 6,125 -- -- -- -- -- 6,125 232 --

District of

Columbia

21,621 125 -- -- -- -- -- 21,496 --

Florida 822,125 122,704 -- -- 93,529 -- -- -- 682 --

Georgia

5,6

218,337 427 -- -- -- -- -- 0 -- 0

Guam n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Hawaii 34,596 34,596 -- -- -- -- -- -- -- --

Idaho 47,547 3,799 -- -- -- 23,425 27,240 27,240 -- --

Illinois 365,802 0 -- -- 31,143 -- -- -- -- --

Indiana 211,716 3,976 -- -- -- -- -- -- 283 --

Iowa 80,715 58,490 -- -- -- -- 58,547 1,275 409 --

Kansas 83,104 38,694 -- -- -- -- -- -- 0 --

State or Territory

Total Medicare-

Medicaid dually

eligible

beneficiaries

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

Kentucky 152,336 55,918 -- -- -- -- -- 0 -- --

Louisiana 228,848 668 -- -- -- 103,234 104,724 443 --

Maine 92,256 -- 0 -- -- -- -- 51,453 -- --

Maryland 145,359 0 -- -- -- -- -- -- 93 --

Massachusetts 357,507 51,401 0 0 -- 0 -- -- 4,202 --

Michigan

327,697 39,166 -- -- 10,587 0 0 -- 2,429 --

Minnesota 142,348 81,117 -- -- -- -- -- -- -- --

Mississippi 161,017 0 -- -- -- -- -- -- -- --

Missouri 181,861 0 -- -- -- -- -- 143,578 -- --

Montana 28,634 -- 0 -- -- -- -- -- -- --

Nebraska 34,773 34,286 -- -- -- -- 34,246 -- 168 --

Nevada

74,484 0 -- -- -- -- 0 0 -- --

New Hampshire 31,816 16,321 -- -- -- -- -- -- -- --

New Jersey 221,266 179,446 -- -- -- -- -- 37,445 956 --

New Mexico 42,041 41,300 -- -- -- -- -- -- 741 --

New York 939,913 17,284 -- -- 189,890 -- -- -- 5,093 --

North Carolina 345,703 -- -- 151,447 -- 187,117 -- -- 680 --

North Dakota 16,909 0 0 -- -- -- -- -- 169 0

Northern Mariana

Islands

n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Ohio 237,185 53,408 -- -- -- -- -- -- 359 --

Oklahoma 114,799 -- 114,799 -- -- -- -- 114,799 432 --

Oregon

76,067 52,057 -- -- -- -- -- 1,317 --

Pennsylvania 468,987 83,728 -- -- -- 73,364 -- 75,251 6,219 61

State or Territory

Total Medicare-

Medicaid dually

eligible

beneficiaries

Comprehensive

MCO (with or

without MLTSS)

PCCM

entity

MLTSS

only

BHO (PIHP

and/or

PAHP)

Dental

Transportation

PACE Other

Puerto Rico 360,506 295,878 -- -- -- -- -- -- -- --

Rhode Island 35,733 0 -- -- -- -- 0 0 0 --

South Carolina 161,803 0 0 -- -- -- -- 161,803 391 --

South Dakota 12,188 -- 0 -- -- -- -- -- -- --

Tennessee

268,671 145,785 -- -- -- -- -- -- 267 --

Texas 649,495 293,046 -- -- -- -- 0 354,597 1,173 --

Utah 31,555 24,238 -- -- -- 30,775 69 27,095 -- --

Vermont

32,036 760 -- -- -- -- -- -- -- --

Virgin Islands n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Virginia 108,805 108,805 -- -- -- -- -- -- 1,481 --

Washington

108,589 0 0 -- -- 0 -- 0 0 --

West Virginia 81,548 0 -- -- -- -- -- -- -- --

Wisconsin 57,536 17,457 -- -- 39,533 3 -- -- 543 0

Wyoming 11,064 -- -- -- -- -- -- -- 132 0

1. Because Medicare-Medicaid beneficiaries may be enrolled concurrently in more than one type of managed care program (e.g., a Comprehensive MCO and a

BHO), users should not sum enrollment across all program types, since the total would count individuals more than once and, in some states, exceed the actual

number of Medicaid enrollees.

2. Total Medicare-Medicaid dually eligible beneficiaries represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including

enrollees receiving full Medicaid benefits or Medicaid cost sharing.

3. Comprehensive MCOs cover acute, primary, and specialty medical care services; they may also cover behavioral health, long-term services and supports, and

other benefits in some states. Limited benefit managed care programs, including PCCM, PCCM entity, MLTSS only, BHO, Dental, Transportation, and Other cover

a narrower set of services.

4. Colorado reported plan level enrollment as 0 for plans that had less than 30 beneficiaries. As a result, reported PACE program-level enrollment may be lower

than actual enrollment.

5. Georgia is unable to provide separate counts of Medicaid-only and dually eligible beneficiaries for their NEMT program. As a result, Medicare-Medicaid

beneficiary enrollment is reported here as zero.

6. The total number of dually eligible beneficiaries reported for Georgia only includes beneficiaries in the QMB, SLMB, and QI programs.

7. Michigan is not able to provide dual-eligible enrollment for the Specialty Prepaid Inpatient Health plan.

8. Oregon’s enrollment in comprehensive MCOs includes beneficiaries in (1) Coordinated Care Organizations (CCOs); (2) Dental Care Organizations (DCOs), or

(3) a Mental Health Organization. CCO enrollees receive physical, dental and mental health services and may be enrolled in more than one plan type

simultaneously. Plan-level enrollment is found in Report 5.

9. Tennessee’s enrollment in comprehensive MCOs includes 381 dually eligible beneficiaries who are also enrolled in an MCO plus Magellan Health Services for

pharmacy benefits and 381 dually eligible beneficiaries who are also enrolled in an MCO plus DentaQuest USA Insurance Company for dental services.

10. Vermont pays for Medicaid services for dually eligible enrollees on a FFS basis. Dually eligible enrollees reported in the Global Commitment to Health

Demonstration are Medicaid enrollees who have become newly eligible for Medicare and, as of July 1, have not yet transferred out of the program.

11. Washington is unable to provide separate counts of Medicaid-only and dual enrollment for their NEMT, ICMH comprehensive MCO, and PACE programs. As a

result, enrollment counts for Medicare-Medicaid beneficiaries are excluded from this report.

Note: "n/a" indicates that a state or territory was not able to report data. "--" indicates states that do not operate programs of the given type. 0 signifies that a state

operated a program of this type in 2018, but it ended before July 1 or began after that date.

Table 4. Share of Medicaid Enrollees in Any Managed Care and in Comprehensive Managed Care, as of July

1, 2018

State or Territory

Total Medicaid

Enrollees

Total Medicaid

Enrollment in Any Type

of Managed Care

Number of Individuals

Total Medicaid Enrollment

in Any Type of Managed

Care

: Percent of all

Medicaid enrollees

Medicaid Enrollment in

Comprehensive

Managed Care

Number of Individuals

Medicaid Enrollment in

Comprehensive Managed

Care

: Percent of all

Medicaid enrollees

TOTALS 79,898,701 66,107,287 83% 55,605,461 70%

Alabama 1,019,417 638,221 62.6% 174 0.0%

Alaska

198,417 0 0.0% 0 0.0%

American Samoa n/a n/a n/a n/a n/a

Arizona 1,849,465 1,560,593 84.4% 1,560,593 84.4%

Arkansas 979,619 871,262 88.9% 258 0.0%

California 13,140,347 10,670,306 81.2% 10,661,382 81.1%

Colorado

1,302,808 1,171,171 89.9% 122,207 9.4%

Connecticut

928,800 0 0.0% 0 0.0%

Delaware 236,760 208,802 88.2% 199,887 84.4%

District of Columbia 264,984 189,363 71.5% 189,363 71.5%

Florida 3,885,169 3,178,981 81.8% 3,027,995 77.9%

Georgia

2,074,310 1,485,250 71.6% 1,445,804 69.7%

Guam n/a n/a n/a n/a n/a

Hawaii 355,873 351,685 98.8% 351,685 98.8%

Idaho 300,252 272,979 90.9% 3,799 1.3%

Illinois 3,110,093 2,176,902 70.0% 2,145,760 69.0%

Indiana 1,457,544 1,126,425 77.3% 1,126,425 77.3%

Iowa 626,011 580,507 92.7% 564,926 90.2%

Kansas 417,140 358,225 85.9% 358,225 85.9%

Kentucky 1,385,239 1,259,525 90.9% 1,259,525 90.9%

State or Territory

Total Medicaid

Enrollees

Total Medicaid

Enrollment in Any Type

of Managed Care

Number of Individuals

Total Medicaid Enrollment

in Any Type of Managed

Care

: Percent of all

Medicaid enrollees

Medicaid Enrollment in

Comprehensive

Managed Care

Number of Individuals

Medicaid Enrollment in

Comprehensive Managed

Care

: Percent of all

Medicaid enrollees

Louisiana 1,640,075 1,504,540 91.7% 1,385,242 84.5%

Maine 270,243 234,327 86.7% 0 0.0%

Maryland 1,401,781 1,169,708 83.4% 1,169,708 83.4%

Massachusetts 1,865,755 1,211,485 64.9% 750,573 40.2%

Michigan

4,623,834 4,608,988 99.7% 2,379,554 51.5%

Minnesota 1,122,672 892,137 79.5% 892,137 79.5%

Mississippi 683,577 441,782 64.6% 441,782 64.6%

Missouri 971,143 954,603 98.3% 712,335 73.4%

Montana 291,890 215,475 73.8% 0 0.0%

Nebraska 250,056 249,024 99.6% 249,022 99.6%

Nevada 666,561 588,111 88.2% 457,782 68.7%

New Hampshire 200,850 133,829 66.6% 133,829 66.6%

New Jersey 1,668,451 1,569,344 94.1% 1,569,344 94.1%

New Mexico 842,138 666,050 79.1% 666,050 79.1%

New York 6,153,799 4,764,261 77.4% 4,552,993 74.0%

North Carolina 2,178,225 1,581,469 72.6% 2,112 0.1%

North Dakota 93,042 48,957 52.6% 19,696 21.2%

Northern Mariana Islands n/a n/a n/a n/a n/a

Ohio 2,915,546 2,450,031 84.0% 2,450,031 84.0%

Oklahoma 880,954 649,023 73.7% 466 0.1%

Oregon 1,062,787 847,570 79.7% 847,570 79.7%

Pennsylvania

2,897,085 2,627,563 90.7% 2,359,277 81.4%

Puerto Rico 1,505,610 1,505,610 100.0% 1,505,610 100.0%

State or Territory

Total Medicaid

Enrollees

Total Medicaid

Enrollment in Any Type

of Managed Care

Number of Individuals

Total Medicaid Enrollment

in Any Type of Managed

Care

: Percent of all

Medicaid enrollees

Medicaid Enrollment in

Comprehensive

Managed Care

Number of Individuals

Medicaid Enrollment in

Comprehensive Managed

Care

: Percent of all

Medicaid enrollees

Rhode Island 313,095 302,407 96.6% 248,278 79.3%

South Carolina 1,195,703 1,195,703 100.0% 745,911 62.4%

South Dakota 123,890 92,184 74.4% 0 0.0%

Tennessee 1,510,045 1,386,664 91.8% 1,386,664 91.8%

Texas 3,981,912 3,845,916 96.6% 3,695,426 92.8%

Utah 275,511 271,137 98.4% 226,893 82.4%

Vermont 174,682 123,310 70.6% 123,310 70.6%

Virgin Islands n/a n/a n/a n/a n/a

Virginia 1,063,122 875,351 82.3% 875,351 82.3%

Washington 1,781,048 1,781,048 100.0% 1,574,163 88.4%

West Virginia 505,528 407,193 80.5% 407,193 80.5%

Wisconsin 1,197,453 811,920 67.8% 759,015 63.4%

Wyoming 58,390 370 0.6% 136 0.2%

1. Total Medicaid Enrollees represents an unduplicated count of all beneficiaries in FFS and any type of managed care, including Medicaid-only and Medicare-

Medicaid ("dual") enrollees receiving full Medicaid benefits or Medicaid cost sharing.

2. Total Medicaid enrollment in Any Type of Managed Care represents an unduplicated count of beneficiaries enrolled in any Medicaid managed care program,

including comprehensive MCOs, limited benefit MCOs, PCCMs, and PCCM entities.

3. Medicaid Enrollment in Comprehensive Managed Care represents an unduplicated count of Medicaid beneficiaries enrolled in a managed care plan that

provides comprehensive benefits (acute, primary care, specialty, and any other), as well as PACE programs. It excludes beneficiaries who are enrolled in a

Financial Alignment Initiative Medicare-Medicaid Plan as their only form of managed care.

4. Alaska was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected through the

Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-4Q-

Medicaid-MBES-Enrollment/qjmt-6zzy.

5. Colorado reported plan level enrollment as 0 for plans that had less than 30 beneficiaries. As a result, reported Medicaid Enrollment in Comprehensive

Managed Care may be lower than actual enrollment.

6. Connecticut was not able to provide total Medicaid enrollment as of July 1, 2018. This figure is from the July - September 2018 enrollment data collected

through the Medicaid Budget and Expenditure System, updated December 2019, and accessed January 14, 2020. See https://data.medicaid.gov/Enrollment/2018-

4Q-Medicaid-MBES-Enrollment/qjmt-6zzy.

7. Georgia's Total Medicaid Enrollment in Any Type of Managed Care does not include 1,626,252 NEMT enrollees; a portion of these enrollees are simultaneously

enrolled in other managed care programs.

Note: "n/a" indicates that a state or territory was not able to report data.

Note:

Comprehensive

managed

care

includes

risk-based

managed

care

organizations

(MCOs)

and

Programs

All-inclusive

Care

for

the

Elderly

(PACE).

Source:

Medicaid

Managed

Care

Enrollment

and

Program

Characteristics,

2018.

Map of State Comprehensive MCO Penetration as of July 1, 2018

Table 5. Enrollment by Program and Plan, as of 2018

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Alabama

Patient 1st (Primary

Care Case

Management (PCCM))

Patient 1st Alabama Medicaid

Agency

Statewide 611,251 0 611,251

Alabama

Health Homes

(Primary Care Case

Management (PCCM))

Health Homes Alabama Medicaid

Agency

Statewide 230,966 0 230,966

Alabama

Maternity Care

Program (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Maternity Care Plan Alabama Medicaid

Agency

Barbour, Bibb, Blount,

Calhoun, Chambers,

Cherokee, Chilton, Choctaw,

Clay, Cleburne, Coffee,

Colbert, Coosa, Cullman,

Dale, Dallas, DeKalb,

Etowah, Fayette, Franklin,

Geneva, Greene, Hale,

Henry, Houston, Jackson,

Jefferson, Lamar,

Lauderdale, Lawrence, Lee,

Limestone, Macon,

Madison, Marengo, Marion,

Marshall, Mobile, Morgan,

Perry, Pickens, Randolph,

Russell, St. Clair, Shelby,

Sumter, Talladega,

Tallapoosa, Tuscaloosa,

Walker, Wilcox, and Winston

Counties

22,844 0 22,844

Alabama

PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Mercy Life of Alabama PACE Mobile and Baldwin

Counties

25 149 174

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

United Healthcare Plan UnitedHealthcare Apache, Cochise, Coconino,

Graham, Greenlee, La Paz,

Maricopa, Mohave, Navajo,

Pima, Santa Cruz, Yavapai,

and Yuma Counties

469,579 46,866 516,445

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Care1st Health Plan WellCare Maricopa and Pima

Counties

130,829 7,821 138,650

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

DCS/CMDP Government

Agency/Non-Profit

Entity

Statewide 13,869 1 13,870

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

DES/Division of

Developmental

Disabilities (MLTSS)

Government

Agency/Non-Profit

Entity

Statewide 25,123 7,131 32,254

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

United Healthcare Plan

(MLTSS)

UnitedHealthcare Apache, Coconino, Gila,

Maricopa, Mohave, Navajo,

Pinal, and Yavapai Counties

1,171 7,538 8,709

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Health Choice Arizona IASIS Healthcare

LLC/Steward

Apache, Coconino, Gila,

Maricopa, Mohave, Navajo,

Pima, and Pinal Counties

227,648 15,421 243,069

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Health Net Access Centene

Corporation

Maricopa County 54,005 3,657 57,662

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Mercy Care Plan Dignity Health and

Carondelet Health

Network

Maricopa and Pima

Counties

339,317 20,885 360,202

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Mercy Care Plan

(MLTSS)

Dignity Health and

Carondelet Health

Network

Gila, Maricopa, Pima, and

Pinal Counties

2,436 9,993 12,429

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

University Family Care Banner Health Cochise, Gila, Graham,

Greenlee, La Paz, Pima,

Pinal, Santa Cruz, Yavapai,

and Yuma Counties

119,538 10,815 130,353

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Mercy Maricopa

Integrated Care

Mercy Care Maricopa County 13,905 7,776 21,681

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Cenpatico Integrated

Care

Centene

Corporation

Cochise, Graham, Greenlee,

La Paz, Pima, Pinal, Santa

Cruz, and Yuma Counties

8,811 4,564 13,375

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Health Choice

Integrated Care

Health Choice

Arizona/NARBHA

Apache, Coconino, Gila,

Mohave, Navajo, and

Yavapai Counties

3,571 2,151 5,722

Arizona Arizona Health Care

Cost Containment

System

(Comprehensive MCO

+ MLTSS)

Banner University

Family Care (MLTSS)

Banner Health Cochise, Gila, Graham,

Greenlee, La Paz, Maricopa,

Pima, Pinal, Santa Cruz,

and Yuma Counties

891 5,281 6,172

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Arkansas Provider-Led Arkansas

Shared Savings Entity

(PASSE) Program

(Primary Care Case

Management Entity

(PCCM Entity))

Summit Community

Care

Anthem Insurance

Companies, Inc.

Statewide 6,433 1,038 7,471

Arkansas Provider-Led Arkansas

Shared Savings Entity

(PASSE) Program

(Primary Care Case

Management Entity

(PCCM Entity))

Arkansas Total Care Centene

Corporation

Statewide 4,477 334 4,811

Arkansas Provider-Led Arkansas

Shared Savings Entity

(PASSE) Program

(Primary Care Case

Management Entity

(PCCM Entity))

Empower Healthcare

Solutions

Beacon Statewide 10,943 1,027 11,970

Arkansas Provider-Led Arkansas

Shared Savings Entity

(PASSE) Program

(Primary Care Case

Management Entity

(PCCM Entity))

Forevercare Gateway Health Statewide 4,462 364 4,826

Arkansas Connect Care

(Primary Care Case

Management (PCCM))

Multiple primary care

providers

Multiple Primary

Care Provider

(PCCM)

Statewide 444,695 589 445,284

Arkansas Arkansas Dental

Managed Care (Dental

only (PAHP))

Delta Dental of

Arkansas

Delta Dental Statewide 269,858 27,377 297,235

Arkansas Arkansas Dental

Managed Care (Dental

only (PAHP))

Managed Care of North

America (MCNA)

Dental

Managed Care of

North America

(MCNA), Inc.

Statewide 253,639 26,096 279,735

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Arkansas Arkansas Non-

Emergency Medical

Transport (NET) (Non-

Emergency Medical

Transportation)

Southeasttrans Southeasttrans Randolph, Clay, Lawrence,

Greene, Craighead,

Mississippi, Poinsett, Cross,

Crittenden, St. Francis,

Faulkner, Pulaski, and

Lonoke Counties

170,302 20,780 191,082

Arkansas Arkansas Non-

Emergency Medical

Transport (NET) (Non-

Emergency Medical

Transportation)

Central Arkansas

Development Council

Central Arkansas

Development

Council

Montgomery, Garland,

Saline, Hot Springs, Clark,

Pike, Sevier, Howard,

Hempstead, Little River,

Miller, Lafayette, Columbia,

Quachita, Dallas, Calhoun,

and Union Counties

89,447 12,239 101,686

Arkansas Arkansas Non-

Emergency Medical

Transport (NET) (Non-

Emergency Medical

Transportation)

Area Agency on Aging

of Western Arkansas

Area Agency on

Aging of Western

Arkansas

Benton, Washington,

Madison, Newton, Searcy,

Baxter, Boone, Carroll,

Fulton, Izard, Sharp, Stone,

Independence, Jackson,

Van Buren, Cleburne, White,

Woodruff, Crawford,

Franklin, Johnson, Pope,

Sebastian, Logan, Yell,

Scott, Polk, Perry, and

Conway Counties

202,853 25,959 228,812

Arkansas Arkansas Non-

Emergency Medical

Transport (NET) (Non-

Emergency Medical

Transportation)

Mid-Delta Mid-Delta Prairie, Monroe, Phillips,

and Lee Counties

9,132 1,966 11,098

Arkansas Arkansas Non-

Emergency Medical

Transport (NET) (Non-

Emergency Medical

Transportation)

Area Agency on Aging

of Southeast Arkansas

Area Agency on

Aging of Southeast

Arkansas

Grant, Jefferson, Arkansas,

Cleveland, Lincoln, Bradley,

Drew, Desha, Chicot, and

Ashley Counties

41,163 6,155 47,318

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Arkansas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Complete Health PACE Statewide 4 54 58

Arkansas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Total Life Healthcare PACE Statewide 6 194 200

California Health Plan of San

Mateo CCS Demo/San

Mateo

(Comprehensive

MCO)

Health Plan of San

Mateo CCS Demo

Health Plan of San

Mateo

San Mateo County 0 0 0

California Regional Model

(Comprehensive

MCO)

California Health &

Wellness Plan/Imperial

Centene

Corporation

Imperial County 59,377 2,439 61,816

California Regional Model

(Comprehensive

MCO)

California Health &

Wellness Plan/Region

Centene

Corporation

Butte, Colusa, Glenn,

Plumas, Sierra, Sutter, and

Tehama Counties

70,540 2,714 73,254

California Regional Model

(Comprehensive

MCO)

California Health &

Wellness Plan/Region

Centene

Corporation

Alpine, Amador, Calaveras,

El Dorado, Inyo, Mariposa,

Mono, Nevada, Placer,

Tuolumne, and Yuba

Counties

60,069 2,273 62,342

California Regional Model

(Comprehensive

MCO)

Molina Healthcare of

CA Partner

Plan/Imperial

Molina Healthcare Imperial County 14,159 807 14,966

California Regional Model

(Comprehensive

MCO)

Anthem Blue Cross

Partnership

Plan/Region 1

Anthem Insurance

Companies, Inc.

Butte, Colusa, Glenn,

Plumas, Sierra, Sutter, and

Tehama Counties

65,657 2,371 68,028

California Regional Model

(Comprehensive

MCO)

Anthem Blue Cross

Partnership

Plan/Region 2

Anthem Insurance

Companies, Inc.

Alpine, Amador, Calaveras,

El Dorado, Inyo, Mariposa,

Mono, Nevada, Placer,

Tuolumne, and Yuba

Counties

84,249 2,880 87,129

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Regional Model

(Comprehensive

MCO)

KP Cal LLC/Amador Kaiser

Permanente

Amador County 94 0 94

California Regional Model

(Comprehensive

MCO)

KP Cal LLC/El Dorado Kaiser

Permanente

El Dorado County 1,950 48 1,998

California Regional Model

(Comprehensive

MCO)

KP Cal LLC/Placer Kaiser

Permanente

Placer County 7,153 211 7,364

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Care 1st Partner

Plan/San Diego

Blue Cross Blue

Shield

San Diego County 69,434 15,053 84,487

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Community Health

Group Partnership

Plan/San Diego

Community Health

Group

San Diego County 254,741 19,408 274,149

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Health Net/San Diego Centene

Corporation

San Diego County 58,742 14,473 73,215

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

KP Cal LLC/San Diego Kaiser

Permanente

San Diego County 45,426 6,450 51,876

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

CA Partner Plan/San

Diego

Molina Healthcare San Diego County 211,450 16,197 227,647

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Aetna Better Health of

CA/San Diego

Aetna San Diego County 4,606 53 4,659

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan/San

Diego

UnitedHealthcare San Diego County 5,988 138 6,126

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership

Plan/Sacramento

Anthem Insurance

Companies, Inc.

Sacramento County 170,285 7,533 177,818

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Health Net/Sacramento Centene

Corporation

Sacramento County 101,630 5,568 107,198

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

KP Cal

LLC/Sacramento

Kaiser

Permanente

Sacramento County 79,367 6,557 85,924

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

CA Partner

Plan/Sacramento

Molina Healthcare Sacramento County 52,675 3,832 56,507

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

Aetna Better Health of

CA/Sacramento

Aetna Sacramento County 2,381 29 2,410

California Geographic Managed

Care (GMC) Model

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community

Plan/Sacramento

UnitedHealthcare Sacramento County 4,764 140 4,904

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health Plan/Los

Angeles

SCAN Health Plan Los Angeles County 0 7,423 7,423

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health

Plan/Riverside

SCAN Health Plan Riverside County 0 2,000 2,000

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health Plan/San

Bernardino

SCAN Health Plan San Bernardino County 0 1,327 1,327

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health Plan

(Nurs hm cert)/Los

Angeles

SCAN Health Plan Los Angeles County 0 1,596 1,596

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health Plan

(Nurs hm

cert)/Riverside

SCAN Health Plan Riverside County 0 531 531

California Senior Care Action

Network (SCAN)

(Comprehensive MCO

+ MLTSS)

SCAN Health Plan

(Nurs hm cert)/San

Bernardino

SCAN Health Plan San Bernardino County 0 328 328

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

CenCal Health/San

Luis Obispo

CenCal Health San Luis Obispo County 46,632 6,482 53,114

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

CenCal Health/Santa

Barbara

CenCal Health Santa Barbara County 113,107 12,078 125,185

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Health Plan of San

Mateo

Health Plan of San

Mateo

San Mateo County 99,652 9,029 108,681

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Partnership HealthPlan

of CA/Northeast

Partnership

HealthPlan of

California

Lassen, Modoc, Shasta,

Siskiyou, and Trinity

Counties

78,321 13,696 92,017

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Partnership HealthPlan

of CA/Northwest

Partnership

HealthPlan of

California

Del Norte and Humboldt

Counties

56,124 7,510 63,634

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Partnership Health

Plan/Southeast

Partnership

HealthPlan of

California

Napa, Solano, and Yolo

Counties

166,390 23,437 189,827

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Partnership Health

Plan/Southwest

Partnership

HealthPlan of

California

Lake, Marin, Mendocino,

and Sonoma Counties

187,299 28,104 215,403

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Central California

Alliance for

Health/Merced

Central California

Alliance for Health

Merced County 113,142 10,795 123,937

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Central California

Alliance for

Health/Monterey Santa

Cruz

Central California

Alliance for Health

Monterey and Santa Cruz

Counties

204,898 20,357 225,255

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

CalOptima/Orange CalOptima Orange County 678,532 80,327 758,859

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California County Organized

Health Systems

(COHS) Model

(Comprehensive MCO

+ MLTSS)

Gold Coast Health

Plan/Ventura

Gold Coast Health

Plan

Ventura County 177,647 21,560 199,207

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Net/Kern Centene

Corporation

Kern County 70,674 3,085 73,759

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Net/Los Angeles Centene

Corporation

Los Angeles County 861,114 139,053 1,000,167

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Net/San Joaquin Centene

Corporation

San Joaquin County 20,530 546 21,076

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Net/Stanislaus Centene

Corporation

Stanislaus County 65,828 2,441 68,269

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Net/Tulare Centene

Corporation

Tulare County 110,699 3,780 114,479

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

CalViva Health/Fresno CalViva Health Fresno County 286,356 10,881 297,237

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

CalViva Health/Kings CalViva Health Kings County 27,328 949 28,277

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

CalViva Health/Madera CalViva Health Madera County 35,920 1,090 37,010

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership

Plan/Fresno

Anthem Insurance

Companies, Inc.

Fresno County 104,856 3,946 108,802

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership Plan/Kings

Anthem Insurance

Companies, Inc.

Kings County 19,155 589 19,744

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership

Plan/Madera

Anthem Insurance

Companies, Inc.

Madera County 18,868 514 19,382

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership

Plan/Alameda

Anthem Insurance

Companies, Inc.

Alameda County 58,024 2,661 60,685

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership

Plan/Contra Costa

Anthem Insurance

Companies, Inc.

Contra Costa County 26,316 836 27,152

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership Plan/San

Francisco

Anthem Insurance

Companies, Inc.

San Francisco County 16,513 2,427 18,940

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership Plan/Santa

Clara

Anthem Insurance

Companies, Inc.

Santa Clara County 57,721 13,268 70,989

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Anthem Blue Cross

Partnership Plan/Tulare

Anthem Insurance

Companies, Inc.

Tulare County 89,538 3,238 92,776

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Kern Family Health

Care

Kern Health

Systems

Kern County 248,909 7,516 256,425

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

L.A. Care Health

Plan/Los Angeles

L.A. Care Los Angeles County 1,841,741 236,123 2,077,864

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Contra Costa Health

Plan

Contra Costa

Health Plan

Contra Costa County 171,320 10,901 182,221

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Alameda Alliance for

Health

Alameda Alliance

for Health

Alameda County 240,968 21,233 262,201

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Inland Empire Health

Plan/Riverside

Inland Empire

Health Plan

Riverside County 575,779 33,781 609,560

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Inland Empire Health

Plan/San Bernardino

Inland Empire

Health Plan

San Bernardino County 586,801 34,322 621,123

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

CA Partner

Plan/Riverside

Molina Healthcare Riverside County 75,018 9,279 84,297

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

CA Partner Plan/San

Bernardino

Molina Healthcare San Bernardino County 64,751 7,588 72,339

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

San Francisco Health

Plan

San Francisco

Health Plan

San Francisco County 116,919 12,550 129,469

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Plan of San

Joaquin/San Joaquin

Health Plan of San

Joaquin

San Joaquin County 208,433 9,576 218,009

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Health Plan of San

Joaquin/Stanislaus

Health Plan of San

Joaquin

Stanislaus County 123,900 4,156 128,056

California Two-Plan Model

(Comprehensive MCO

+ MLTSS)

Santa Clara Family

Health Plan

Santa Clara

Family Health Plan

Santa Clara County 220,347 30,708 251,055

California Family Mosaic

Program/San

Francisco (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Family Mosaic

Project/San Francisco

San Francisco

Health Plan

San Francisco 32 0 32

California Dental Managed

Care/Los Angeles

(Dental only (PAHP))

Health Net Dental

Plan/Los Angeles

Health Net Los Angeles County 173,986 14,023 188,009

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Dental Managed

Care/Los Angeles

(Dental only (PAHP))

Access Dental Plan/Los

Angeles

Access Dental,

Inc.

Los Angeles County 155,811 13,734 169,545

California Dental Managed

Care/Los Angeles

(Dental only (PAHP))

LIBERTY Dental

Plan/Los Angeles

LIBERTY Dental

Plan

Los Angeles County 58,936 5,269 64,205

California Dental Managed

Care/Sacramento

(Dental only (PAHP))

Health Net Dental

Plan/Sacramento

Health Net Sacramento County 121,027 6,671 127,698

California Dental Managed

Care/Sacramento

(Dental only (PAHP))

Access Dental

Plan/Sacramento

Access Dental,

Inc.

Sacramento County 127,500 6,115 133,615

California Dental Managed

Care/Sacramento

(Dental only (PAHP))

LIBERTY Dental

Plan/Sacramento

LIBERTY Dental

Plan

Sacramento County 155,037 7,687 162,724

California Positive

Healthcare/Los

Angeles (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Positive Healthcare/Los

Angeles

AIDS Healthcare

Foundation

Los Angeles 331 339 670

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Redwood Coast

Pace/Humboldt

Humboldt Senior

Resource Center

Humboldt County 14 141 155

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

San Diego PACE PACE San Diego County 86 236 322

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

St. Paul's PACE/San

Diego

Community

Eldercare of San

Diego

San Diego County 149 580 729

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Sutter SeniorCare

PACE/Sacramento

Sutter Health Sacramento County 31 263 294

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

AltaMed Senior

Buenacare/Los

Angeles

AltaMed Health

Services

Corporation

Los Angeles County 673 1,858 2,531

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Brandman Centers for

Senior Care/Los

Angeles

Brandman Centers

for Senior Care

Los Angeles County 30 199 229

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

CalOptima

PACE/Orange

CalOptima Orange County 110 164 274

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Center for Elders

Independence/Alameda

Center for Elders

Independence

Alameda County 68 558 626

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Center for Elders

Independence/Contra

Costa

Center for Elders

Independence

Contra Costa County 15 65 80

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Fresno PACE Central Valley

Medical Services

Corporation

Fresno County 213 307 520

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

InnovAge

PACE/Riverside

InnovAge Riverside County 37 104 141

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

InnovAge PACE/San

Bernardino County

InnovAge San Bernardino County 97 287 384

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

On Lok

Lifeways/Alameda

On Lok Lifeways Alameda County 56 194 250

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

On Lok Lifeways/Santa

Clara

On Lok Lifeways Santa Clara County 49 207 256

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

California Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

On Lok Lifeways/San

Francisco

On Lok Lifeways San Francisco County 88 905 993

Colorado

3,4

Denver Health

Medicaid Choice

(Comprehensive

MCO)

Denver Health

Medicaid Choice

Denver Health and

Hospital Authority

Denver, Arapahoe, Adams,

and Jefferson Counties

78,073 3,852 81,925

Colorado

3,4

Accountable Care

Collaborative: Rocky

Mountain Health Plans

Prime

(Comprehensive

MCO)

Accountable Care

Collaborative: Rocky

Mountain Health Plans

Prime

Rocky Mountain

Health

Garfield, Gunnison, Mesa,

Montrose, Pitkin, and Rio

Blanco Counties

32,477 4,006 36,483

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 1: Rocky

Mountain Health Plans

UnitedHealthcare Moffat, Routt, Jackson,

Grand, Summit, Eagle,

Garfield, Mesa, Delta, Pitkin,

Gunnison, Montrose, Ouray,

San Miguel, Hinsdale,

Dolores, San Juan,

Montezuma, La Plata,

Archuleta, and Larimer

Counties

137,867 8,669 146,536

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 2: Northeast

Health Partners

Northeast Health

Partners

Cheyenne, Kit Carson,

Lincoln, Logan, Morgan,

Phillips, Sedgwick,

Washington, Weld, and

Yuma Counties

81,472 6,132 87,604

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 3: Colorado

Access

Colorado Access Adams, Arapahoe, Douglas,

and Elbert Counties

238,753 13,526 252,279

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 4: Health

Colorado, Inc.

Health Colorado,

Inc.

Alamosa, Baca, Bent,

Chaffee, Conejos, Costilla,

Crowley, Custer, Fremont,

Huerfano, Kiowa, Lake, Las

Animas, Mineral, Otero,

Prowers, Pueblo, Rio

Grande, and Saguache

Counties

115,816 12,262 128,078

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 5: Colorado

Access

Colorado Access Denver County 115,179 8,614 123,793

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 6: Colorado

Community Health

Alliance

Colorado

Community Health

Alliance

Boulder, Clear Creek, Gilpin,

Broomfield, and Jefferson

Counties

132,836 10,673 143,509

Colorado

3,4

Accountable Care

Collaborative (ACC)

(Primary Care Case

Management Entity

(PCCM Entity))

RAE 7: Colorado

Community Health

Alliance

Colorado

Community Health

Alliance

El Paso, Park, and Teller

Counties

158,255 8,827 167,082

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Colorado

3,4

Colorado Medicaid

Community Behavioral

Health Services

Program (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Colorado Health

Partnerships

Colorado Health

Partnerships

Alamosta, Archuleta, Baca,

Bent, Chaffee, Conejos,

Costilla, Crowley, Custer,

Delta, Dolores, Eagle, El

Paso, Fremont, Garfield,

Grand, Gunnison, Hinsdale,

Huerfano, Jackson, Kiowa,

Lake, La Plata, Las Animas,

Mesa, Mineral, Moffat,

Montezuma, Montrose,

Ouray, Otero, Park, Pitkin,

Prowers, Pueblo, Rio

Blanco, Rio Grande, Routt,

Saguache, San Juan, San

Miguel, Summit and Teller

Counties

0 0 0

Colorado

3,4

Colorado Medicaid

Community Behavioral

Health Services

Program (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Behavioral Healthcare,

Inc.

Behavioral

Healthcare Inc.

Adams, Arapahoe, and

Douglas Counties

0 0 0

Colorado

3,4

Colorado Medicaid

Community Behavioral

Health Services

Program (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Foothills Behavioral

Health Partners

Foothills

Behavioral Health

Partners

Boulder, Broomfield, Clear

Creek, Gilpin, and Jefferson

Counties

0 0 0

Colorado

3,4

Colorado Medicaid

Community Behavioral

Health Services

Program (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Access Behavioral

Care - Denver

Access Behavioral

Care

Denver County 0 0 0

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Colorado

3,4

Colorado Medicaid

Community Behavioral

Health Services

Program (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Access Behavioral

Care - Northeast

Access Behavioral

Care

Cheyenne, Elbert, Kit

Carson, Larimer, Lincoln,

Logan, Morgan, Phillips,

Sedgwick, Washington,

Weld, and Yuma Counties

0 0 0

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Rocky Mountain Health

Care Services (PACE)

Health Care

Service

Corporation

El Paso County 41 531 572

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Total Longterm Care -

Pueblo DBA Innovage

Greater Colorado

PACE

Total Community

Options, Inc.

Pueblo County 0 451 451

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Total Longterm Care -

Innovage Aurora

(PACE)

Total Community

Options, Inc.

Aurora 112 1,916 2,028

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Volunteers of America

(VOANS) PACE DBA

Senior Community

Care

Volunteers of

America

Delta and Montrose

Counties

0 308 308

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Total Longterm Care -

Innovage Loveland

(PACE)

Total Community

Options, Inc.

Larimer and Weld Counties 0 216 216

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

TRU Community Care Community Care

Health Plan (WI)

Boulder and Weld Counties 0 84 84

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Total Longterm Care -

Innovage Lakewood

(PACE)

Total Community

Options, Inc.

Lakewood 0 140 140

Colorado

3,4

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Total Longterm Care -

Innovage Thornton

(PACE)

Total Community

Options, Inc.

Thornton 0 0 0

Delaware Diamond State Health

Plan (Comprehensive

MCO + MLTSS)

Highmark Health

Options of Delaware

Highmark Statewide 148,290 4,241 152,531

Delaware Diamond State Health

Plan (Comprehensive

MCO + MLTSS)

AmeriHealth Caritas of

Delaware

AmeriHealth Statewide 45,230 1,884 47,114

Delaware LogistiCare/Circulation

Non-Emergency

Medical Transportation

(Non-Emergency

Medical

Transportation)

LogistiCare/Circulation

Non-Emergency

Medical Transportation

LogistiCare Statewide 202,677 6,125 208,802

Delaware Saint Francis Life

(Program of All-

inclusive Care for the

Elderly (PACE))

Saint Francis Life Saint Francis

Healthcare

New Castle County 10 232 242

District of

Columbia

DC Healthy Families

(Comprehensive

MCO)

AmeriHealth Caritas

District of Columbia

AmeriHealth Statewide 110,092 7 110,099

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

District of

Columbia

DC Healthy Families

(Comprehensive

MCO)

Amerigroup District of

Columbia

Anthem Insurance

Companies, Inc.

Statewide 43,374 2 43,376

District of

Columbia

DC Healthy Families

(Comprehensive

MCO)

Trusted Health Plan Trusted Health

Plan, Inc.

Statewide 30,584 1 30,585

District of

Columbia

Child and Adolescent

Supplemental Security

Income Program

(CASSIP)

(Comprehensive

MCO)

Health Services for

Children with Special

Needs

The HSC

Foundation

Statewide 5,188 115 5,303

District of

Columbia

Non-Emergency

Medical Transportation

(NEMT) (Non-

Emergency Medical

Transportation)

Medical Transportation

Management, Inc.

Medical

Transportation

Management, Inc.

Statewide 33,098 21,496 54,594

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Amerigroup Florida,

Inc.

Anthem Insurance

Companies, Inc.

Regions 5, 6, 7, and 11 297,550 7,794 305,344

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Better Health, Inc. Anthem Insurance

Companies, Inc.

Regions 6 and 10 90,521 2,783 93,304

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Aetna DBA Coventry

Healthcare of FL, Inc.

Aetna Region 11 48,206 1,966 50,172

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Humana Medical Plan Humana Regions 1, 6, 9, 10, and 11 279,019 15,400 294,419

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Molina Healthcare of

Florida, Inc.

Molina Healthcare Regions 1, 4, 6, 7, 8, 9, and

279,019 15,400 294,419

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Prestige Health Choice Prestige Health

Choice

Regions 2, 3, 5, 6, 7, 8, 9,

and 11

312,830 12,497 325,327

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

South Florida

Community Care

Network DBA

Community Care Plan

Community Care

Health Plan (WI)

Region 10 39,556 1,392 40,948

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Simply Healthcare

Plans, Inc.

Anthem Insurance

Companies, Inc.

Region 11 64,436 6,823 71,259

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Wellcare Health Plan of

Florida DBA Staywell

WellCare Regions 2, 3, 4, 5, 6, 7, 8,

and 11

615,568 18,213 633,781

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Centene DBA Sunshine

State Health Plan, Inc.

Centene

Corporation

Regions 3, 4, 5, 6, 7, 8, 9,

10, and 11

462,503 14,259 476,762

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

United Healthcare of

Florida, Inc.

UnitedHealthcare Regions 3, 4, 7, and 11 247,869 12,803 260,672

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

AIDS Healthcare

Foundation DBA

Positive Healthcare,

Inc.

AIDS Healthcare

Foundation, Inc.

Regions 10 and 11 1,290 668 1,958

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Freedom Health, Inc. Freedom Health,

Inc.

Regions 3, 5, 6, 7, 8, 9, 10,

and 11

53 60 113

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Magellan Complete

Care, LLC

Magellan Health Regions 2, 4, 5, 6, 7, 9, 10,

and 11

72,147 10,003 82,150

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Simply Healthcare

Plans DBA Clear

Health Alliance

Anthem Insurance

Companies, Inc.

Regions 1, 2, 3, 5, 6, 7, 8, 9,

10, and 11

6,555 2,502 9,057

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Sunshine State Health

Plan, Inc.

Centene

Corporation

Statewide 34,219 0 34,219

Florida Managed Medical

Assistance Program

(Comprehensive

MCO)

Children's Medical

Services

State of Florida,

Department of

Health

Statewide 52,271 141 52,412

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

Amerigroup Florida,

Inc.

Anthem Insurance

Companies, Inc.

Regions 10 and 11 512 4,857 5,369

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

Aetna DBA Coventry

Healthcare of FL, Inc.

Aetna Regions 6, 7, 9, and 11 430 4,748 5,178

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

Molina Healthcare of

FL, Inc.

Molina Healthcare Regions 5, 6, and 11 567 5,651 6,218

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

Centene DBA Sunshine

State Health Plan, Inc.

Centene

Corporation

Regions 1, 3,4, 5, 6, 7, 8, 9,

10, and 11

3,507 39,936 43,443

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

United Healthcare of

FL, Inc.

UnitedHealthcare Regions 2, 3, 4, 5, 6, 7, 8, 9,

and 11

1,388 17,681 19,069

Florida Long-term Care

Program (MLTSS only

(PIHP and/or PAHP))

Humana Medical Plan,

Inc.

Humana Statewide 1,591 20,656 22,247

Florida Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Florida PACE Center Miami Jewish

Health

Miami-Dade County 90 651 741

Florida Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Hope Select Care Hope Healthcare Collier, Charlotte, and Lee

Counties

241 3 244

Florida Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Morselife Home Care,

Inc.

PACE Palm Beach County 386 13 399

Florida Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Suncoast Neighborly

Care, Inc.

Empath Health Pinellas County 280 15 295

Georgia Georgia Families

(Comprehensive

MCO)

Amerigroup Community

Care

Anthem Insurance

Companies, Inc.

Statewide 342,503 115 342,618

Georgia Georgia Families

(Comprehensive

MCO)

CareSource - Georgia CareSource Statewide 209,400 60 209,460

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Georgia Georgia Families

(Comprehensive

MCO)

Peach State Health

Plan

Centene

Corporation

Statewide 359,957 80 360,037

Georgia Georgia Families

(Comprehensive

MCO)

WellCare of Georgia WellCare Statewide 504,259 172 504,431

Georgia Georgia Families 360

(Comprehensive

MCO)

Amerigroup Anthem Insurance

Companies, Inc.

Statewide 29,258 0 29,258

Georgia

Non-Emergency

Medical Transportation

(NEMT) (Non-

Emergency Medical

Transportation)

Southeast Trans Southeastrans,

Inc. - Atlanta, GA

Atlanta, Georgia

30337

Banks, Barrow, Bartow,

Catoosa, Chattooga,

Cherokee, Cobb, Dade,

Dawson, Douglas, Fannin,

Floyd, Forsyth, Franklin,

Gilmer, Gordon,

Habersham, Hall, Haralson,

Jackson, Lumpkin, Morgan,

Murray, Paulding, Pickens,

Polk, Rabun, Stephens,

Towns, Union, Walker,

Walton, White, Whitfield,

Fulton, DeKalb, and

Gwinnett Counites

753,966 0 753,966

Georgia

Non-Emergency

Medical Transportation

(NEMT) (Non-

Emergency Medical

Transportation)

Logisticare LogistiCare Baldwin, Bibb, Bleckley,

Butts, Carroll, Clayton,

Coweta, Dodge, Fayette,

Heard, Henry, Jasper,

Jones, Lamar, Laurens,

Meriwether, Monroe,

Newton, Pike, Putnam,

869,286 0 869,286

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Georgia

(cont

)

Non-Emergency

Medical Transportation

(NEMT) (Non-

Emergency Medical

Transportation)

Logisticare LogistiCare Rockdale, Spalding, Telfair,

Troup, Twiggs, Wilkinson,

Appling, Bacon, Brantley,

Bryan, Bulloch, Burke,

Camden, Candler, Charlton,

Chatham, Clarke, Columbia,

Effingham, Elbert, Emanuel,

Evans, Glascock, Glynn,

Greene, Hancock, Hart, Jeff

Davis, Jefferson, Jenkins,

Johnson, Liberty, Lincoln,

Long, Madison, McDuffie,

McIntosh, Montgomery,

Oconee, Oglethorpe

, Pierce,

Richmond, Screven,

Taliaferro, Tattnall, Toombs,

Treutlen, Ware, Warren,

Washington, Wayne,

Wheeler, Wilkes, Atkinson,

Baker, Ben Hill, Berrien,

Brooks, Calhoun,

Chattahoochee, Clay,

Clinch, Coffee, Colquitt,

Cook, Crawford, Crisp,

Decatur, Dooly, Dougherty,

Early, Echols, Grady, Harris,

Houston, Irwin, Lanier, Lee,

Lowndes, Macon, Marion,

Miller, Mitchell, Muscogee,

Peach, Pulaski, Quitman,

Randolph, Schley,

Seminole, Stewart, Sumter,

Talbot, Taylor, Terrell,

Thomas, Tift, Turner,

Upson, Webster, Wilcox,

and Worth Counties

869,286 0 869,286

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Georgia Planning for Healthy

Babies (P4HB) (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Amerigroup Anthem Insurance

Companies, Inc.

Statewide 10,556 0 10,556

Georgia Planning for Healthy

Babies (P4HB) (Other

Prepaid Health Plan

(PHP) (limited

benefits))

CareSource- Georgia CareSource Statewide 7,458 0 7,458

Georgia Planning for Healthy

Babies (P4HB) (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Peach State Health

Plan

Centene

Corporation

Statewide 10,734 0 10,734

Georgia Planning for Healthy

Babies (P4HB) (Other

Prepaid Health Plan

(PHP) (limited

benefits))

WellCare of Georgia WellCare Statewide 10,698 0 10,698

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

AlohaCare QUEST AlohaCare Statewide 62,174 34 62,208

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Hawaii Medical Service

Association (HMSA)

QUEST

HMSA Statewide 157,990 97 158,087

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Kaiser Permanente

QUEST

Kaiser

Permanente

Oahu and Maui 29,268 20 29,288

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Ohana Health Plan

QUEST

WellCare Statewide 22,235 40 22,275

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan

QUEST

UnitedHealthcare Statewide 27,666 33 27,699

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

AlohaCare ABD AlohaCare Statewide 2,712 2,958 5,670

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

HMSA ABD HMSA Statewide 4,386 4,575 8,961

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Kaiser ABD Kaiser

Permanente

Oahu and Maui 774 1,030 1,804

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Ohana ABD WellCare Statewide 6,418 10,864 17,282

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

UnitedHealth ABD UnitedHealthcare Statewide 5,724 14,945 20,669

Hawaii

Hawaii QUEST

Integration

(Comprehensive MCO

+ MLTSS)

Ohana Community

Care Service (BHS)

WellCare Statewide 4,470 0 4,470

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Idaho Medicare/Medicaid

Coordinated Plan

(Comprehensive MCO

+ MLTSS)

Medicare/Medicaid

Coordinated Plan

Molina Healthcare Ada, Bannock, Bingham,

Bonner, Bonneville, Canyon,

Kootenai, Nez Perce, and

Twin Falls Counties. Blue

Cross of Idaho administers

the MMCP in additional

Idaho counties, including

Boise, Boundary, Cassia,

Clark, Elmore,

Fremont, Gem, Jefferson,

Madison, Minidoka,

Owyhee, Payette, and

Power Counties.

0 3,799 3,799

Idaho Healthy Connections

(Primary Care Case

Management (PCCM))

Healthy Connections Healthy

Connections

Statewide 235,469 19,322 254,791

Idaho Idaho Behavioral

Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Idaho Behavioral

Health Plan

UnitedHealthcare Statewide 245,815 23,425 269,240

Idaho Idaho Smiles (Dental

only (PAHP))

Idaho Smiles Managed Care of

North America

(MCNA), Inc.

Statewide 245,739 27,240 272,979

Idaho Non-Emergency

Medical Transportation

(Non-Emergency

Medical

Transportation)

Non-Emergency

Medical Transportation

Medical

Transportation

Management, Inc.

Statewide 245,739 27,240 272,979

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

Blue Cross Blue Shield

of Illinois

Health Care

Service

Corporation

Statewide 414,925 0 414,925

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

CountyCare Cook County

Health and

Hospitals System

Cook County 321,345 0 321,345

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

IlliniCare Health Plan Centene

Corporation

Statewide 317,402 0 317,402

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

Meridian Health Plan WellCare Statewide 572,164 0 572,164

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

Illinois

Molina Healthcare Statewide 212,613 0 212,613

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

NextLevel Health

Partners

NextLevel Health

Partners

Cook County 56,702 0 56,702

Illinois HealthChoice Illinois

(Comprehensive MCO

+ MLTSS)

Harmony Health Plan WellCare Statewide 250,609 0 250,609

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

Blue Cross Blue Shield

of Illinois

Health Care

Service

Corporation

Cook, DuPage, Kane,

Kankakee, Lake and Will

Counties

0 9,878 9,878

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

CountyCare Cook County

Health and

Hospitals System

Cook County 0 5,355 5,355

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

Harmony Health Plan WellCare Cook, DuPage, Kane,

Kankakee, Lake and Will

Counties

0 1,180 1,180

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

IlliniCare Health Plan Centene

Corporation

Cook, DuPage, Kane,

Kankakee, Lake and Will

Counties

0 7,012 7,012

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

Meridian Health Plan WellCare Cook, DuPage, Kane,

Kankakee, Lake and Will

Counties

0 6,849 6,849

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

Molina Healthcare of

Illinois

Molina Healthcare Cook, DuPage, Kane,

Kankakee, Lake and Will

Counties

0 579 579

Illinois HealthChoice Illinois -

Managed Long-Term

Services and Supports

(MLTSS only (PIHP

and/or PAHP))

NextLevel Health

Partners

NextLevel Health

Partners

Cook County 0 290 290

Indiana Hoosier Care Connect

(Comprehensive

MCO)

Anthem Anthem Insurance

Companies, Inc.

Statewide 56,491 302 56,793

Indiana Hoosier Care Connect

(Comprehensive

MCO)

Managed Health

Services of Indiana

Cenete

Corporation

Statewide 34,059 138 34,197

Indiana Hoosier Healthwise

(Comprehensive

MCO)

Anthem Anthem Insurance

Companies, Inc.

Statewide 207,717 1 207,718

Indiana Hoosier Healthwise

(Comprehensive

MCO)

Caresource Indiana,

Inc

CareSource Statewide 61,413 1 61,414

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Indiana Hoosier Healthwise

(Comprehensive

MCO)

Managed Health

Services of Indiana

Centene

Corporation

Statewide 150,441 2 150,443

Indiana Hoosier Healthwise

(Comprehensive

MCO)

MDWise McLaren Health

Plan

Statewide 213,253 0 213,253

Indiana Healthy Indiana Plan

(2.0) (Comprehensive

MCO)

Anthem Anthem Insurance

Companies, Inc.

Statewide 174,341 1,680 176,021

Indiana Healthy Indiana Plan

(2.0) (Comprehensive

MCO)

Caresource Indiana,

Inc

CareSource Statewide 44,850 216 45,066

Indiana Healthy Indiana Plan

(2.0) (Comprehensive

MCO)

Managed Health

Services of Indiana

Centene

Corporation

Statewide 70,153 644 70,797

Indiana Healthy Indiana Plan

(2.0) (Comprehensive

MCO)

MDWise McLaren Health

Plan

Statewide 109,439 992 110,431

Indiana PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Franciscan Senior

Health and Wellness

PACE Lake and Johnson Counties,

and the following zip codes:

46107, 46201, 46202,

46203, 46204, 46217,

46218, 46219, 46221,

46222, 46225, 46227,

46229, 46237, 46239,

46241, 46259

3 173 176

Indiana PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Saint Joseph PACE PACE 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

6 110 116

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Iowa IA Healthlink

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare UnitedHealthcare Statewide 344,032 40,156 384,188

Iowa IA Healthlink

(Comprehensive MCO

+ MLTSS)

Amerigroup of Iowa,

Inc.

Amerigroup, Inc. Statewide 161,970 18,334 180,304

Iowa Dental Wellness Plan

(Dental only (PAHP))

Delta Dental of Iowa Delta Dental Statewide 169,173 38,695 207,868

Iowa Dental Wellness Plan

(Dental only (PAHP))

MCNA Dental Plans,

Inc.

Managed Care of

North America,

Inc.

Statewide 74,961 19,852 94,813

Iowa NEMT (Non-

Emergency Medical

Transportation)

Access2Care, LLC Mission Care

Services, LLC

Statewide 14,306 1,275 15,581

Iowa PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE PACE Harrison, Mills,

Pottawattamie, Cherokee,

Monona, Plymouth,

Woodbury, Boone, Dallas,

Jasper, Marshall, Madison,

Marion, Polk, Story, and

Warren Counties

25 409 434

Kansas KanCare

(Comprehensive MCO

+ MLTSS)

Amerigroup Kansas,

Inc.

Anthem Insurance

Companies, Inc.

Statewide 102,427 12,182 114,609

Kansas KanCare

(Comprehensive MCO

+ MLTSS)

Sunflower State Health

Plan

Centene

Corporation

Statewide 104,857 13,655 118,512

Kansas KanCare

(Comprehensive MCO

+ MLTSS)

United HealthCare

Community Plan of

Kansas

UnitedHealthcare Statewide 111,705 12,857 124,562

Kansas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Via Christi PACE Sedgwick County 225 0 225

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Kansas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Midland Care PACE Douglas, Jackson,

Jefferson, Leavenworth,

Lyon, Marshall, Nemaha,

Osage, Shawnee,

Pottawatomie, Wabaunsee

and Wyandotte Counties

264 0 264

Kansas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Bluestem Pace, Inc. PACE McPherson, Ottawa,

Lincoln, Ellsworth, Saline,

Dickinson, Rice, Marion,

Reno and Harvey Counties

53 0 53

Kentucky Kentucky Managed

Care (Comprehensive

MCO)

Aetna Better Health of

Kentucky

Aetna Statewide 208,336 15,540 223,876

Kentucky Kentucky Managed

Care (Comprehensive

MCO)

Anthem Blue Cross

Blue Shield Medicaid

Anthem BCBS Statewide 126,166 3,591 129,757

Kentucky Kentucky Managed

Care (Comprehensive

MCO)

Humana-Caresource Humana Statewide 143,126 4,728 147,854

Kentucky Kentucky Managed

Care (Comprehensive

MCO)

Passport Health Plan Passport Health

Plan

Statewide 301,394 10,322 311,716

Kentucky Kentucky Managed

Care (Comprehensive

MCO)

WellCare of Kentucky WellCare Statewide 424,585 21,737 446,322

Kentucky Kentucky Non-

Emergency Medical

Transportation (Non-

Emergency Medical

Transportation)

NEMT - Human

Services Transportation

Delivery

NEMT - Human

Services

Transportation

Delivery

Statewide 1,232,903 0 1,232,903

Louisiana Healthy Louisiana

(Comprehensive

MCO)

Aetna Better Health Aetna Statewide 96,417 97 96,514

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Louisiana Healthy Louisiana

(Comprehensive

MCO)

AmeriHealth Caritas of

Louisiana

AmeriHealth Statewide 189,098 109 189,207

Louisiana Healthy Louisiana

(Comprehensive

MCO)

Healthy Blue Anthem Insurance

Companies, Inc.

Statewide 233,157 105 233,262

Louisiana Healthy Louisiana

(Comprehensive

MCO)

Louisiana Healthcare

Connections

Centene

Corporation

Statewide 450,896 191 451,087

Louisiana Healthy Louisiana

(Comprehensive

MCO)

UnitedHealthcare

Community Plan

UnitedHealthcare Statewide 414,548 166 414,714

Louisiana Healthy Louisiana

BHO (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Aetna Better Health Aetna Statewide 1,957 19,019 20,976

Louisiana Healthy Louisiana

BHO (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

AmeriHealth Caritas of

Louisiana

AmeriHealth Statewide 2,025 18,576 20,601

Louisiana Healthy Louisiana

BHO (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Healthy Blue Anthem Insurance

Companies, Inc.

Statewide 2,325 19,355 21,680

Louisiana Healthy Louisiana

BHO (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Louisiana Healthcare

Connections

Centene

Corporation

Statewide 2,902 22,876 25,778

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Louisiana Healthy Louisiana

BHO (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

UnitedHealthcare

Community Plan

UnitedHealthcare Statewide 3,132 23,408 26,540

Louisiana Coordinated System of

Care (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Magellan Magellan Health Statewide 2,532 0 2,532

Louisiana Dental Benefit

Management Program

(Dental only (PAHP))

MCNA of Louisiana Managed Care of

North America

(MCNA), Inc.

Statewide 1,398,468 104,724 1,503,192

Louisiana PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Baton Rouge PACE 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

0 196 196

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Louisiana PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Greater New Orleans PACE 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

13 170 183

Louisiana PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Lafayette PACE 70501, 70503, 70506,

70507, 70508, 70517,

70518, 70520, 70529,

70578, 70583, 70584,

70592

2 77 79

Maine MaineCare (Primary

Care Case

Management (PCCM))

Multiple Primary Care

Providers

MaineCare Statewide 141,777 0 141,777

Maine NET (Non-Emergency

Medical

Transportation)

Logisticare MaineCare NET Regions 1, 2, 6, 7, and 8 109,632 30,586 140,218

Maine NET (Non-Emergency

Medical

Transportation)

MidCoast Connector MaineCare NET Region 5 19,559 4,917 24,476

Maine NET (Non-Emergency

Medical

Transportation)

Penquis CAP MaineCare NET Regions 3 and 4 53,683 15,950 69,633

Maryland HealthChoice

(Comprehensive

MCO)

Amerigroup Community

Care

Anthem Insurance

Companies, Inc.

Statewide 276,054 0 276,054

Maryland HealthChoice

(Comprehensive

MCO)

Aetna Better Health of

Maryland

Aetna Statewide 7,203 0 7,203

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Maryland HealthChoice

(Comprehensive

MCO)

Jai Medical Systems Jai Medical

Systems

Baltimore City, Anne

Arundel and Baltimore

Counties

25,998 0 25,998

Maryland HealthChoice

(Comprehensive

MCO)

Kaiser Permanete Kaiser Permanete

of the Mid Atlantic

States

Anne Arundel, Baltimore,

Calver, Charles, Harford,

Howard, Montgomery, and

Prince George's Counties

63,724 0 63,724

Maryland HealthChoice

(Comprehensive

MCO)

Maryland Physician's

Care

Maryland Care Inc Statewide 213,677 0 213,677

Maryland HealthChoice

(Comprehensive

MCO)

MedStar MedStar Baltimore City, Anne

Arundel, Baltimore, Charles,

Harford, Montgomery,

Prince George's, and St.

Mary's Counties

90,488 0 90,488

Maryland HealthChoice

(Comprehensive

MCO)

Priority Partners Johns Hopkins

Health Care

Statewide 297,179 0 297,179

Maryland HealthChoice

(Comprehensive

MCO)

United HealthCare UnitedHealthcare Baltimore City, Anne

Arundel, Baltimore, Carroll,

Cecil, Charles, Harford,

Howard, Montgomery,

Prince George's, and St.

Mary's Counties

149,565 0 149,565

Maryland HealthChoice

(Comprehensive

MCO)

University of Maryland

Health Partners

University of

Maryland Medical

Systems

Statewide except for

Allegany, Garrett and

Washington Counties

45,715 0 45,715

Maryland Hopkins Elder Plus

(Program of All-

inclusive Care for the

Elderly (PACE))

Hopkins Elder Plus Johns Hopkins 21052, 21202, 21205,

21206, 21213, 21214,

21217, 21218, 21219,

21220, 21221, 21222,

21224, 21227, 21231,

21237

12 93 105

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts MassHealth Managed

Care (Comprehensive

MCO)

Tufts Health Plan Tufts Health Plan Statewide (excluding

islands)

105,265 0 105,265

Massachusetts MassHealth Managed

Care (Comprehensive

MCO)

Boston Medical Center

Health Plan

Boston Medical

System

Statewide 72,409 0 72,409

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Atrius Health in

partnership with Tufts

Health Public Plans

(THPP)

Tufts Health Plan Attleboro, Beverly, Boston,

Brockton, Falmouth,

Framingham. Gardner,

Fitchburg, Lawrence, Lowell,

Lynn, Malden, Plymouth,

Quincy, Revere, Salem,

Somerville, Waltham,

Wareham, Woburn

31,788 0 31,788

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Beth Israel Deaconess

Care Organization

(BIDCO) in partnership

with Tufts Health Publi

Plans (THPP)

Tufts Health Plan Attleboro, Barnstable,

Beverly, Boston, Brockton,

Falmouth, Framingham,

Haverhill, Lowell, Lynn,

Malden, Orleans, Plymouth,

Quincy, Revere, Salem,

Somerville, Waltham,

Wareham, Woburn

33,629 0 33,629

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Boston Children’s

Health ACO in

partnership with Tufts

Health Public Plans

(THPP)

Tufts Health Plan Attleboro, Barnstable,

Beverly, Boston, Brockton,

Fall River, Falmouth,

Framingham, Haverhill,

Holyoke, Lawrence, Lowell,

Lynn, Malden, New Bedford,

Northampton, Orleans,

Plymouth, Quincy, Revere,

Salem, Somerville,

Southbridge, Springfield,

Taunton, Waltham,

Wareham, Westfield,

Woburn, Worcester

83,442 0 83,442

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Cambridge Health

Alliance (CHA) in

partnership with Tufts

Health Public Plans

(THPP)

Tufts Health Plan Boston, Lynn, Malden,

Revere, Somerville,

Waltham, Woburn

26,068 0 26,068

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Merrimack Valley ACO

in partnership with

AllWays Health

Partners

Allways Health

Partners

Haverhill, Lawrence, Lowell 31,865 0 31,865

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Boston Accountable

Care Organization in

partnership with BMC

HealthNet Plan

Boston Medical

Health Plan

Attleboro, Boston, Brockton,

Fall River, Falmouth,

Greenfield, Holyoke, Lynn,

Malden, New Bedford,

Northampton, Plymouth,

Quincy, Revere, Somerville,

Springfield, Taunton,

Waltham, Wareham,

Westfield, Woburn

107,081 0 107,081

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Mercy Medical Center

in partnership with

BMC HealthNet Plan

Boston Medical

Health Plan

Holyoke, Northampton,

Springfield, Westfield

28,148 0 28,148

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Signature Healthcare in

partnership with BMC

HealthNet Plan

Boston Medical

Health Plan

Brockton, Plymouth, Quincy,

Taunton

17,924 0 17,924

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Southcoast Health in

partnership with BMC

HealthNet Plan

Boston Medical

Health Plan

Attleboro, Fall River,

Falmouth, New Bedford,

Plymouth, Taunton,

Wareham

16,044 0 16,044

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Health Collaborative of

the Berkshires in

partnership with Fallon

Health

Fallon Health Plan Adams, Pittsfield 15,461 0 15,461

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Reliant Medical Group

in partnership with

Fallon Health

Fallon Health Plan Gardner-Fitchburg,

Framingham, Southbridge,

Worcester

30,168 0 30,168

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Wellforce in partnership

with Fallon Health

Fallon Health Plan Attleboro, Barnstable,

Beverly, Boston, Brockton,

Falmouth, Framingham,

Haverhill, Lawrence, Lowell,

Lynn, Malden, Orleans,

Plymouth, Quincy, Revere,

Salem, Somerville,

Waltham, Wareham,

Woburn

52,821 0 52,821

Massachusetts Accountable Care

Partnership Plans

(Comprehensive

MCO)

Baystate Health Care

Alliance in partnership

with Health New

England

Health New

England

Holyoke, Northampton,

Springfield, Westfield

37,474 0 37,474

Massachusetts Primary Care

Accountable Care

Organizations

(Primary Care ACO)

(Primary Care Case

Management Entity

(PCCM Entity))

Community Care

Cooperative

Community Care

Health Plan (WI)

Statewide 112,875 0 112,875

Massachusetts Primary Care

Accountable Care

Organizations

(Primary Care ACO)

(Primary Care Case

Management Entity

(PCCM Entity))

Partners HealthCare

Choice

Partners

HealthCare Choice

Statewide 105,032 0 105,032

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Primary Care

Accountable Care

Organizations

(Primary Care ACO)

(Primary Care Case

Management Entity

(PCCM Entity))

Steward Health Choice Steward Health

Choice

Statewide 121,443 0 121,443

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

Boston Medical Center

Healthnet Plan

Boston Medical

Health Plan

Suffolk County 139 705 844

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

Commonwealth Care

Alliance

Commonwealth

Care Alliance

01330, 01337, 01338,

01339, 01340, 01341,

01342, 01344, 01354,

01301, 01302, 01039,

01346, 01347, 01054,

01349, 01350, 01351,

01360, 01367, 01369,

01370, 01072, 01373,

01375, 01376, 01379,

01380, 01093, 02322,

02157, 02457, 02184,

02185, 02146, 02445,

02446, 02147, 02447,

02021, 02467, 02025,

02026, 02027, 02030,

02032, 02035, 02343,

02052, 02053, 02054,

02186, 02187, 02192,

02194, 02492, 02494,

02056, 02171, 02062,

02762, 02169, 02170,

02171, 02269, 02368,

02067, 02070, 02071,

02072, 02081, 02181,

02481, 02482, 02090,

02188, 02189, 02190,

696 9,251 9,947

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts

(cont)

Senior Care Options

(Comprehensive MCO

+ MLTSS)

Commonwealth Care

Alliance

02191, 02170, 02093,

02351, 02020, 02324,

02301, 02302, 02303,

02304, 02305, 02327,

02330, 02332, 02333,

02338, 02339, 02341,

02018, 02043, 02044,

02045, 02364, 02050,

02065, 02346, 02061,

02355, 02059, 02358,

02558, 02359, 02360,

02362, 02367, 02770,

02370, 02040, 02055,

02060, 02066, 02379,

02382

696 9,251 9,947

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

Navicare HMO Fallon Health Plan Barnstable, Brisol, Essex,

Franklin, Hampden,

Middlesex, Norfolk,

Plymouth, Suffolk, and

Worcester Counties

436 6,270 6,706

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

Senior Whole Health Magellan Health Bristol, Essex, Hampden,

Middlesex, Norfolk,

Plymouth, Suffolk, and

Worcester Counties

1,321 13,465 14,786

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

Tufts Health Plan Tufts Health Plan Barnstable, Bristol, Essex,

Hampden, Middlesex,

Norfolk, Plymouth, Suffolk,

and Worcester Counties

633 4,081 4,714

Massachusetts Senior Care Options

(Comprehensive MCO

+ MLTSS)

United Healthcare UnitedHealthcare Bristol, Essex, Hampden,

Middlesex, Norfolk,

Plymouth, Suffolk and

Worcester Counties

1,838 17,629 19,467

Massachusetts Primary Care Clinician

Program (PCC Plan)

(Primary Care Case

Management (PCCM))

Multiple Primary Care

Providers

Multiple Primary

Care Provider

(PCCM)

Statewide 119,512 0 119,512

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts MassHealth BH/SUD

PIHP (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Massachusetts

Behavioral Health

Partnership

Beacon Statewide 528,106 0 528,106

Massachusetts Money Follows the

Person- Behavioral

Health Supports

(MFP-BH) (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Money Follows the

Person- Behavioral

Health Supports (MFP-

BH)

Money Follows the

Person-

Behavioral Health

Supports (MFP-

BH)

Statewide 0 0 0

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Elder Service Plan of

Cambridge Health

Alliance

Elder Service Plan Middlesex and Suffolk

Counties

32 396 428

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Upham's Elder Service

Plan

Elder Service Plan 02108, 02445 30 246 276

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Elder Service Plan of

Harbor Health

Elder Service Plan 02108, 02445, 02021,

02026, 02048, 02062,

02067, 02072, 02169,

02184, 02186, 02188,

02301, 02322, 02324,

02333, 02334, 02338,

02339, 02341, 02343,

02351, 02359, 02367,

02368, 02370, 02379,

02382, 02458, 02766,

02767, 02780

13 462 475

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Fallon Health Summit

Eldercare

Fallon Health Plan 01001, 01008, 01010,

01011, 01013, 01027,

01028, 01033, 01034,

01036, 01040, 01056,

01057, 01069, 01071,

01073, 01075, 01077,

01081, 01085, 01089,

01095, 01101, 01106,

01521, 01034, 01810,

01821, 01824, 01826,

01827, 01840, 01844,

01850, 01876, 01879,

01886, 01005, 01037,

01068, 01083, 01331,

01331, 01366, 01368,

01420, 01430, 01431,

01432, 01440, 01441,

01450, 01451, 01452,

01453, 01460, 01462,

01463, 01464, 01468,

01469, 01475, 01501,

01503, 01504, 01505,

01506, 01507, 01510,

01515, 01516, 01519,

01520, 01523, 01524,

01527, 01529, 01531,

01532, 01534, 01535,

01540, 01541, 01543,

01545, 01550, 01562,

01564, 01566, 01568,

01569, 01570, 01571,

01581, 01583, 01585,

01590, 01601, 01612,

01719, 01720, 01730,

01740, 01741, 01742,

01747, 01749, 01752,

01756, 01757, 01772,

01151, 01845

46 1,127 1,173

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Element Care Inc Element Care Inc 02176, 02180, 01810,

01821, 01824, 01826,

01827, 01840, 01844,

01850, 01876, 01879,

01886, 01845, 01801,

01803, 01830, 01833,

01834, 01860, 01864,

01867, 01880, 01887,

01890, 01901, 01906,

01907, 01908, 01913,

01915, 01921, 01923,

01929, 01930, 01936,

01938, 01940, 01944,

01945, 01949, 01950,

01951, 01952, 01960,

01966, 01969, 01970,

01983, 01984, 01985

67 927 994

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Serenity Care PACE

Program

PACE 01002, 01027, 01350,

01001, 01002, 01007,

01008, 01010, 01011,

01012, 01013, 01026,

01027, 01028, 01032,

01033, 01034, 01035,

01036, 01038, 01040,

01050, 01056, 01057,

01060, 01069, 01070,

01071, 01073, 01075,

01077, 01081, 01082,

01085, 01089, 01095,

01096, 01098, 01101,

01106, 01151, 01243,

01521, 01009, 01030,

01039, 01053, 01054,

01059, 01062, 01066,

01072, 01079, 01080,

01084, 01088, 01093,

01097, 01301, 01330,

01337, 01338, 01339,

01340, 01341, 01342,

01344, 01346, 01351,

01354, 01355, 01360,

01364, 01367, 01370,

01375, 01378, 01379

66 325 391

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Mercy Life Inc Mercy Life Inc 01008, 01010, 01011,

01013, 01027, 01028,

01033, 01034, 01036,

01040, 01056, 01057,

01069, 01071, 01073,

01075, 01077, 01081,

01085, 01089, 01095,

01101, 01106, 01521,

01151, 01002, 01027,

01350, 01002, 01007,

01012, 01026, 01032,

01035, 01038, 01050,

01060, 01070, 01082,

01096, 01098, 01243,

01034

11 223 234

Massachusetts Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Neighborhood PACE PACE Middlesex and Suffolk

Counties

55 496 551

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Aetna Better Health of

Michigan

Aetna Berrien, Branch, Calhoun,

Cass, Hillsdale, Jackson,

Kalamazoo, Lenawee,

Livingston, Macomb,

Monroe, Oakland, St.

Joseph, Van Buren,

Washtenaw, and Wayne

Counties

37,306 214 37,520

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Blue Cross Complete of

Michigan

Blue Cross Blue

Shield

Allegan, Barry, Clinton,

Eaton, Genesee, Hillsdale,

Huron, Ingham, Ionia,

Jackson, Kent, Lake,

Lapeer, Lenawee,

Livingston, Macomb, Mason,

Mecosta, Monroe,

Montcalm, Muskegon,

Newaygo, Oakland,

Oceana, Osceola, St. Clair,

Sanilac, Shiawassee,

Tuscola, Washtenaw, and

Wayne Counties

209,603 3,535 213,138

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Harbor Health Plan Trusted Health

Plan

Macomb, Oakland, and

Wayne Counties

7,128 4 7,132

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

HAP Midwest Health

Plan

Health Alliance

Plan

Genesee, Huron, Lapeer,

St. Clair, Sanilac,

Shiawassee, and Tuscola

Counties

3,031 33 3,064

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

McLaren Health Plan McLaren Health

Plan

Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, Hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston,

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogema,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

201,833 6,022 207,855

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Meridian Health Plan of

Michigan

Meridian Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, Hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogemaw,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

499,221 11,331 510,552

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan

Managed Care Plan

Division

(Comprehensive

MCO)

Molina Healthcare of

Michigan

Molina Healthcare Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, Hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston,

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogemaw,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

351,204 9,960 361,164

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Priority Health Choice Priority Health

Choice, Inc.

Allegan, Barry, Berrien,

Branch, Calhoun, Cass,

Ionia, Kalamazoo, Kent,

Lake, Mason, Mecosta,

Montcalm, Muskegon,

Newaygo, Oceana, Osceola,

Ottawa, St. Joseph, and Van

Buren Counties

127,003 4,588 131,591

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Total Health Care Total Health Care Macomb, Oakland, and

Wayne Counties

52,441 231 52,672

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

UnitedHealthcare

Community Plan

UnitedHealthcare Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare,

Crawford, Emmet, Genesee,

Gladwin, Grand Traverse,

Gratiot, Hillsdale, Huron,

Ionia, Iosco, Isabella,

Jackson, Kalamazoo,

Kalkaska, Kent, Lake,

Lapeer, Leelanau, Lenewee,

Livingston, Macomb,

Manistee, Mason, Mecosta,

Midland, Missaukee,

Monroe, Montcalm,

Montmorency, Muskegon,

Newaygo, Oakland,

Oceana, Ogemaw, Osceola,

Oscoda, Otsego, Ottawa,

Presque Isle, Roscommon,

Saginaw, St. Clair, St.

Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

251,312 3,240 254,552

Michigan Managed Care Plan

Division

(Comprehensive

MCO)

Upper Peninsula Health

Plan

Upper Peninsula

Health Plan

Alger, Baraga, Chippewa,

Delta, Dickinson, Gogebic,

Houghton, Iron, Keweenaw,

Luce, Mackinac, Marquette,

Menominee, Ontonagon,

and Schoolcraft Counties

43,558 8 43,566

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Aetna Better Health Aetna Berrien, Branch, Calhoun,

Cass, Hillsdale, Jackson,

Kalamazoo, Lenawee,

Livingston, Macomb,

Monroe, Oakland, St.

Joseph, Van Buren,

Washtenaw, and Wayne

Counties

9,975 0 9,975

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Blue Cross Complete of

Michigan

Blue Cross Blue

Shield

Allegan, Barry, Clinton,

Eaton, Genesee, Hillsdale,

Huron, Ingham, Ionia,

Jackson, Kent, Lake,

Lapeer, Lenawee,

Livingston, Macomb, Mason,

Mecosta, Monroe,

Montcalm, Muskegon,

Newaygo, Oakland,

Oceana, Osceola, St. Clair,

Sanilac, Shiawassee,

Tuscola, Washtenaw, and

Wayne Counties

85,852 0 85,852

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Harbor Health Plan Trusted Health

Plan

Macomb, Oakland, and

Wayne Counties

3,173 0 3,173

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

HAP Midwest Health

Plan

Health Alliance

Plan

Genesee, Huron, Lapeer,

St. Clair, Sanilac,

Shiawassee, and Tuscola

Counties

1,501 0 1,501

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

McLaren Health Plan McLaren Health

Plan

Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, Hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston,

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogemaw,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

68,214 0 68,214

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Meridian Health Plan of

Michigan

Meridian Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, Hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston,

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogemaw,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

152,706 0 152,706

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Molina Healthcare of

Michigan

Molina Healthcare Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare, Clinton,

Crawford, Eaton, Emmet,

Genesee, Gladwin, Grand

Traverse, Gratiot, hillsdale,

Huron, Ingham, Ionia, Iosco,

Isabella, Jackson,

Kalamazoo, Kalkaska, Kent,

Lake, Lapeer, Leelanau,

Lenawee, Livingston,

Macomb, Manistee, Mason,

Mecosta, Midland,

Missaukee, Monroe,

Montcalm, Montmorency,

Muskegon, Newaygo,

Oakland, Oceana, Ogemaw,

Osceola, Oscoda, Otsego,

Ottawa, Presque Isle,

Roscommon, Saginaw, St.

Clair, St. Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

93,375 0 93,375

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Priority Health Choice Priority Health

Choice, Inc.

Allegan, Barry, Berrien,

Branch, Calhoun, Cass,

Ionia, Kalamazoo, Kent,

Lake, Mason, Mecosta,

Montcalm, Muskegon,

Newaygo, Oceana, Osceola,

Ottawa, St. Joseph, and Van

Buren Counties

36,872 0 36,872

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Total Health Choice Total Health

Choice

Macomb, Oakland, and

Wayne Counties

16,804 0 16,804

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

UnitedHealthcare

Community Plan

UnitedHealthcare Alcona, Allegan, Alpena,

Antrim, Arenac, Barry, Bay,

Benzie, Berrien, Branch,

Calhoun, Cass, Charlevoix,

Cheboygan, Clare,

Crawford, Emmet,

Genesee,

Gladwin, Grand Traverse,

Gratiot, Hillsdale, Huron,

Ionia, Iosco, Isabella,

Jackson, Kalamazoo,

Kalkaska, Kent, Lake

Lapeer, Leelanau, Lenawee,

Livingston, Macomb,

Manistee, Mason, Mecosta,

Midland, Missaukee,

Monroe, Montcalm,

Montmorency, Muskegon,

Newaygo, Oakland,

Oceana, Ogemaw, Osceola,

Oscoda, Otsego, Ottawa,

Presque Isle, Roscommon,

Saginaw, St. Clair, St.

Joseph, Sanilac,

Shiawassee, Tuscola, Van

Buren, Washtenaw, Wayne,

and Wexford Counties

70,061 0 70,061

Michigan Healthy Michigan Plan

(Comprehensive

MCO)

Upper Peninsula Health

Plan

Upper Peninsula

Health Plan

Alger, Baraga, Chippewa,

Delta, Dickinson, Gogebic,

Houghton, Iron, Keweenaw,

Luce, Mackinac, Marquette,

Menominee, Ontonagon,

and Schoolcraft Counties

15,670 0 15,670

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Northern Healthcare

Management

Northern Lakes

Community Mental

Health

Antrim, Benzie, Charlevoix,

Emmet, Grand Traverse,

Kalkaska, Leelanau,

Manistee, Missaukee, and

Wexford Counties

29 304 333

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Region 2 Area Agency

on Aging

Area Agencies on

Aging

Hillsdale, Jackson, and

Lenawee Counties

27 566 593

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Region 3B Area

Agency on Aging

Area Agencies on

Aging

Barry, Berrien, Branch,

Calhoun, Cass, Kalamazoo,

and Van Buren Counties

34 448 482

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Region 4 Area Agency

on Aging

Area Agencies on

Aging

Berrien, Cass, and Van

Buren Counties

24 433 457

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Region 7 Area Agency

on Aging

Area Agencies on

Aging

Bay, Clare, Gladwin, Gratiot,

Huron, Isabella, Midland,

Saginaw, Sanilac, and

Tuscola Counties

56 802 858

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Region 9 Area Agency

on Aging

Area Agencies on

Aging

Alcona, Alpena, Arenac,

Cheboygan, Crawford,

Iosco, Montmorency,

Ogemaw, Oscoda, Otsego,

Presque Isle, and

Roscommon Counties

25 379 404

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Reliance Community

Care Partners

Community Care

Health Plan (WI)

Allegan, Ionia, Kent, Lake,

Mason, Mecosta,

Muskegon, Newaygo,

Oceana, Osceola, and

Ottawa Counties

43 573 616

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Senior Resources of

West Michigan

Area Agencies on

Aging

Muskegon, Oceana, and

Ottawa Counties

32 646 678

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Senior Services Inc. Senior Services

Inc.

Barry, Branch, Calhoun, and

Kalamazoo Counties

21 255 276

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

The Information Center The Information

Center

Wayne County 13 274 287

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

The Senior Alliance Area Agencies on

Aging

Wayne County 20 506 526

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Tri County Office on

Aging

Tri County Office

on Aging

Clinton, Eaton, and Ingham

Counties

81 649 730

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

UPCAP Area Agency

on Aging

Area Agencies on

Aging

Alger, Baraga, Chippewa,

Delta, Dickinson, Gogebic,

Houghton, Iron, Keweenaw,

Luce, Mackinac, Marquette,

Menominee, Ontonagon,

and Schoolcraft Counties

24 349 373

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Valley Area Agency on

Aging

Area Agencies on

Aging

Genesee, Lapeer, and

Shiawassee Counties

26 309 335

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

A & D Home Health

Care, Inc.

A & D Home

Heatlh Care, Inc.

Bay, Clare, Gladwin, Huron,

Isabella, Midland, Saginaw,

Sanilac, and Tuscola

Counties

90 778 868

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Area Agency on Aging

1-B

Area Agencies on

Aging

Livingston, Macomb,

Monroe, Oakland, and

Washtenaw Counties

42 768 810

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Area Agency on Aging

of NW Michigan

Area Agencies on

Aging

Antrim, Benzie Charlevoix,

Emmet, Grand Traverse,

Kalkaska, Leelanau,

Manistee, Missaukee, and

Wexford Counties

21 316 337

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Area Agency on Aging

of Western Michigan

Area Agencies on

Aging

Allegan, Ionia, Kent, Lake,

Mason, Mecosta, Montcalm,

Newaygo, and Osceola

Counties

35 799 834

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

Detroit Area Agency on

Aging

Area Agencies on

Aging

Wayne County 56 1,201 1,257

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan MI Choice (MLTSS

only (PIHP and/or

PAHP))

MORC Home Care Inc. MORC Home Care

Inc.

Livingston, Macomb,

Monroe, Oakland, and

Washtenaw Counties

9 232 241

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Lakeshore Regional

Entity

Lakeshore

Regional Entity

Allegan, Kent, Lake, Mason,

Muskegon, Oceana, and

Ottawa Counties

249,865 0 249,865

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Macomb County CMH

Services

Macomb County

CMH Services

Macomb County 179,951 0 179,951

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Mid-State Health

Network

Mid-State Health

Network

Arenac, Bay, Clare, Clinton,

Eaton, Gladwin, Gratiot,

Hillsdale, Huron, Ingham,

Ionia, Isabella, Jackson,

Mecosta, Midland,

Montcalm, Newaygo,

Oceola, Saginaw,

Shiawassee, and Tuscola

Counties

367,503 0 367,503

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northcare Network Northcare Network Alger, Baraga, Chippewa,

Delta, Dickinson, Houghton,

Iron, Keewanaw, Luce,

Mackinac, Marquette,

Menominee, Ontonagon,

and Schoolcraft Counties

63,431 0 63,431

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northern Michigan

Regional Entity

Northern Michigan

Regional Entity

Alcona, Alpena, Antrim,

Benzie, Charlevoix,

Cheboygan, Crawford,

Emmet, Grand Traverse,

Iosco, Kalkaska, Leelanau,

Manistee, Missaukee,

Montmorency, Ogemaw,

Oscoda, Otsego, Presque

Isle, Roscommon, and

Wexford Counties

115,735 0 115,735

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Oakland County CMH

Authority

Oakland County

CMH Authority

Oakland County 170,905 0 170,905

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Region 10 Region 10 Genesee, Lapeer, Sanilac,

and St. Clair Counties

187,376 0 187,376

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Southwest Michigan

Behavioral Health

Southwest

Michigan

Behavioral Health

Berry, Berrien, Branch,

Calhoun, Cass, Kalamazoo,

St. Joseph, and Van Buren

Counties

193,479 0 193,479

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

CMH Partnership of

Southeast Michigan

CMH Partnership

of Southeast

Michigan

Lenawee, Livingston,

Monroe, and Washtenaw

Counties

115,556 0 115,556

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan

Specialty Prepaid

Inpatient Health Plan

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Detroit Wayne Mental

Health Authority

Detroit Wayne

Mental Health

Authority

Wayne County 632,552 0 632,552

Michigan Healthy Kids Dental

(Dental only (PAHP))

Healthy Kids Dental Healthy Kids

Dental

Statewide 969,152 0 969,152

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Care Resources PACE Kent and Ottawa Counties 8 220 228

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Community PACE PACE Lake, Mason, Mecosta,

Montcalm, Newaygo,

Oceana, and Osceola

Counties

0 28 28

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Genesys PACE PACE Genesee County 8 77 85

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Great Lakes PACE PACE Arenac, Bay, Gratiot,

Midland, Saginaw,

Shiawassee, and Tuscola

Counties

12 109 121

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Huron Valley PACE PACE Livingston, Monroe,

Oakland, Wayne, and

Washtenaw Counties

1 174 175

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Life Circles PACE Muskegon County, parts of

Allegan and Ottawa

Counties

11 300 311

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE of Southeast MI PACE Macomb, Oakland, and

Wayne Counties

37 715 752

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE of Southwest MI PACE Berrien, Cass, and Van

Buren Counties

4 167 171

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Senior Care Partners PACE Calhoun, Kalamazoo,

Allegan, Barry, and Van

Buren Counties

18 396 414

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Senior Community

Care

PACE Barry, Clinton, Eaton,

Ingham, Ionia, Livingston,

and Shiawassee Counties

11 139 150

Michigan PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Thome PACE PACE Hillsdale, Jackson, and

Lenawee Counties

6 104 110

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

Health Partners Health Partners,

Inc.

Statewide 2,387 2,795 5,182

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

Hennepin Health Hennepin Health

Systems

Hennepin County 1,143 858 2,001

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

Medica Medica Holding

Company

Statewide 5,956 6,833 12,789

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

Prime West Prime West Health Beltrami, Bigstone,

Clearwater, Douglas, Grant,

Hubbard, McLeod, Meeker,

Pipestone, Pope, Renville,

Stevens, and Traverse

Counties

802 1,423 2,225

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

South Country South Country

Health Alliance

Brown, Dodge, Freeborn,

Kanabec, Morrison, Sibley,

Steele, Todd, Wabasha,

Wadena, and Waseca

Counties

987 1,957 2,944

Minnesota Special Needs Basic

Care (SNBC)

(Comprehensive MCO

+ MLTSS)

U Care U Care of

Minnesota

Statewide 13,781 14,795 28,576

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

Blue Plus Blue Cross Blue

Shield

Statewide 325,097 0 325,097

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

Health Partners Health Partners,

Inc.

Statewide 135,270 0 135,270

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

Hennepin Health Hennepin Health

Systems

Hennepin County 23,811 0 23,811

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

Itasca Medical Care Itasca Medical

Care

Itasca County 7,282 0 7,282

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

Prime West Prime West Health Beltrami, Bigstone,

Clearwater, Douglas, Grant,

Hubbard, McLeod, Meeker,

Pipestone, Pope, Renville,

Stevens, and Traverse

Counties

34,842 0 34,842

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

South Country South Country

Health Alliance

Brown, Dodge, Freeborn,

Kanabec, Morrison, Sibley,

Steele, Todd, Wabasha,

Wadena, and Waseca

Counties

32,964 0 32,964

Minnesota Prepaid Medical

Assistance Plan Plus

(PMAP+)

(Comprehensive MCO

+ MLTSS)

U Care U Care of

Minnesota

Statewide 224,055 0 224,055

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

Blue Plus Blue Cross Blue

Shield

Statewide 397 3,057 3,454

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

Health Partners Health Partners,

Inc.

Statewide 271 2,000 2,271

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

Itasca Medical Care Itasca Medical

Care

Itasca County 2 216 218

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

Medica Medica Holding

Company

Statewide 567 3,400 3,967

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

Prime West Prime West Health Beltrami, Bigstone,

Clearwater, Douglas, Grant,

Hubbard, McLeod, Meeker,

Pipestone, Pope, Renville,

Stevens, and Traverse

Counties

19 817 836

100

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

South Country South Country

Health Alliance

Brown, Dodge, Freeborn,

Kanabec, Morrison, Sibley,

Steele, Todd, Wabasha,

Wadena, and Waseca

Counties

34 798 832

Minnesota Minnesota Senior

Care Plus (MSC+)

(Comprehensive MCO

+ MLTSS)

U Care U Care of

Minnesota

Statewide 1,353 3,360 4,713

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

Blue Plus Blue Cross Blue

Shield

Statewide 0 8,607 8,607

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

Health Partners Health Partners,

Inc.

Statewide 0 3,114 3,114

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

Itasca Medical Care Itasca Medical

Care

Itasca County 0 453 453

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

Medica Medica Holding

Company

Statewide 0 10,746 10,746

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

Prime West Prime West Health Beltrami, Bigstone,

Clearwater, Douglas, Grant,

Hubbard, McLeod, Meeker,

Pipestone, Pope, Renville,

Stevens, and Traverse

Counties

0 1,920 1,920

101

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

South Country South Country

Health Alliance

Brown, Dodge, Freeborn,

Kanabec, Morrison, Sibley,

Steele, Todd, Wabasha,

Wadena, and Waseca

Counties

0 1,828 1,828

Minnesota Minnesota Senior

Health Option (MSHO)

(Comprehensive MCO

+ MLTSS)

U Care U Care of

Minnesota

Statewide 0 12,140 12,140

Mississippi Mississippi

Coordinated Access

Network

(MississippiCAN)

(Comprehensive

MCO)

Magnolia Health Plan Centene

Corporation

Statewide 232,443 0 232,443

Mississippi Mississippi

Coordinated Access

Network

(MississippiCAN)

(Comprehensive

MCO)

UnitedHealthcare of

Mississippi Community

Plan

UnitedHealthcare Statewide 209,339 0 209,339

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Home State Health

Eastern

Centene

Corporation

Franklin, Jefferson, Lincoln,

Madison, Perry, Pike, St

Charles, St Francois, Ste

Genevieve, St Louis Co,

Warren, Washington, and St

Louis City

104,539 0 104,539

102

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Home State Health

Central

Centene

Corporation

Adair, Andrew, Atchison,

Audrain, Benton, Bollinger,

Boone, Buchanan, Butler,

Caldwell, Callaway,

Camden, Cape Girardeau,

Carroll, Carter, Chariton,

Clark, Clinton, Cole, Cooper,

Crawford, Daviess, DeKalb,

Dent, Dunklin, Gasconade,

Gentry, Grundy, Harrison,

Holt, Howard, Iron, Knox,

Laclede, Lewis, Linn,

Livingston, Macon, Maries,

Marion, Mercer, Miller,

Mississippi, Moniteau,

Monroe, Montgomery,

Morgan, New Madrid,

Nodaway, Osage, Pettis,

Phelps, Pulaski, Putman,

Ralls, Randolph, Reynolds,

Ripley, Saline, Schuyler,

Scotland, Scott, Shelby,

Stoddard, Sullivan, Wayne

and Worth

63,646 0 63,646

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Home State Health

Western

Centene

Corporation

Bates, Cass, Cedar, Clay,

Henry, Jackson, Johnson,

Lafayette, Platte, Polk, Ray,

St Clair, and Vernon

50,541 0 50,541

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Home State Health

Southwest

Centene

Corporation

Barry, Barton, Christian,

Dade, Dallas, Douglas,

Greene, Hickory, Howell,

Jasper, Lawrence,

McDonald, Newton, Oregon,

Ozark, Shannon, Stone,

Taney, Texas, Webster and

Wright

46,983 0 46,983

103

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Missouri Care Eastern WellCare Franklin, Jefferson, Lincoln,

Madison, Perry, Pike, St

Charles, St Francois, Ste

Genevieve, St Louis Co,

Warren, Washington, and St

Louis City

75,195 0 75,195

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Missouri Care Central WellCare Adair, Andrew, Atchison,

Audrain, Benton, Bollinger,

Boone, Buchanan, Butler,

Caldwell, Callaway,

Camden, Cape Girardeau,

Carroll, Carter, Chariton,

Clark, Clinton, Cole, Co

oper,

Crawford, Daviess, DeKalb,

Dent, Dunklin, Gasconade,

Gentry, Grundy, Harrison,

Holt, Howard, Iron, Knox,

Laclede, Lewis, Linn,

Livingston, Macon, Maries,

Marion, Mercer, Miller,

Mississippi, Moniteau,

Monroe, Montgomery,

Morgan, New Madrid,

Nodaway, Osage, Pettis,

Phelps, Pulaski, Putman,

Ralls, Randolph, Reynolds,

Ripley, Saline, Schuyler,

Scotland, Scott, Shelby,

Stoddard, Sullivan, Wayne

and Worth

79,314 0 79,314

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Missouri Care Western WellCare Bates, Cass, Cedar, Clay,

Henry, Jackson, Johnson,

Lafayette, Platte, Polk, Ray,

St Clair, and Vernon

71,377 0 71,377

104

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

Missouri Care

Southwest

WellCare Barry, Barton, Christian,

Dade, Dallas, Douglas,

Greene, Hickory, Howell,

Jasper, Lawrence,

McDonald, Newton,

Oregon,

Ozark, Shannon, Stone,

Taney, Texas, Webster and

Wright

52,537 0 52,537

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

United Healthcare

Eastern

UnitedHealthcare Franklin, Jefferson, Lincoln,

Madison, Perry, Pike, St

Charles, St Francois, Ste

Genevieve, St Louis Co,

Warren, Washington, and St

Louis City

51,016 0 51,016

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

United Healthcare

Central

UnitedHealthcare Adair, Andrew, Atchison,

Audrain, Benton, Bollinger,

Boone, Buchanan, Butler,

Caldwell, Callaway,

Camden, Cape Girardeau,

Carroll, Carter, Chariton,

Clark, Clinton, Cole, Cooper,

Crawford, Daviess, DeKalb,

Dent, Dunklin, Gasconade,

Gentry, Grundy, Harrison,

Holt, Howard, Iron, Knox,

Laclede, Lewis, Linn,

Livingston, Macon, Maries,

Marion, Mercer, Miller,

Mississippi, Moniteau,

Monroe, Montgomery,

Morgan, New Madrid,

Nodaway, Osage, Pettis,

Phelps, Pulaski, Putman,

Ralls, Randolph, Reynolds,

Ripley, Saline, Schuyler,

Scotland, Scott, Shelby,

Stoddard, Sullivan, Wayne

and Worth

48,376 0 48,376

105

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

United Healthcare

Western

UnitedHealthcare Barry, Barton, Christian,

Dade, Dallas, Douglas,

Greene, Hickory, Howell,

Jasper, Lawrence,

McDonald, Newton, Oregon,

Ozark, Shannon, Stone,

Taney, Texas, Webster and

Wright

37,865 0 37,865

Missouri MO HealthNet

Managed Care/1915b

(Comprehensive

MCO)

United Healthcare

Southwest

UnitedHealthcare Barry, Barton, Christian,

Dade, Dallas, Douglas,

Greene, Hickory, Howell,

Jasper, Lawrence,

McDonald, Newton, Oregon,

Ozark, Shannon, Stone,

Taney, Texas, Webster and

Wright

30,946 0 30,946

Missouri Non-Emergency

Medical Transportation

Program (NEMT)

(Non-Emergency

Medical

Transportation)

Logisticare Solutions Providence

Service

Corporation

Statewide 98,690 143,578 242,268

Montana Passport to Health

(Primary Care Case

Management (PCCM))

Multiple Primary Care

Providers

Passport to Health Statewide 215,475 0 215,475

Nebraska Heritage Health

(Comprehensive

MCO)

UnitedHealthcare

Community Plan of

Nebraska

UnitedHealthcare Statewide 69,592 12,626 82,218

Nebraska Heritage Health

(Comprehensive

MCO)

WellCare of Nebraska WellCare Statewide 76,075 7,718 83,793

Nebraska Heritage Health

(Comprehensive

MCO)

Nebraska Total Care Nebraska Total

Care Inc.

Statewide 68,879 13,942 82,821

106

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Nebraska Dental Benefit

Manager (Dental only

(PAHP))

MCNA Nebraska Managed Care of

North America

(MCNA), Inc.

Statewide 213,334 34,246 247,580

Nebraska Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Immanuel Pathways Immanual

Pathways

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

22 168 190

Nevada Mandatory Health

Maintenance Program

(Comprehensive

MCO)

Health Plan of Nevada

(HPN)

UnitedHealthcare Urban zip codes in Washoe

and Clark Counties

242,408 0 242,408

Nevada Mandatory Health

Maintenance Program

(Comprehensive

MCO)

Anthem Blue Cross

Blue Shield of Nevada

Anthem BCBS Urban zip codes in Washoe

and Clark Counties

165,519 0 165,519

Nevada Mandatory Health

Maintenance Program

(Comprehensive

MCO)

Silver Summit Health

Plan

Centene

Corporation

Urban zip codes in Washoe

and Clark Counties

49,855 0 49,855

107

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Nevada Dental Benefits

Administrator (Dental

only (PAHP))

Liberty Dental Plan of

Nevada

Liberty Dental Plan

Corporation

Sufficiently populated Urban

Zip Codes in Washoe and

Clark counties

457,782 0 457,782

Nevada Non-Emergency

Transportation (Non-

Emergency Medical

Transportation)

Medical Transportation

Management (MTM

Nevada)

MTM Inc Statewide 588,111 0 588,111

New Hampshire New Hampshire

Medicaid Care

Management

(Comprehensive

MCO)

New Hampshire

Healthy Families

Centene

Corporation

Statewide 49,599 8,341 57,940

New Hampshire New Hampshire

Medicaid Care

Management

(Comprehensive

MCO)

Well Sense Health Plan Boston Medical

Health Plan

Statewide 60,024 7,980 68,004

New Hampshire New Hampshire

Health Protection

Program Medicaid

Care Management

ABP (Comprehensive

MCO)

New Hampshire

Healthy Families

Centene

Corporation

Statewide 3,158 0 3,158

New Hampshire New Hampshire

Health Protection

Program Medicaid

Care Management

ABP (Comprehensive

MCO)

Well Sense Health Plan Boston Medical

Health Plan

Statewide 4,727 0 4,727

New Jersey NJFamilyCare

(Comprehensive MCO

+ MLTSS)

Aetna Better Health NJ CVS Health Statewide 43,062 5,194 48,256

New Jersey NJFamilyCare

(Comprehensive MCO

+ MLTSS)

Amerigroup New

Jersey Inc

Anthem Insurance

Companies, Inc.

Statewide 148,670 16,743 165,413

108

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New Jersey NJFamilyCare

(Comprehensive MCO

+ MLTSS)

Horizon NJ Health Blue Cross Blue

Shield

Statewide 748,954 72,804 821,758

New Jersey NJFamilyCare

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan

UnitedHealthcare Statewide 396,903 34,653 431,556

New Jersey NJFamilyCare

(Comprehensive MCO

+ MLTSS)

WellCare of New

Jersey

WellCare All counties except

Hunterdon

51,242 12,195 63,437

New Jersey FIDE SNP

(Comprehensive MCO

+ MLTSS)

Amerivantage Dual

Coordination (HMO

SNP)

Amerigroup, Inc. Atlantic, Bergen, Burlington,

Camden, Cumberland,

Essex, Gloucester, Hudson,

Mercer, Middlesex,

Monmouth, Morris, Ocean,

Passaic, Somerset, and

Union Counties

0 9,221 9,221

New Jersey FIDE SNP

(Comprehensive MCO

+ MLTSS)

Horizon NJ TotalCare

(HMO SNP)

Horizon

Healthcare of New

Jersey, Inc.

Atlantic, Cumberland,

Essex, Gloucester, Hudson,

Hunterdon, Mercer,

Monmouth, Morris, Passaic,

Salem, Somerset, Sussex,

Union, and Warren Counties

0 6,781 6,781

New Jersey FIDE SNP

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare Dual

Complete ONE (HMO

SNP)

UnitedHealthcare Atlantic, Bergen, Burlington,

Camden, Cumberland,

Essex, Gloucester, Hudson,

Hunterdon, Mercer,

Middlesex, Monmouth,

Morris, Ocean, Passaic,

Salem, Somerset, Sussex,

and Union Counties

0 19,158 19,158

New Jersey FIDE SNP

(Comprehensive MCO

+ MLTSS)

WellCare Liberty (HMO

SNP)

WellCare Bergen, Essex, Hudson,

Middlesex, Morris, Passaic,

Somerset, and Union

Counties

0 2,697 2,697

109

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New Jersey Non-Emergency

Medical Transportation

(Non-Emergency

Medical

Transportation)

Logisticare Providence

Service

Corporation

Statewide 1,523,821 37,445 1,561,266

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Atlanticare LIFE PACE Atlantic and Cape May

Counties

9 35 44

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Beacon of LIFE PACE Monmouth County 8 98 106

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Inspira LIFE PACE Portions of Cumberland,

Gloucester and Salem

Counties, specifically,

residents of zip codes:

08028, 08062, 08071,

08094, 08098, 08302,

08311, 08312, 08314,

08316, 08318, 08321,

08322, 08323, 08324,

08327, 08328, 08329,

08332, 08343, 08344,

08345, 08348, 08349,

08352, 08353, 08360,

08361, 08362

23 245 268

110

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

LIFE at Lourdes PACE Most of Camden County,

some of Burlington County,

and zip codes: 08002,

08003, 08004, 08007,

08009, 08012, 08021,

08026, 08029, 08030,

08031, 08033, 08034,

08035, 08043, 08045,

08049, 08052, 08059,

08065, 08076, 08077,

08078, 08081, 08083,

08084, 08091, 08095,

08099, 08101, 08102,

08103, 08104, 08105,

08106, 08107, 08108,

08109, 08110

22 177 199

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

LIFE St. Francis PACE Mercer County and those

who reside in Burlington

County with one of the

following zip codes: 08015,

08016, 08022, 08060,

08068, 08505, 08515,

08518, 08554

36 281 317

New Jersey PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Lutheran Senior Life PACE Most of Hudson County,

including residents of zip

codes: 07002, 07030,

07047, 07086, 07087,

07093, 07094, 07302,

07304, 07305, 07306,

07307, 07310, 07311

13 120 133

New Mexico Centennial Care

(Comprehensive MCO

+ MLTSS)

Blue Cross Blue Shield

of NM

Blue Cross Blue

Shield

Statewide 138,619 8,292 146,911

New Mexico Centennial Care

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

New Mexico Inc

Molina Healthcare Statewide 203,235 8,201 211,436

111

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New Mexico Centennial Care

(Comprehensive MCO

+ MLTSS)

Presbyterian Health

Plan

Presbyterian

Health Plan

Statewide 212,275 8,223 220,498

New Mexico Centennial Care

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan

UnitedHealthcare Statewide 69,821 16,584 86,405

New Mexico Program of All-

Inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Innovage New Mexico

PACE dba Total

Community Care

PACE Bernalillo County, Sandoval

County, Valencia County

59 741 800

New York Health and Recovery

Plans (Comprehensive

MCO)

Affinity Health Plan Affinity Health Plan Nassau, Orange, Rockland,

Suffolk and Westchester

Counties, New York City

4,355 0 4,355

New York Health and Recovery

Plans (Comprehensive

MCO)

Capital District

Physician's Health Plan

Capital District

Physician's Health

Plan

Albany, Broome, Columbia,

Fulton, Greene,

Montgomery, Rensselaer,

Saratoga, Schenectady,

Schoharie, Tioga, Warren

and Washington Counties

2,782 0 2,782

New York Health and Recovery

Plans (Comprehensive

MCO)

Excellus Health Plan Excellus Health

Plan

Broome, Erie, Herkimer,

Livingston, Monroe, Oneida,

Ontario, Orleans, Otsego,

Seneca, Wayne, and Yates

Counties

7,293 0 7,293

New York Health and Recovery

Plans (Comprehensive

MCO)

Fidelis Care Centene

Corporation

New York City and 57

counties

29,706 0 29,706

New York Health and Recovery

Plans (Comprehensive

MCO)

HealthFirst HealthFirst Nassau and Suffolk

Counties, New York City

23,526 0 23,526

112

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Health and Recovery

Plans (Comprehensive

MCO)

HealthPlus Anthem Insurance

Companies, Inc.

Nassau and Putnam

Counties, New York City

5,935 0 5,935

New York Health and Recovery

Plans (Comprehensive

MCO)

HIP GNY HIP GNY Nassau, Suffolk, and

Westchester Counties, New

York City

4,635 0 4,635

New York Health and Recovery

Plans (Comprehensive

MCO)

Independent Health

Association

Independent

Health

Erie County 1,925 0 1,925

New York Health and Recovery

Plans (Comprehensive

MCO)

MetroPlus MetroPlus Health

Plan

New York City 10,901 0 10,901

New York Health and Recovery

Plans (Comprehensive

MCO)

Molina HealthCare of

New York

Molina Healthcare Cortland, Onondaga and

Tompkins Counties

1,484 0 1,484

New York Health and Recovery

Plans (Comprehensive

MCO)

MVP Health Plan MVP Health Plan Albany, Columbia,

Dutchess, Genesee,

Greene, Jefferson, Lewis,

Livingston, Monroe, Oneida,

Ontario, Orange, Putnam,

Rensselaer, Rockland,

Saratoga, Schenectady,

Sullivan, Ulster, Warren,

Washington, and

Westchester Counties

4,673 0 4,673

New York Health and Recovery

Plans (Comprehensive

MCO)

United HealthCare UnitedHealthcare New York City and 42

counties

6,813 0 6,813

New York Health and Recovery

Plans (Comprehensive

MCO)

YourCare Health Plan YourCare Health

Plan

Allegany, Cattaraugus,

Chautauqua, Erie, Monroe,

Ontario and Wyoming

Counties

1,785 0 1,785

113

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Medicaid Advantage

(Comprehensive

MCO)

Affinity Affinity Health Plan New York City 0 0 0

New York Medicaid Advantage

(Comprehensive

MCO)

Fidelis Legacy Plan Fidelis Legacy

Plan

New York City and 35

counties

33 1,325 1,358

New York Medicaid Advantage

(Comprehensive

MCO)

Liberty Health

Advantage

Liberty Health

Advantage

New York City and Nassau

County

96 0 96

New York Medicaid Advantage

(Comprehensive

MCO)

United HealthCare UnitedHealthcare New York City and Nassau

County

21 2,920 2,941

New York Medicaid Advantage

(Comprehensive

MCO)

VNS Choice VNS Choice Nassau, Suffolk and

Westchester Counties, New

York City

15 298 313

New York Medicaid Advantage

(Comprehensive

MCO)

WellCare WellCare Albany, Broome, Erie,

Monroe, Niagara, Oneida,

Orange, Rensselaer,

Rockland, Saratoga,

Schenectady, Ulster, and

Wayne Counties

51 1,642 1,693

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

HealthNow HealthNow Allegany, Cattaraugus,

Chautauqua, Erie, Genesee,

Niagara, Orleans, and

Wyoming Counties

31,719 0 31,719

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

HealthPlus Anthem Insurance

Companies, Inc.

Nassau and Putnam

Counties, New York City

336,121 0 336,121

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

HIP Combined HIP Combined Nassau, Suffolk, and

Westchester Counties, New

York City

134,405 0 134,405

114

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Independent

Health/Hudson Valley &

WNY

Independent

Health

Erie County 57,271 0 57,271

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

MetroPlus Health Plan MetroPlus Health

Plan

New York City 374,574 0 374,574

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

MetroPlus Health Plan

Special Needs

MetroPlus Health

Plan

New York City 4,095 0 4,095

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Molina Healthcare of

New York

Molina Healthcare Cortland, Onondaga, and

Tompkins Counties

28,592 0 28,592

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

MVP Health Plan MVP Health Plan Albany, Columbia,

Dutchess, Genesee,

Greene, Jefferson, Lewis,

Livingston, Monroe, Oneida,

Ontario, Orange, Putnam,

Rensselaer, Rockland,

Saratoga, Schenectady,

Sullivan, Ulster, Warren,

Washington, and

Westchester Counties

167,637 0 167,637

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

United HealthCare UnitedHealthcare New York City and 42

counties

481,881 0 481,881

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

VNS Choice Special

Needs

VNS Choice New York City 3,313 0 3,313

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

WellCare WellCare Albany, Dutchess, Erie,

Nassau, Niagara, Orange,

Rensselaer, Rockland,

Schenectady, Schuyler,

Steuben, and Ulster

Counties, New York City

104,961 0 104,961

115

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

YourCare Health Plan YourCare Health

Plan

Allegany, Cattaraugus,

Chautauqua, Erie, Monroe,

Ontario, and Wyoming

Counties

38,679 0 38,679

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Fidelis Care Centene

Corporation

New York City and 57

Counties

1,244,926 0 1,244,926

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

HealthFirst HealthFirst Nassau and Suffolk

Counties, New York City

939,799 0 939,799

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Affinity Health Plan Affinity Health Plan Nassau, Orange, Rockland,

Suffolk, and Westchester

Counties, New York City

213,679 0 213,679

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Amida Care Special

Needs

Amida Care

Special Needs

New York City 6,488 0 6,488

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Capital District

Physician's Health Plan

Capital District

Physician's Health

Plan

Albany, Broome, Clinton,

Columbia, Essex, Franklin,

Fulton, Greene,

Montgomery, Rensselaer,

Saratoga, Schenectady,

Schoharie, Tioga, Warren,

and Washington Counties

82,622 0 82,622

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Crystal Run Health

Plan

Crystal Run Health

Plan

Orange and Sullivan

Counties

1,427 0 1,427

New York Medicaid Managed

Care (Comprehensive

MCO + MLTSS)

Excellus Health Plan Excellus Health

Plan

Broome, Erie, Herkimer,

Livingston, Monroe, Oneida,

Ontario, Orleans, Otsego,

Seneca, Wayne, and Yates

Counties

171,752 0 171,752

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

ElderPlan ElderPlan Nassau and Westchester

Counties, New York City

6 1,397 1,403

116

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

Fidelis Legacy Plan Fidelis Legacy

Plan

Albany, Montgomery,

Rensselaer, and

Schenectady Counties, New

York City

2 94 96

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

GuildNet GuildNet New York City 2 453 455

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

HealthFirst HealthFirst Nassau County and New

York City

22 7,038 7,060

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

HealthPlus Advantage

Plus

HealthPlus

Advantage Plus

New York City 0 2 2

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

Senior Whole Health Senior Whole

Health

Nassau and Westchester

Counties, New York City

0 91 91

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

Village Care Village Care New York City 5 585 590

New York Medicaid Advantage

Plus (Comprehensive

MCO + MLTSS)

VNS Choice Plus VNS Choice Nassau, Suffolk, and

Westchester Counties, New

York City

8 1,439 1,447

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Aetna Better Health Aetna Nassau and Suffolk

Counties, New York City

321 5,919 6,240

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

AgeWell New York AgeWell New York Nassau, Suffolk, and

Westchester Counties, New

York City

308 9,309 9,617

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

AlphaCare AlphaCare Westchester County and

New York City

3 0 3

117

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

ArchCare Community

Life

ArchCare Putnam and Westchester

Counties, New York City

441 3,422 3,863

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Centers Plan for

Healthy Living

Centers Plan for

Healthy Living

Erie, Nassau, Niagara,

Rockland, Suffolk, and

Westchester Counties, New

York City

4,141 24,805 28,946

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

ElderPlan ElderPlan Dutchess, Nassau, Orange,

Putnam, Rockland, Suffolk,

Sullivan, Ulster, and

Westchester Counties, New

York City

807 12,095 12,902

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

ElderServe ElderServe Nassau, Suffolk, and

Westchester Counties, New

York City

1,025 11,319 12,344

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

ElderWood ElderWood Erie, Genesee, Monroe,

Niagara, Orleans, and

Wyoming Counties, New

York City

11 299 310

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Extended MLTC Extended MLTC Nassau and Suffolk

Counties, New York City

507 4,217 4,724

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Fallon Health Weinberg Fallon Health Plan Erie and Niagara Counties 69 657 726

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Fidelis Care Fidelis Care New York City and 57

counties

1,366 20,000 21,366

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

GuildNet GuildNet Nassau, Suffolk, and

Westchester Counties, New

York City

557 6,892 7,449

118

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Hamaspik Choice Hamaspik Choice Dutchess, Orange, Putnam,

Rockland, Sullivan, and

Ulster Counties

122 2,069 2,191

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Health Advantage/Elant

Choice

Health

Advantage/Elant

Choice

Dutchess, Orange, and

Rockland Counties

80 907 987

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

HealthPlus HealthPlus New York City 429 4,621 5,050

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

iCircle Care iCircle Care Broome, Cayuga, Chemung,

Chenango, Cortland,

Genesee, Livingston,

Madison, Monroe,

Onondaga, Ontario,

Orleans, Oswego, Otsego,

Schuyler, Seneca, Steuben,

Tioga, Tompkins, Wayne,

Wyoming, and Yates

Counties

120 2,522 2,642

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Independent Care

Systems

iCare New York City 982 5,292 6,274

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Integra Integra Nassau, Suffolk, and

Westchester Counties, New

York City

1,868 9,879 11,747

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Kalos Health Plan Kalos Health Plan Chautauqua, Erie, Genesee,

Monroe, Niagara, and

Orleans Counties

52 1,238 1,290

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

MetroPlus MetroPlus Health

Plan

New York City 561 1,291 1,852

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Montefiore Montefiore Westchester County and

New York City

128 1,385 1,513

119

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

North Shore - LIJ

Health Plan

North Shore - LIJ

Health Plan

Nassau and Suffolk

Counties, New York City

15 0 15

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Prime Health Choice Prime Health

Choice

Albany, Dutchess, Orange,

Putnam, Rockland, Warren,

and Washington Counties

28 352 380

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Senior Health Partners Senior Health

Partners

Nassau and Westchester

Counties, New York City

2,158 12,303 14,461

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Senior Network Health Senior Network

Health

Herkimer and Oneida

Counties

23 526 549

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Senior Whole Health Senior Whole

Health

Westchester County and

New York City

1,747 12,124 13,871

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

United HealthCare UnitedHealthcare Albany, Broome, Erie,

Monroe, Oneida, Onondaga,

Orange, and Rockland

Counties

167 4,066 4,233

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

Village Care Village Care New York City 2,004 8,679 10,683

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

VNA HomeCare

Options

VNA HomeCare

Options

48 counties 262 6,498 6,760

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

VNS Choice VNS Choice New York City and 28

counties

792 11,969 12,761

New York Managed Long Term

Care (MLTSS only

(PIHP and/or PAHP))

WellCare Advocate WellCare Albany, Erie, Nassau,

Orange, Rockland, Suffolk,

Ulster, and Westchester

Counties, New York City

284 5,235 5,519

120

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

ArchCare Senior Life PACE Westchester County and

New York City

81 644 725

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Catholic Health - Life PACE Erie County 14 232 246

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

CenterLight (CCM) PACE Nassau, Suffolk, and

Westchester Counties, New

York City

414 2,408 2,822

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Complete Senior Care PACE Niagara County 7 111 118

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Eddy Senior Care PACE Albany and Schenectady

Counties

17 199 216

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Fallon Health Weinberg PACE Erie County 4 116 120

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Independent Living for

Seniors

PACE Monroe, Ontario and Wayne

Counties

28 744 772

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE CNY PACE Onondaga County 22 541 563

New York PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Total Senior Care PACE Allegany, Cattaraugus, and

Chautauqua Counties

14 98 112

North Carolina Community Care of

North Carolina

(Primary Care Case

Management Entity

(PCCM Entity))

North Carolina

Community Care

Carolina Access

Community Care

Health Plan (WI)

Statewide 1,341,900 151,447 1,493,347

121

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Alliance Behavioral

Healthcare

Alliance

Behavioral

Healthcare

Counties: Cumberland,

Durham, Johnston, Wake

212,280 22,741 235,021

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Cardinal Innovations

Healthcare Solutions

Cardinal

Innovations

Healthcare

Solutions

Counties: Alamance,

Cabarrus, Caswell,

Chatham, Davidson, Davie,

Forsyth, Franklin, Granville,

Halifax, Mecklenburg,

Orange, Rockingham,

Person, Rowan, Stanly,

Stokes, Union, Vance and

Warren

410,013 49,011 459,024

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Eastpointe Human

Services

Eastpointe Human

Services

Counties: Bladen,

Columbus, Duplin,

Edgecombe, Greene,

Lenoir, Nash, Robeson,

Sampson, Scotland, Wayne,

Wilson

149,171 23,487 172,658

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Partners Behavioral

Health Management

Partners

Behavioral Health

Management

Counties: Burke, Catawba,

Cleveland, Gaston, Iredell,

Lincoln, Surry, Yadkin

132,093 18,235 150,328

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Sandhills Center for

MH DD SA

Sandhills Center

for MH DD SA

Counties: Anson, Guilford,

Harnett, Hoke, Lee,

Montgomery, Moore,

Randolph, Richmond

168,686 20,816 189,502

122

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Trillium Health

Resources

Trillium Health Counties: Brunswick,

Carteret, New Hanover,

Onslow, Pender, Beaufort,

Bertie, Camden, Chowan,

Craven, Currituck, Dare,

Gates, Hertford, Hyde,

Jones, Martin, Northampton,

Pamlico, Pasquotank,

Perquimans, Pitt, Tyrrell,

Washington

181,765 28,257 210,022

North Carolina 1915(b)/(c) Medicaid

Waiver for MH/DD/SA

Services (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

VAYA Health VAYA Health Counties: Alexander,

Alleghany, Ashe, Avery,

Buncombe, Caldwell,

Cherokee, Clay, Graham,

Haywood, Henderson,

Jackson, Macon, Madison,

McDowell, Mitchell, Polk,

Rutherford, Swain,

Transylvania, Watauga,

Wilkes, Yancey

137,852 24,570 162,422

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Carolina Seniorcare Carolina

Seniorcare

Serving the following zip

codes in Davidson, Davie,

Iredell and Rowan Counties:

27012, 27107, 27127,

27239, 27262, 27265,

27284, 27292, 27295,

27299, 27360, 28127,

27013, 27054, 28023,

28071, 28081, 28083,

28088, 28125, 28137,

28138, 28144, 28146,

28147, 28159, 27006,

27028, 27013, 27020,

28115, 28117, 28166,

28625, 28634, 28636,

28660, 28677, 28689

145 61 206

123

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Community

Carepartners, Inc.

Community Care

Health Plan (WI)

Serving the following zip

codes in Buncombe and

Henderson Counties: 28701,

28704, 28709, 28710,

28711, 28715, 28726,

28729, 28730, 28731,

28732, 28735, 28739,

28742, 28748, 28757,

28758, 28759, 28766,

28773, 28778, 28787,

28784, 28790, 28791,

28792, 28801, 28803,

28804, 28805, 28806,

28810

118 48 166

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Elderhaus, Inc. Elderhaus, Inc. New Hanover County and

the following zip codes in

Brunswick County: 28422,

28451, 28461, 28479 and

the following zip code in

Pender County: 28443

89 34 123

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Life St. Joseph of the

Pines, Inc.

Life St. Joseph of

the Pines, Inc.

Serving the following zip

codes in Cumberland,

Harnett Hoke, Moore and

Robeson Counties: 28301,

28302, 28303, 28304,

28305, 28306, 28307,

28308, 28309, 28310,

28311, 28312, 28314,

28318, 28342, 28344,

28348, 28356, 28371,

28382, 28390, 28391,

28395, 28315, 28326,

28373, 28376, 28357,

28371, 28377, 28384,

28315, 28357, 28376,

28377, 28386, 28314,

28334, 28339

176 98 274

124

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

PACE at Home, Inc. PACE Catawba County and

portions of zip codes in

Alexander, Burke, Caldwell

and Lincoln Counties:

28037, 28092, 28168,

28601, 28602, 28609,

28610, 28612, 28613,

28630, 28637, 28638,

28650, 28658, 28673,

28678, 28681, 28682,

28690

107 38 145

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

PACE of the Southern

Piedmont

PACE Serving the following zip

codes in Mecklenburg,

Cabarrus, Stanly and Union

Counties: 28025, 28027,

28031, 28036, 28071,

28075, 28078, 28079,

28081, 28083, 28097,

28103, 28104, 28105,

28107, 28109, 28110,

28112, 28124, 28129,

28134, 28137, 28138,

28215, 28163, 28173,

28174, 28202, 28203,

28204, 28205, 28206,

28207, 28208, 28209,

28210, 28211, 28212,

28213, 28214, 28216,

28217, 28223, 28226,

28227, 28244, 28226,

28227, 28244, 28246,

28254, 28262, 28269,

28270, 28273, 28274,

28277, 28278, 28280,

28281, 28282, 28284,

28285, 28287

121 41 162

125

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

PACE of the Triad PACE Serving the following zip

codes in Guilford and

Rockingham Counties:

27027, 27048, 27288,

27235, 27282, 27301,

27310, 27377, 27401,

27403, 27405, 27406,

27407, 27408, 27409,

27410, 27455, 27495,

27025, 27214, 27233,

27244, 27249, 27260,

27262, 27263, 27265,

27283, 27284, 27298,

27311, 27313, 27320,

27326, 27357, 27358

146 59 205

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Piedmont Health

Services, Inc.

Piedmont Health

Services, Inc.

Serving the following zip

codes in Alamance,

Caswell, Orange, Chatham,

Lee Counties and the

portion of 27278 located in

Durham County: 27231,

27243, 27278, 27302,

27510, 27514, 27516,

27517, 27541, 27572,

27705, 27583, 27707,

27712, 27207, 27208,

27252, 27298, 27312,

27330, 27344, 27349,

27355, 27502, 27519,

27523, 27559, 27562,

27713, 27330, 27332,

27505, 28326

191 136 327

126

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior Total Life Care,

Inc.

Senior Total Life

Care, Inc.

Serving the following zip

codes in Cleveland, Gaston

and Lincoln Counties:

28006, 28012, 28016,

28021, 28032, 28033,

28034, 28052, 28053,

28054, 28055, 28056,

28077, 28080, 28086,

28092, 28098, 28101,

28120, 28164, 28021,

28073, 28086, 28150,

28152, 28006, 28021,

28033, 28080, 28164

147 64 211

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Stay Well Senior Care Stay Well Senior

Care

Serving the following zip

codes in Montgomery,

Moore and Randolph

Counties: 27203, 27205,

27208, 27233, 27239,

27248, 27260, 27263,

27283, 27292, 27298,

27313, 27316, 27317,

27325, 27341, 27344,

27350, 27355, 27360,

27370, 27371, 28127,

27209, 27229, 27281,

27306, 27341, 27356,

27371, 28127, 27208,

27209, 27242, 27281,

27325, 27330, 27341,

27356, 27376, 28327,

28347, 28350, 28374,

28387, 28394

69 35 104

127

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Carolina Program of All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

VOANS Senior

Community Care

Health Plan (WI)

Serving the following zip

codes in Durham, Wake

County: 27503, 27613,

27701, 27703, 27704,

27705, 27706, 27707,

27712, 27713, 27502,

27511, 27513, 27518,

27519, 27523, 27526,

27529, 27539, 27540,

27545, 27560, 27562,

27571, 27587, 27591,

27592, 27597, 27601,

27603, 27604, 27605,

27606, 27607, 27608,

27609, 27610, 27612,

27613, 27614, 27615,

27616, 27617 and Granville

County zip codes: 27509,

27522

123 66 189

North Dakota North Dakota Medicaid

Expansion

(Comprehensive

MCO)

ND Medicaid

Expansion MCO

Sanford Health

Plan

Statewide 19,515 0 19,515

North Dakota PCCM (Primary Care

Case Management

(PCCM))

Multiple Primary Care

Providers

Multiple Primary

Care Provider

(PCCM)

Statewide 48,957 0 48,957

North Dakota Health Management

Program (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Health Management US Care

Management

Statewide 0 0 0

128

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

North Dakota PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE PACE Zip codes: 58501, 58502,

58503 (Bismarck), 58504

(Lincoln), 58554 (Mandan),

58558 (Menoken), 58601,

58602 (Dickinson), 58652

(Richardton), 58655 (South

Heart), 58656 (Taylor),

58701, 58702, 58703,

58722, 58785 (Minot)

12 169 181

Ohio Ohio Medicaid

Managed Care

Program

(Comprehensive

MCO)

Buckeye Health Plan Centene

Corporation

Statewide 307,779 0 307,779

Ohio Ohio Medicaid

Managed Care

Program

(Comprehensive

MCO)

CareSource CareSource Statewide 1,254,635 0 1,254,635

Ohio Ohio Medicaid

Managed Care

Program

(Comprehensive

MCO)

Molina Healthcare of

Ohio, Inc.

Molina Healthcare Statewide 292,128 0 292,128

Ohio Ohio Medicaid

Managed Care

Program

(Comprehensive

MCO)

Paramount Advantage Promedica Statewide 244,867 0 244,867

Ohio Ohio Medicaid

Managed Care

Program

(Comprehensive

MCO)

UnitedHealthcare

Community Plan of

Ohio, Inc.

UnitedHealthcare Statewide 296,760 0 296,760

129

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Ohio MyCare Ohio Opt-Out

Program

(Comprehensive MCO

+ MLTSS)

Aetna Better Health of

Ohio

Aetna Central, Northwest,

Southwest

0 11,117 11,117

Ohio MyCare Ohio Opt-Out

Program

(Comprehensive MCO

+ MLTSS)

Buckeye Health Plan Centene

Corporation

Northeast, Northwest, West

Central

0 9,647 9,647

Ohio MyCare Ohio Opt-Out

Program

(Comprehensive MCO

+ MLTSS)

CareSource CareSource East Central, Northeast,

Northeast Central

0 11,233 11,233

Ohio MyCare Ohio Opt-Out

Program

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

Ohio, Inc.

Molina Healthcare Central, Southwest, West

Central

0 9,531 9,531

Ohio MyCare Ohio Opt-Out

Program

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan of

Ohio, Inc.

UnitedHealthcare East Central, Northeast,

Northeast Central

0 11,880 11,880

Ohio Ohio PACE (Program

of All-inclusive Care

for the Elderly (PACE))

McGregor PACE PACE Cuyahoga County 95 359 454

Oklahoma SoonerCare Choice

(Primary Care Case

Management (PCCM))

SoonerCare Choice Oklahoma Health

Care Authority

Statewide 533,758 114,799 648,557

Oklahoma SoonerRide (Non-

Emergency Medical

Transportation)

SoonerRide Oklahoma Health

Care Authority

Statewide 533,758 114,799 648,557

130

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oklahoma PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Cherokee Elder Care

(CEC)

PACE 74464, 74441, 74423,

74960, 74427, 74465,

74403, 74457, 74451,

74352, 74434, 74401,

74471, 74364, 74347,

74402, 74444, 74368,

74964, 74446, 74452,

74359, 74965, 74439

14 134 148

Oklahoma PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Life PACE PACE 74103, 74104, 74105,

74106, 74107, 74110,

74112, 74114, 74115,

74119, 74120, 74126,

74127, 74128, 74129,

74130, 74132, 74133,

74136, 74137, 74145,

74146, 74134, 74135,

74117, 74116, 74108

14 117 131

131

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oklahoma PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Valir PACE PACE 73008, 73106, 73143,

73003, 73147, 73025,

73134, 73084, 73119,

73140, 73124, 73157,

73170, 73163, 73066,

73150, 73110, 73139,

73105, 73142, 73185,

73109, 73194, 73113,

73169, 73103, 73154,

73121, 73156, 73165,

73127, 73013, 73131,

73198, 73118, 73178,

73141, 73184, 73160,

73146, 73120, 73149,

73083, 73137, 73122,

73155, 73132, 73108,

73162, 73112, 73167,

73102, 73152, 73012,

73179, 73135, 73126,

73190, 73129, 73196,

73117, 73173, 73123,

73153, 73144, 73116,

73148, 73034, 73136,

73120, 73115, 73107,

73159, 73111, 73164,

73101, 73151, 73130,

73145, 73125, 73189,

73128, 73195, 73114,

73172, 73104

6 181 187

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Access Dental Plan,

LLC

Access Dental,

Inc.

Clackamas, Multnomah, and

Washington Counties

1,490 72 1,562

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Advantage Dental

Services

Advantage Dental

Services

Statewide except Tillamook

County

14,280 4,160 18,440

132

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Capitol Dental Care,

Inc.

HealthShare of

Oregon

Benton, Clackamas,

Clatsop, Columbia, Hood

River, Jackson, Josephine,

Klamath, Lane, Lincoln,

Linn, Marion, Multnomah,

Polk, Umatilla, Wasco,

Washington, and Yamhill

Counties

10,319 974 11,293

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

CareOregon Dental CareOregon Clackamas, Multnomah, and

Washington Counties

1,522 95 1,617

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Family Dental Care HealthShare of

Oregon

Clackamas, Multnomah, and

Washington Counties

1,542 70 1,612

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Greater Oregon

Behavioral Health, Inc.

Greater Oregon

Behavioral Health,

Inc.

Baker (97869 excluded),

Clatsop, Columbia, Douglas,

Gilliam, Grant, Harney,

Hood River, Lake, Malheur

(97710 excluded), Morrow,

Sherman, Umatilla, Union,

Wallowa, Wasco, and

Wheeler (97848 excluded)

Counties

507 3,076 3,583

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Managed Dental Care

of Oregon

HealthShare of

Oregon

Clackamas, Multnomah, and

Washington Counties

1,534 66 1,600

133

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

ODS Community

Health Inc.

MODA Health Baker, Benton, Clackamas,

Clatsop, Columbia, Crook,

Deschutes (97733, 97735

excluded), Hood River,

Jackson, Jefferson,

Josephine, Lane, Linn

(97759 excluded), Malheur,

Marion, Multnomah, Polk

(97370 excluded),

Tillamook, Wallowa (97828,

97846 only), Wasco,

Washington, and Yamhill

Counties

6,452 1,224 7,676

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

AllCare Health Plan AllCare Health

Plan

Curry, Douglas (97410,

97442 only), Jackson, and

Josephine Counties

46,073 2,199 48,272

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Cascade Health

Alliance

Cascade Health

Alliance

Klamath (97731, 97733,

97737, 97739, 97425

excluded) County

16,230 683 16,913

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Columbia Pacific Columbia Pacific Clatsop, Columbia, and

Tillamook Counties

22,762 749 23,511

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Eastern Oregon CCO Eastern Oregon

CCO

Baker, Gilliam, Grant,

Harney, Lake, Malheur,

Morrow, Sherman, Umatilla,

Union, Wallowa, and

Wheeler Counties

46,209 1,557 47,766

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

HealthShare of Oregon HealthShare of

Oregon

Clackamas, Multnomah, and

Washington Counties

290,073 18,525 308,598

134

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

InterCommunity Health

Network

InterCommunity

Health Network

Benton, Lincoln, and Linn

Counties

50,152 2,432 52,584

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Jackson Care Connect Jackson Care

Connect

Jackson County 28,814 1,109 29,923

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

PacificSource

Community Solutions -

Central Oregon

PacificSource

Community

Solutions

Crook, Deschutes,

Jefferson, and Klamath

(97731, 97733, 97737,

97739 only)

45,636 2,249 47,885

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

PacificSource

Community Solutions -

Columbia Gorge

PacificSource

Community

Solutions

Hood River and Wasco

Counties

11,569 322 11,891

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

PrimaryHealth of

Josephine County

PrimaryHealth of

Josephine County

Douglas (97410, 97442

only), Jackson and

Josephine Counties

9,148 521 9,669

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Trillium Community

Health Plan

Trillium Health Benton (97448, 97456 only),

Coos (97449 only), Douglas

(97424, 97493, 97436,

97441, 97467, 97473 only),

Lane, and Linn (97446 only)

Counties

81,804 4,227 86,031

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Umpqua Health

Alliance

Umpqua Health

Alliance

Douglas (97441, 97467,

97473 excluded) County

24,879 1,345 26,224

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Advanced Health Advanced Health Coos, Curry, and Douglas

(97459 only) Counties

17,866 1,173 19,039

135

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Willamette Valley

Community Health

Willamette Valley

Community Health

Benton (97361 only),

Clackamas (97002, 97032,

97071, 97362, 97375 only),

Linn (97346, 97350, 97352,

97358, 97360, 97383 only),

Marion, Polk, and Yamhill

(97304 only)

94,312 4,560 98,872

Oregon

Oregon Health Plan

(OHP)

(Comprehensive

MCO)

Yamhill Community

Care

Community Care

Health Plan (WI)

Clackamas (97002, 97071,

97140 only), Marion (97137

only), Polk (97101, 97304,

97347, 97371, 97378,

97396 only), Tillamook

(97347 only), Washington

(97119, 97123, 97132,

97140 only), and Yamhill

Counties

22,668 669 23,337

Oregon PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Providence Elder Place PACE Multnomah, Washington,

Clatsop, Clackamas and

Tillamook Counties

75 1,317 1,392

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

Aetna Better Health Aetna Southeast zone, Southwest

zone, Lehigh/Capital zone,

Northwest zone, Northeast

zone

199,482 631 200,113

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

Gateway Health Gateway Health Southwest zone,

Lehigh/Capital zone,

Northwest zone

289,736 996 290,732

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

Health Partners Plan Health Partners

Plan

Southeast zone 244,990 752 245,742

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

United Healthcare

Community Plan, Inc.

UnitedHealthcare Southeast zone, Southwest

zone, Lehigh/Capital zone

222,275 747 223,022

136

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

UPMC for You UPMC Health Plan Southwest zone,

Lehigh/Capital zone,

Northwest zone

413,437 1,817 415,254

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

Geisinger Health Plan Geisinger Health

Plan

Northeast 183,218 556 183,774

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

AmeriHealth

Caritas/AmeriHealth

Caritas Northeast

Vista Lehigh/Capital, Northwest,

Northeast

281,763 848 282,611

Pennsylvania HealthChoices -

Physical Health

(Comprehensive

MCO)

Keystone First Vista Southeast 430,155 1,306 431,461

Pennsylvania Community

HealthChoices

(Comprehensive MCO

+ MLTSS)

UPMC Community

HealthChoices

UPMC Southwest PA: Allegheny

County, Armstrong County,

Beaver County, Bedford

County, Blair County, Butler

County, Cambria County,

Fayette County, Greene

County, Indiana County,

Lawrence County, Somerset

County, Washington County

and Westmoreland County

2,401 40,643 43,044

Pennsylvania Community

HealthChoices

(Comprehensive MCO

+ MLTSS)

Pennsylvania Health &

Wellness

Centene

Corporation

Southwest PA: Allegheny

County, Armstrong County,

Beaver County, Bedford

County, Blair County, Butler

County, Cambria County,

Fayette County, Greene

County, Indiana County,

Lawrence County, Somerset

County, Washington County

and Westmoreland County

812 20,908 21,720

137

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Community

HealthChoices

(Comprehensive MCO

+ MLTSS)

Amerihealth Caritas /

Keystone First

Vista Southwest PA: Allegheny

County, Armstrong County,

Beaver County, Bedford

County, Blair County, Butler

County, Cambria County,

Fayette County, Greene

County, Indiana County,

Lawrence County, Somerset

County, Washington County

and Westmoreland County

630 14,524 15,154

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Allegheny County

HealthChoices

Community Care

Health Plan (WI)

Allegheny County 59,156 7,508 66,664

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Beaver County

HealthChoices

Beacon Beaver County 9,848 1,338 11,186

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Behavioral Health

Services of Bedford

and Somerset

PerformCare Bedford and Somerset

Counties

7,722 1,289 9,011

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Berks County

HealthChoices

Community Care

Health Plan (WI)

Berks County 27,868 2,255 30,123

138

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Blair County

HealthChoices

Community Care

Health Plan (WI)

Blair County 8,717 1,266 9,983

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Bucks County

HealthChoices

Magellan Health Bucks County 21,897 1,909 23,806

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Cambria County

HealthChoices

Beacon Cambria County 9,517 1,262 10,779

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Carbon-Monroe-Pike

Joinder Board

Community Care

Health Plan (WI)

Carbon, Monroe and Pike

Counties

21,392 1,540 22,932

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Chester County

HealthChoices

Community Care

Health Plan (WI)

Chester County 15,562 1,229 16,791

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Cumberland County

HealthChoices

PerformCare Cumberland County 11,803 928 12,731

139

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Dauphin County

HealthChoices

PerformCare Dauphin County 22,532 1,856 24,388

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Delaware County

HealthChoices

Magellan Health Delaware County 37,229 2,548 39,777

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Erie County

HealthChoices

Community Care

Health Plan (WI)

Erie County 21,200 1,612 22,812

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Fayette County

HealthChoices

Beacon Fayette County 11,701 1,531 13,232

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Greene County

(Commonwealth)

Beacon Greene County 2,907 397 3,304

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Lancaster County

HealthChoices

PerformCare Lancaster County 29,600 2,015 31,615

140

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Lebanon County

HealthChoices

PerformCare Lebanon County 9,425 647 10,072

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Lehigh County

HealthChoices

Magellan Health Lehigh County 27,976 2,151 30,127

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Lycoming-Clinton

Joinder Board

Community Care

Health Plan (WI)

Clinton and Lycoming

Counties

10,603 944 11,547

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Montgomery County

HealthChoices

Magellan Health Montgomery County 30,823 2,495 33,318

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

North Central State

Option

Community Care

Health Plan (WI)

Bradford, Cameron, Centre,

Clarion, Clearfield,

Columbia, Elk, Forest,

Huntingdon, Jefferson,

Juniata, McKean, Mifflin,

Montour, Northumberland,

Potter, Schuylkill, Snyder,

Sullivan, Tioga, Union,

Warren and Wayne

Counties

70,567 7,153 77,720

141

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northampton County

HealthChoices

Magellan Health Northampton County 17,993 1,520 19,513

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northeast Behavioral

Health Care

Consortium

Community Care

Health Plan (WI)

Lackawanna, Luzerne,

Susquehanna and Wyoming

Counties

46,956 3,777 50,733

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northwest Behavioral

Health Partnership

Beacon Crawford, Mercer and

Venango Counties

17,873 1,829 19,702

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Perry County

HealthChoices

PerformCare Perry County 2,484 224 2,708

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Philadelphia County

HealthChoices

Community

Behavioral Health

Philadelphia County 173,309 11,945 185,254

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Southwest Behavioral

Health Management

Beacon Armstrong, Butler, Indianna,

Lawrence, Washington and

Westmoreland Counties

52,461 7,154 59,615

142

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Tuscarora Managed

Care Alliance

PerformCare Franklin and Fulton

Counties

10,210 752 10,962

Pennsylvania Behavioral Health

HealthChoices

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

York/Adams County

HealthChoices

Community Care

Health Plan (WI)

York and Adams Counties 33,771 2,290 36,061

Pennsylvania MATP (Medical

Assistance

Transportation

Program) (Non-

Emergency Medical

Transportation)

LogistiCare LogistiCare Philadelphia 546,802 75,251 622,053

Pennsylvania Adult Community

Autism Program

(Other Prepaid Health

Plan (PHP) (limited

benefits))

Adult Community

Autism Program

Keystone Autism

Services

Dauphin, Cumberland,

Lancaster and Chester

Counties

90 61 151

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE

Greensburg H-2937

Senior LIFE Westmoreland County 6 195 201

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE Johnstown

H-3925

Senior LIFE Cambria County, Somerset

County (partial)

24 197 221

143

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE Altonna H-

5902

Senior LIFE Blair, Cambria and Indiana

Counties

17 284 301

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE York H-

0819

Senior LIFE York County and Dauphin

County

13 209 222

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE Lehigh H-

5978

Senior LIFE Lehigh County, Berks

County and Northampton

County

19 315 334

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Senior LIFE

Washington H-2992

Senior LIFE Washington County, Fayette

County and Greene County

76 531 607

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

SpiriTrust LIFE H-2537 SpiriTrust LIFE H-

2537

Franklin County,

Cumberland County and

Perry County

2 95 97

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

LIFE NWPA H-4999 LIFE NWPA H-

4999

Erie County, Mercer County,

Crawford County and

Warren County

9 207 216

144

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

LIFE Geisinger H-2064 Geisinger Health

Plan

Luzerne County,

Lackawanna County,

Columbia County, Montour

County, Northumberland

County and Schuylkill

County

4 197 201

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Mercy LIFE H-3919 Mercy LIFE H-

3919

Philadelphia County and

Delaware County

59 690 749

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Mercy LIFE West

Philadelphia H-3908

Mercy LIFE West

Philadelphia H-

3908

Philadelphia County 36 476 512

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

LIFE St. Mary H-6551 LIFE St. Mary H-

6551

Bucks County 11 219 230

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Innovage LIFE H-9830 Innovage LIFE H-

9830

Philadelphia County 41 605 646

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Albright LIFE H-9068 Albright LIFE H-

9068

Lancaster County, Lebanon

County, Lycoming County,

Clinton County, Union

County and Chester County

5 180 185

145

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Community LIFE H-

3917

Community LIFE

H-3917

Allegheny County,

Westmoreland County and

Washington County

25 563 588

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

LIFE Pittsburgh H-3918 LIFE Pittsburgh H-

3918

Allegheny County 40 552 592

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

VieCare Butler H-3060 VieCare Butler H-

3060

Butler County 12 189 201

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

VieCare Beaver H-

7660

VieCare Beaver H-

7660

Beaver County and

Lawrence County

29 451 480

Pennsylvania PA Living

Independence for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

VieCare Armstrong H-

6118

VieCare

Armstrong H-6118

Armstrong County 3 64 67

Puerto Rico Government Health

Plan (Comprehensive

MCO)

First Medical Plan Inc. First Medical Plan

Inc.

North, San Juan, Special 270,421 16,614 287,035

Puerto Rico Government Health

Plan (Comprehensive

MCO)

Triple S Salud, Inc. Blue Cross Blue

Shield

Metro North, West 382,031 20,090 402,121

Puerto Rico Government Health

Plan (Comprehensive

MCO)

Molina Health Care PR,

Inc.

Molina Healthcare East, Southwest 302,829 17,840 320,669

146

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Puerto Rico Government Health

Plan (Comprehensive

MCO)

MMM MultiHealth, Inc. Medicare and

Much More

(MMM), Inc.

Northeast, Southeast 254,451 14,969 269,420

Puerto Rico Medicare Platino

(Comprehensive

MCO)

Triple S Advantage Blue Cross Blue

Shield

Statewide 0 40,996 40,996

Puerto Rico Medicare Platino

(Comprehensive

MCO)

Humana Health Plan of

PR Inc.

Humana Statewide 0 22,276 22,276

Puerto Rico Medicare Platino

(Comprehensive

MCO)

MCS Advantage Inc. MCS Advantage

Inc.

Statewide 0 88,379 88,379

Puerto Rico Medicare Platino

(Comprehensive

MCO)

MMM Health Care Inc. Medicare and

Much More

(MMM), Inc.

Statewide 0 64,161 64,161

Puerto Rico Medicare Platino

(Comprehensive

MCO)

Constellation Health

LLC

Constellation

Health LLC

Statewide 0 10,553 10,553

Rhode Island RIte Care, RHP and

Medicaid Expansion

(Comprehensive

MCO)

Neighborhood Health

Plan of RI

Neighborhood

Health Plan of RI

Statewide 155,216 0 155,216

Rhode Island RIte Care, RHP and

Medicaid Expansion

(Comprehensive

MCO)

UnitedHealthCare of

Rhode Island

Community Plan

UnitedHealthcare Statewide 92,767 0 92,767

Rhode Island Rite Smiles Dental

Program (Dental only

(PAHP))

UnitedHealthCare

Dental of Rhode Island

UnitedHealthcare Statewide 111,315 0 111,315

Rhode Island Transportation Broker

(Non-Emergency

Medical

Transportation)

Logisticare, Inc. LogistiCare Statewide 267,396 0 267,396

147

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Rhode Island PACE (Program of All-

inclusive Care for the

Elderly (PACE))

PACE Organization of

PACE Statewide 295 0 295

South Carolina South Carolina

Managed Care

Organizations

(Comprehensive

MCO)

Select Health of South

Carolina

AmeriHealth Statewide 354,400 0 354,400

South Carolina South Carolina

Managed Care

Organizations

(Comprehensive

MCO)

Absolute Total Care Centene

Corporation

Statewide 108,032 0 108,032

South Carolina South Carolina

Managed Care

Organizations

(Comprehensive

MCO)

BlueChoice Healthplan

Medicaid

Blue Cross Blue

Shield

Statewide 96,346 0 96,346

South Carolina South Carolina

Managed Care

Organizations

(Comprehensive

MCO)

Molina Healthcare of

South Carolina

Molina Healthcare Statewide 111,302 0 111,302

South Carolina South Carolina

Managed Care

Organizations

(Comprehensive

MCO)

WellCare of South

Carolina

WellCare Statewide 75,389 0 75,389

South Carolina South Carolina

Medical Homes

Network (Primary Care

Case Management

(PCCM))

South Carolina

Solutions

Community Health

Solutions America

Statewide 558 0 558

148

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

South Carolina South Carolina Non-

Emergency Medical

Transportation (Non-

Emergency Medical

Transportation)

Logisticare LogistiCare Statewide 1,033,900 161,803 1,195,703

South Carolina South Carolina

Program for All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Palmetto Senior Care PRISMA Health Richland and Lexington

County

32 247 279

South Carolina South Carolina

Program for All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

The Methodist Oaks The Methodist

Oaks

Orangeburg County 14 93 107

South Carolina South Carolina

Program for All

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Greenville Health

System Senior Care

PRISMA Health Greenville Anderson

Pickens Counties

5 51 56

South Dakota PRIME (Primary Care

Case Management

(PCCM))

Multiple Primary Care

Providers

Multiple Primary

Care Provider

(PCCM)

Statewide 92,184 0 92,184

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

Amerigroup Amerigroup, Inc. Statewide 337,584 38,699 376,283

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

DentaQuest USA

Insurance Company

DentaQuest USA

Insurance

Company

Statewide 802,783 381 803,164

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

Magellan Health

Services

Magellan Health Statewide 1,241,360 381 1,241,741

149

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Community Plan

UnitedHealthcare Statewide 381,108 52,094 433,202

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

Volunteer State Health

Plan (BlueCare)

Blue Cross Blue

Shield

Statewide 459,478 51,512 510,990

Tennessee

TennCare II

(Comprehensive MCO

+ MLTSS)

Volunteer State Health

Plan (TennCare Select)

Blue Cross Blue

Shield

Statewide 63,190 2,718 65,908

Tennessee

Program of All-

Inclusive Care for the

Elderly (Program of

All-inclusive Care for

the Elderly (PACE))

Alexian Brothers

Community Services

Alexian Brothers

Community

Services

Hamilton County 14 267 281

Texas STAR Health

(Comprehensive

MCO)

Superior HealthPlan Centene

Corporation

Statewide 34,117 0 34,117

Texas STAR

(Comprehensive

MCO)

Amerigroup Texas, Inc. Amerigroup, Inc. Bexar SDA, Dallas SDA,

Harris SDA, Jefferson SDA,

Lubbock SDA, MRSA

Central, MRSA Northeast,

MRSA West, Tarrant SDA

539,812 0 539,812

Texas STAR

(Comprehensive

MCO)

Superior Health Plan,

Inc.

Centene

Corporation

Bexar SDA, El Paso SDA,

Hidalgo SDA, Lubbock SDA,

MRSA Central, MRSA

Northeast, MRSA West,

Nueces SDA, Travis SDA

737,410 0 737,410

Texas STAR

(Comprehensive

MCO)

El Paso Health Plans,

Inc., dba El Paso

Health

El Paso County

Hospital District -

DBA University

Medical Center of

El Paso

Bexar SDA, El Paso SDA 66,563 0 66,563

150

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas STAR

(Comprehensive

MCO)

Aetna Better Health of

Texas, Inc.

Aetna Bexar SDA, Tarrant SDA 74,678 0 74,678

Texas STAR

(Comprehensive

MCO)

Community First Health

Plans, Inc.

Bexar County

Hospital District,

dba University

Health System

Bexar SDA 108,453 0 108,453

Texas STAR

(Comprehensive

MCO)

UnitedHealthcare

Insurance Company,

dba United Healthcare

Community Plan

UnitedHealthcare Harris SDA, Hidalgo SDA,

Jefferson SDA

139,036 0 139,036

Texas STAR

(Comprehensive

MCO)

Texas Children's

Health Plan, Inc.

Texas Children's Harris SDA, Jefferson SDA 348,467 0 348,467

Texas STAR

(Comprehensive

MCO)

Molina Healthcare of

Texas, Inc.

Molina Healthcare Dallas SDA, El Paso SDA,

Harris SDA, Hidalgo SDA,

Jefferson SDA

95,739 0 95,739

Texas STAR

(Comprehensive

MCO)

Driscoll Children's

Health Plan

Driscoll Hidalgo SDA, Nueces SDA 157,744 0 157,744

Texas STAR

(Comprehensive

MCO)

Parkland Community

Health Plan, Inc.

Dallas County

Hospital District

Dallas SDA 165,083 0 165,083

Texas STAR

(Comprehensive

MCO)

Cook Children's Health

Plan

Cook Children's

Health Care

System

Tarrant SDA 107,151 0 107,151

Texas STAR

(Comprehensive

MCO)

Community First Health

Plans, Inc.

Bexar County

Hospital District,

dba University

Health System

Harris SDA, Jefferson SDA 245,466 0 245,466

Texas STAR

(Comprehensive

MCO)

Seton Health Plan, Inc.,

dba Dell Childrens

Health Plan

Seton Insurance

Services

Corporation

Travis SDA 23,122 0 23,122

151

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas STAR

(Comprehensive

MCO)

Health Care Service

Corp. (dba Blue Cross

Blue Shield)

Health Care

Service

Corporation

Travis SDA 31,971 0 31,971

Texas STAR

(Comprehensive

MCO)

SHA. LLC, dba

FirstCare Health Plans

Scott and White

Health Plan

Lubbock SDA, MRSA West 84,226 0 84,226

Texas STAR

(Comprehensive

MCO)

Scott & White Health

Plan

Baylor Scott &

White Holdings

MRSA Central 45,067 0 45,067

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Amerigroup Insurance

Company

Amerigroup, Inc. Dallas SDA, El Paso SDA,

Harris SDA, MRSA West,

Lubbock SDA

26,925 147 27,072

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Superior HealthPlan,

Inc.

Centene

Corporation

Bexar SDA, El Paso SDA,

Hidalgo SDA, Lubbock SDA,

MRSA West SDA, Travis

SDA, Nueces SDA

28,479 189 28,668

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Aetna Better Health of

Texas Inc.

Aetna Tarrant SDA 4,807 36 4,843

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Community First Health

Plans, Inc.

Bexar County

Hospital District,

dba University

Health System

Bexar SDA 7,858 41 7,899

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Insurance Company,

dba United Healthcare

Community Plan

UnitedHealthcare Harris SDA, Hidalgo SDA,

Jefferson SDA, MRSA

Central SDA, MRSA

Northeast SDA

30,436 159 30,595

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Texas Children’s

Health Plan, Inc.

Texas Children's Harris SDA, Jefferson SDA,

MRSA Northeast SDA

26,084 100 26,184

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Driscoll Children’s

Health Plan

Driscoll Hidalgo SDA, Nueces SDA 10,396 45 10,441

152

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Cook Children's Health

Plan

Cook Children's

Health Care

System

Tarrant SDA 9,447 46 9,493

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Health Care Service

Corporation DBA Blue

Cross and Blue Shield

of Texas (BCBSTX)

Health Care

Service

Corporation

MRSA Central SDA, Travis

SDA

7,870 48 7,918

Texas STAR Kids

(Comprehensive MCO

+ MLTSS)

Children’s Medical

Center Health Plan

Children's Health

System of Texas

Dallas SDA 9,202 34 9,236

Texas STAR+PLUS

(Comprehensive MCO

+ MLTSS)

Amerigroup Texas, Inc. Anthem Insurance

Companies, Inc.

Bexar SDA, El Paso SDA,

Harris SDA, Jefferson SDA,

Lubbock SDA, MRSA West,

Tarrant SDA, Travis SDA

58,450 72,405 130,855

Texas STAR+PLUS

(Comprehensive MCO

+ MLTSS)

Superior HealthPlan,

Inc

Centene

Corporation

Bexar SDA, Dallas SDA,

Hidalgo SDA, Lubbock SDA,

Nueces SDA, MRSA

Central, MRSA West

65,788 73,702 139,490

Texas STAR+PLUS

(Comprehensive MCO

+ MLTSS)

UnitedHealthcare

Insurance Company,

dba United Healthcare

Community Plan

UnitedHealthcare Harris SDA, Jefferson SDA,

Nueces SDA, Travis SDA,

MRSA Central, MRSA

Northeast

55,929 64,561 120,490

Texas STAR+PLUS

(Comprehensive MCO

+ MLTSS)

Molina Healthcare of

Texas, Inc.

Molina Healthcare Bexar SDA, Dallas SDA, El

Paso SDA, Harris SDA,

Hidalgo SDA, Jefferson SDA

35,570 51,751 87,321

Texas STAR+PLUS

(Comprehensive MCO

+ MLTSS)

HealthSpring Life &

Health Insurance Co.,

Inc.

Cigna Hidalgo SDA, MRSA

Northeast, Tarrant SDA

19,819 29,782 49,601

Texas Children's Medicaid

Dental Services

(Dental only (PAHP))

MCNA Insurance

Company

Managed Care of

North America

(MCNA), Inc.

Statewide 1,229,546 0 1,229,546

153

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas Children's Medicaid

Dental Services

(Dental only (PAHP))

DentaQuest USA

Insurance Company,

Inc.

DentaQuest, LLC

(owned by

DentaQuest

Group, Inc.)

Statewide 1,650,398 0 1,650,398

Texas Medical Transportation

Program (Non-

Emergency Medical

Transportation)

American Medical

Response

American Medical

Response

Brown, Callahan, Coke,

Coleman, Comanche,

Concho, Crockett, Dimmit,

Eastland, Edwards, Fisher,

Haskell, Irion, Jones, Kent,

Kimble, Kinney, Knox,

Maverick, Mcculloch,

Menard, Mitchell, Nolan,

Reagan, Real, Runnels,

Schleicher, Scurry,

Shackelford, Stephens,

Sterling, Stonewall, Sutton,

Taylor, Throckmorton, Tom

Green, Uvalde, Val Verde,

Zavala

93,639 14,863 108,502

154

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas Medical Transportation

Program (Non-

Emergency Medical

Transportation)

LogistiCare LogistiCare Aransas, Armstrong,

Atascosa, Bailey, Bandera,

Bastrop, Bee, Bell, Bexar,

Blanco, Bosque, Brazos,

Brisco, Brooks, Burleson,

Burnet, Caldwell, Cameron,

Carson, Castro, Childress,

Collingsworth, Cochran,

Comal, Coryell, Crosby,

Dallas, Dallam, Deaf Smith,

Denton, Dickens, Donley,

Duval, Ellis, Erath, Falls,

Fayette, Floyd, Freestone,

Frio, Garza, Gray, Gillespie,

Grimes, Guadalupe, Hall,

Hale, Hamilton, Hansford,

Hartley, Hays, Hemphill,

Hidalgo, Hill, Hockley, Hood,

Hunt, Hutchinson, Jim Hogg,

Jim Wells, Johnson, Karnes,

Kaufman, Kendall, Kenedy,

Kerr, King, Kleberg, Lamb,

Lampasas, Lee, Leon,

Lipscomb, Limestone, Live

Oak, Llano, Lubbock,

2,022,031 202,581 2,224,612

155

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas (cont.) Medical Transportation

Program (Non-

Emergency Medical

Transportation)

LogistiCare LogistiCare Lynn, Madison, Mason,

Mclennan, McMullen,

Medina, Milam, Mills, Moore,

Motley, Navarro, Nueces,

Ochiltree, Oldham, Palo

Pinto, Parker, Parmer,

Potter, Randall, Refugio,

Roberts, Robertson,

Rockwall, San Patricio, San

Saba, Sherman, Somervell,

Starr, Swisher, Tarrant,

Terry, Travis, Washington,

Webb, Wheeler, Willacy,

Williamson, Wilson,

Yoakum, Zapata

2,022,031 202,581 2,224,612

Texas Medical Transportation

Program (Non-

Emergency Medical

Transportation)

Medical Transportation

Management

Medical

Transportation

Management, Inc.

Anderson, Angelina, Austin,

Bowie, Brazoria, Calhoun,

Camp, Cass, Chambers,

Cherokee, Colorado, De

Witt, Delta, Fort Bend,

Franklin, Galveston, Goliad,

Gonzales, Gregg, Hardin,

Harris, Harrison, Henderson,

Hopkins, Houston, Jackson,

Jasper, Jefferson, Lamar,

Lavaca, Liberty, Marion,

Matagorda, Montgomery,

Morris, Nacogdoches,

Newton, Orange, Panola,

Polk, Rains, Red River,

Rusk, Sabine, San

Augustine, San Jacinto,

Shelby, Smith, Titus, Trinity,

Tyler, Upshur, Van Zandt,

Victoria, Walker, Waller,

Wharton, Wood

1,174,476 110,262 1,284,738

156

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Texas Medical Transportation

Program (Non-

Emergency Medical

Transportation)

Project Armistad Project Armistad Andrews, Borden, Brewster,

Crane, Culberson, Dawson,

Ector, El Paso, Gaines,

Glasscock, Howard,

Hudspeth, Jeff Davis,

Loving, Martin, Midland,

Pecos, Presidio, Reeves,

Terrell, Upton, Ward,

Winkler

199,829 26,891 226,720

Texas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Bienvivir Senior Health

Services (El Paso)

PACE 79901, 79902, 79903,

79904, 79905, 79907,

79915, 79924, 79925,

79930, 79935, 79936

28 892 920

Texas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Silver Star Health

Network (Lubbock)

PACE 79401, 79402, 79403,

79404, 79405, 79406,

79407, 79408, 79409,

79410, 79411, 79412,

79413, 79414, 79415,

79416, 79423, 79424,

79430, 79452, 79453,

79454, 79464, 79490,

79491, 79493, 79499

12 156 168

Texas PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Werner (Amarillo) PACE 9015, 79101, 79102, 79103,

79104, 79106, 79107,

79108, 79109, 79110,

79111, 79118, 79119,

79121, 79124

2 125 127

Utah UNI HOME

(Comprehensive

MCO)

HOME University of Utah

Health Plans

Statewide 720 475 1,195

Utah Choice of Health Care

Delivery

(Comprehensive

MCO)

Healthy U University of Utah

Health Plans

Statewide 42,297 6,446 48,743

157

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Utah Choice of Health Care

Delivery

(Comprehensive

MCO)

Molina Molina Healthcare Statewide 58,234 6,479 64,713

Utah Choice of Health Care

Delivery

(Comprehensive

MCO)

Health Choice Steward Health

Care System

Beaver, Box Elder, Cache,

Davis, Iron, Juab, Miller,

Morgan, Rich, Salt Lake,

Sanpete, Sevier, Summit,

Tooele, Utah, Wasatch,

Washington and Weber

Counties

16,895 1,563 18,458

Utah Choice of Health Care

Delivery

(Comprehensive

MCO)

SelectHealth Select Health, Inc. Statewide 84,509 9,275 93,784

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Bear River Mental

Health

Bear River Mental

Health

Box Elder, Cache, and Rich

Counties

15,133 1,507 16,640

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Central Utah Mental

Health

Central Utah

Mental Health

Juab, Millard, Piute,

Sanpete, Sevier and Wayne

Counties

8,177 1,059 9,236

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Davis Behavioral

Health

Davis Behavioral

Health

Davis County 19,907 2,366 22,273

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Four Corners

Community Behavioral

Health

Four Corners

Community

Behavioral Health

Grand, Emery and Carbon

Counties

4,362 822 5,184

158

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Northeastern

Counseling

Northeastern

Counseling

Duchesne, Uintah, Daggett,

and San Juan Counties

9,189 1,163 10,352

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Optum Health Optum Health Salt Lake County 86,925 13,130 100,055

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Southwest Behavioral

Health

Southwest

Behavioral Health

Beaver, Garfield, Kane, Iron

and Washington Counties

22,546 2,659 25,205

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Valley Behavioral

Health

Valley Behavioral

Health

Summit and Tooele

Counties

6,931 773 7,704

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Wasatch Mental Health Wasatch Mental

Health

Utah County 41,758 3,871 45,629

Utah Prepaid Mental Health

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Weber Mental Health Weber Mental

Health

Weber and Morgan

Counties

22,749 3,425 26,174

Utah Dental (Dental only

(PAHP))

Premier Access Avesis

Incorporated

Salt Lake, Weber, Davis and

Utah Counties

64,738 37 64,775

Utah Dental (Dental only

(PAHP))

Delta Dental Delta Dental Davis, Salt Lake, Weber and

Utah Counties

60,391 32 60,423

159

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Utah Transportation (Non-

Emergency Medical

Transportation)

Logisticare Solutions Providence

Service

Corporation

Statewide 204,436 27,095 231,531

Vermont

Global Commitment to

Health Demonstration

(Comprehensive MCO

+ MLTSS)

Department of Vermont

Health Access

Vermont Agency

of Human Services

Statewide 122,550 760 123,310

Virginia Medallion 3.0

(Comprehensive

MCO)

Virginia Premier Health

Plan

Virginia Premier

Health Plan

Statewide 158,008 0 158,008

Virginia Medallion 3.0

(Comprehensive

MCO)

Anthem Anthem Insurance

Companies, Inc.

Statewide 251,115 0 251,115

Virginia Medallion 3.0

(Comprehensive

MCO)

Intotal Health Inova Health

System

Statewide 52,799 0 52,799

Virginia Medallion 3.0

(Comprehensive

MCO)

Kaiser Kaiser Statewide 12,887 0 12,887

Virginia Medallion 3.0

(Comprehensive

MCO)

Optima Health Care PACE Statewide 149,500 0 149,500

Virginia Medallion 3.0

(Comprehensive

MCO)

Coventry Health Plan Coventry Health

Plan

Statewide 35,658 0 35,658

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

Aetna Better Health for

Virginia

Aetna Statewide 14,431 16,160 30,591

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

Anthem HealthKeepers Anthem Insurance

Companies, Inc.

Statewide 27,059 33,254 60,313

160

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

Magellan Complete

Care of Virginia

Magellan Health Statewide 10,213 11,746 21,959

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

Optima Health Optima Health Statewide 19,949 14,395 34,344

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

United Health Care UnitedHealthcare Statewide 10,607 12,899 23,506

Virginia CCC Plus

(Comprehensive MCO

+ MLTSS)

Virginia Premier Virginia Premier Statewide 21,377 20,351 41,728

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Innovage Innovage 23112 23113 23114

23120 23124 23129

23139 23140 23141

23146 23173 23181

23221 23224 23225

23226 23227 23228

23231 23232 23234

23235 23236 23237

23238 23240 23241

23249 23260 23261

23269 23273 23274

23276 23278 23279

23282 23284 23285

23286 23289 23290

23291 23293 23295

22546 23005 23009

23011 23015 23030

23039 23047 23058

23059 23060 23069

23075 23086 23089

23102 23103 23106

23111 23116 23150

23162 23192 23218

0 134 134

161

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia (cont) DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Innovage Innovage 23219 23220 23222

23223 23229 23230

23233 23242 23250

23255 23288 23801

23803 23804 23805

23806 23830 23831

23832 23833 23834

23836 23838 23840

23841 23842 23850

23860 23875 23882

23885 23601 23605

23607 23651 23661

23662 23663 23664

23665 23666 23669 23602

23603 23604 23606

23608 23692 23693

23696

0 134 134

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Mountain Empire/All

Care PACE

PACE 24215 24216 24218

24219 24221 24230

24243 24244 24245

24246 24248 24250

24251 24258 24263

24265 24271 24273

24277 24279 24281

24282 24283 24290

24293

4 189 193

162

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

INOVA PACE Inova Health

System

22034 22035 22036

22037 22038 22039

22040 22041 22042

22043 22044 22046

22047 22060 22066

22067 22079 22081

22082 22092 22093

22095 22096 22101

22102 22103 22106

22107 22108 22109

22116 22118 22119

22120 22121 22122

22124 22125 22134

22135 22150 22151

22152 22153 22156

22158 22159 22160

22161 22172 22180

22181 22182 22183

22184 22185 22191

22192 22193 22194

22195 22199 22201

22202 22203 22204

22205 22206 22207

22209 22210 22211

22212 22213 22214

22215 22216 22217

22218 22219 22222

22223 22225 22226

22227 22229 22230

22234 22240 22241

22242 22243 22244

22245 22246 22301

1,405 60 1,465

163

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Riverside PACE Riverside Health

System

23112 23113 23114

23120 23124 23129

23139 23140 23141

23146 23173 23181

23221 23224 23225

23226 23227 23228

23231 23232 23234

23235 23236 23237

23238 23240 23241

23249 23260 23261

23269 23273 23274

23276 23278 23279

23282 23284 23285

23286 23289 23290

23291 23293 23295

22546 23005 23009

23011 23015 23030

23039 23047 23058

23059 23060 23069

23075 23086 23089

23102 23103 23106

23111 23116 23150

23162 23192 23218

23219 23220 23222

23223 23229 23230

23233 23242 23250

23255 23288 23801

23803 23804 23805

23806 23830 23831

5 401 406

164

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia (cont) DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Riverside PACE Riverside Health

System

23832 23833 23834

23836 23838 23840

23841 23842 23850

23860 23875 23882

23885 23601 23605

23607 23651 23661

23662 23663 23664

23665 23666 23669

23602 23603 23604

23606 23608 23692

23693 23696

5 401 406

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Innovage PACE Innovage 24011 24012 24013

24014 24015 24016

24017 24018 24019

24020 24059 24060

24064 24065 24066

24067 24070 24073

24077 24079 24083

24087 24090 24092

24095 24101 24121

24122 24138 24149

24151 24153 24162

24174 24175 24176

24179 24184

19 263 282

165

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Centra PACE Centra 23002 23004 23027

23040 23083 23123

23824 23894 23901

23909 23921 23922

23923 23930 23934

23936 23937 23939

23941 23942 23943

23947 23952 23954

23955 23958 23959

23960 23963 23966

23974 23976 24599

24501 24502 24503

24504 24521 24522

24523 24536 24538

24550 24551 24553

24554 24556 24570

24572 24574 24588

24593 24054 24055

24069 24078 24082

24089 24102 24104

24112 24137 24139

24146 24148 24161

24165 24168 24517

24527 24528 24530

24531 24540 24541

24549 24557 24563

24565 24566 24569

24571 24586 24594

24133 24176 24543

24576

5 208 213

166

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Virginia DMAS PACE

(Program of All-

inclusive Care for the

Elderly (PACE))

Sentara PACE Sentara

Healthcare

23320 23321 23322

23323 23324 23325

23432 23433 23434

23435 23436 23437

23438 23701 23702

23703 23704 23707

23709 23314 23315

23430 23487 23846

23851 23883 23898

23451 23452 23453

23454 23455 23456

23457 23459 23460

23461 23462 23463

23464 23502 23503

23504 23505 23507

23508 23509 23510

23511 23513 23517

23518 23521 23523

23529

24 226 250

Washington

Apple Health/Healthy

Options Health Home

Program

(Comprehensive

MCO)

Multiple Sites Multiple Sites 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, Snohomish,

Skagit, Skamania, Spokane,

Stevens, Thurston,

Wahkiakum, Walla Walla,

Whatcom, Whitman, Yakima

22,412 0 22,412

167

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Apple Health

(Comprehensive

MCO)

Amerigroup Amerigroup, Inc. Adams, Asotin, Benton,

Chelan, 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, Snohomish,

Spokane, Stevens,

Thurston, Wahkiakum,

Walla Walla, Whatcom,

Whitman, Yakima

126,669 0 126,669

Washington Apple Health

(Comprehensive

MCO)

Community Health Plan

of Washington

Community Health

Plan of

Washington

Adams, Asotin, Benton,

Chelan, Clark, Columbia,

Cowlitz, Douglas, Ferry,

Franklin, 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,

Yakima.

226,519 0 226,519

168

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Apple Health

(Comprehensive

MCO)

Coordinated Care of

Washington

Coordinated Care

of Washington

Adams, Asotin, Benton,

Chelan, Columbia,

Douglas, Franklin, Grant,

Island, Jefferson, King,

Kitsap, Kittitas, Lewis,

Lincoln, Mason, Okanogan,

Pacific, Pierce, San Juan,

Skagit, Snohomish,

Spokane, Stevens,

Thurston, Wahkiakum,

Walla Walla, Whatcom,

Whitman, Yakima.

173,341 0 173,341

Washington Apple Health

(Comprehensive

MCO)

Molina Health Care of

Washington

Molina Healthcare Adams, Asotin, Benton,

Chelan, Clallam, Clark,

Columbia, Cowlitz, Douglas,

Ferry, Franklin, Garfield,

Grant, Grays Harbor

, Island,

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, Yakima

569,871 0 569,871

169

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Apple Health

(Comprehensive

MCO)

United Health Care UnitedHealthcare Adams, Asotin, Benton,

Chelan, Clallam, Columbia,

Cowlitz, Douglas, Ferry,

Franklin, Garfield, Grant,

Grays Harbor, Island,

Jefferson, King, Kitsap,

Kittitas, Lewis, Lincoln,

Mason, Okanogan, Pacific,

Pierce, Skagit, Snohomish,

Spokane, Stevens,

Thurston, Wahkiakum,

Walla Walla, Whatcom,

Whitman, Yakima

201,693 0 201,693

Washington Healthy Options -

Blind Disabled

(Comprehensive

MCO)

Amerigroup Amerigroup, Inc. Adams, Asotin, Benton,

Chelan, 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, Snohomish,

Spokane, Stevens,

Thurston, Wahkiakum,

Walla Walla, Whatcom,

Whitman, Yakima

10,146 0 10,146

170

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Healthy Options -

Blind Disabled

(Comprehensive

MCO)

Community Health Plan

of WA

Community Health

Plan of WA

Adams, Asotin, Benton,

Chelan, Clark, Columbia,

Cowlitz, Douglas, Ferry,

Franklin, 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, Yakima

16,372 0 16,372

Washington Healthy Options -

Blind Disabled

(Comprehensive

MCO)

Coordinated Care of

Washington

Coordinated Care

of Washington

Adams, Asotin, Benton,

Chelan, Columbia, Douglas,

Franklin, Grant, Island,

Jefferson, King, Kitsap,

Kittitas, Lewis, Lincoln,

Mason, Okanogan, Pacific,

Pierce, San Juan, Skagit,

Snohomish, Spokane,

Stevens, Thurston,

Wahkiakum, Walla Walla,

Whatcom, Whitman, Yakima

11,465 0 11,465

171

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Healthy Options -

Blind Disabled

(Comprehensive

MCO)

Molina Health Care Molina Healthcare Adams, Asotin, Benton,

Chelan, Clallam, Clark,

Columbia, Cowlitz, Douglas,

Ferry, Franklin, Garfield,

Grant, Grays Harbor, Island,

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, Yakima

32,295 0 32,295

Washington Healthy Options -

Blind Disabled

(Comprehensive

MCO)

United Health Care UnitedHealthcare Adams, Asotin, Benton,

Chelan, Clallam, Columbia,

Cowlitz, Douglas, Ferry,

Franklin, Garfield, Grant,

Grays Harbor, Island,

Jefferson, King, Kitsap,

Kittitas, Lewis, Lincoln,

Mason, Okanogan, Pacific,

Pierce, Skagit, Snohomish,

Spokane, Stevens,

Thurston, Wahkiakum,

Walla Walla, Whatcom,

Whitman, Yakima

13,890 0 13,890

Washington Fully Integrated

Managed Care (FIMC)

(Comprehensive

MCO)

Amerigroup Amerigroup, Inc. Grant, Chelan, Douglas 3,831 0 3,831

Washington Fully Integrated

Managed Care (FIMC)

(Comprehensive

MCO)

Coordinated Care of

Washington

Coordinated Care

of Washington

Grant, Chelan, Douglas 14,165 0 14,165

172

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington Fully Integrated

Managed Care (FIMC)

(Comprehensive

MCO)

Community Health Plan

of Washington

Community Health

Plan of

Washington

Chelan, Clark, Douglas,

Grant, Skamania

16,576 0 16,576

Washington Fully Integrated

Managed Care (FIMC)

(Comprehensive

MCO)

Molina Health Care Molina Healthcare Chelan, Clark, Douglas,

Grant, Skamania

134,248 0 134,248

Washington PCCM (Primary Care

Case Management

(PCCM))

Multiple Primary Care

Providers

Multiple Primary

Care Provider

(PCCM)

Clallam, Grays Harbor, King,

Snohomish, Whatcom,

Okanogan, Ferry, Stevens,

Lincoln, Spokane, Benton

and Yakima

5,186 0 5,186

Washington

Behavioral Health

Services Only (BHSO)

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Amerigroup Amerigroup, Inc. Grant, Chelan, Douglas 1,398 0 1,398

Washington

Behavioral Health

Services Only (BHSO)

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Coordinated Care of

Washington

Coordinated Care

of Washington

Grant, Chelan, Douglas 2,381 0 2,381

Washington

Behavioral Health

Services Only (BHSO)

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Molina Health Care Molina Healthcare Chelan, Clark, Douglas,

Grant, Skamania

7,081 0 7,081

173

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Washington

Behavioral Health

Services Only (BHSO)

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

Community Health

Care Plan of WA

Community Health

Care Plan of

Washington

Chelan, Clark, Douglas,

Grant, Skamania

4,813 0 4,813

Washington

Washington State

Integrated Community

Mental Health

Program (ICMH)

(Behavioral Health

Organization (BHO)

only (PIHP and/or

PAHP))

BHO Behavorial Health

Organizations of

Statewide 1,765,375 0 1,765,375

Washington

NEMT (Non-

Emergency Medical

Transportation)

Multiple Transportation

Brokers

Multiple

Transportation

Brokers

Statewide 1,781,048 0 1,781,048

Washington

PACE (Program of All-

inclusive Care for the

Elderly (PACE))

Providence Elder Place PACE Statewide 670 0 670

West Virginia Mountain Health Trust

(Comprehensive

MCO)

Aetna Better Health of

Aetna Statewide 122,563 0 122,563

West Virginia Mountain Health Trust

(Comprehensive

MCO)

The Health Plan The Health Plan Statewide 80,725 0 80,725

West Virginia Mountain Health Trust

(Comprehensive

MCO)

Unicare Anthem Insurance

Companies, Inc.

Statewide 139,509 0 139,509

West Virginia Mountain Health Trust

(Comprehensive

MCO)

West Virginia Family

Health

West Virginia

Family

Health/Highmark

Statewide 64,396 0 64,396

174

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Anthem Blue Cross

Blue Shield

Anthem BCBS Counties: Brown, Calumet,

Dane, Dodge, Door,

Florence, Fond du Lac,

Forest, Green Lake,

Jefferson, Kenosha,

Kewaunee, Langlade,

Manitowoc, Marinette,

Marquette, Menominee,

Milwaukee, Oconto,

Outagamie, Ozaukee, Polk,

Portage, Racine, Rock,

Shawano, Sheboygan,

Taylor, Walworth,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

83,735 91 83,826

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Children’s Community

Health Plan

Children’s

Community Health

Plan

Counties: Brown, Calumet,

Kenosha, Milwaukee,

Outagamie, Ozaukee,

Racine, Sheboygan,

Walworth, Washington,

Waukesha, Waupaca,

Winnebago

124,131 59 124,190

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Dean Health Plan Dean Health Plan Counties: Columbia, Dane,

Dodge, Grant, Iowa,

Jefferson, Rock, Sauk

37,613 43 37,656

175

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Group Health

Cooperative Of Eau

Claire

Group Health

Cooperative

Counties: Adams, Ashland,

Barron, Bayfield, Buffalo,

Burnett, Chippewa, Clark,

Columbia, Crawford,

Douglas, Dunn, Eau Claire,

Forest, Grant, Green, Iowa,

Iron, Jackson, Juneau, La

Crosse, Lafayette,

Langlade, Lincoln,

Marathon, Monroe, Oneida,

Pepin, Pierce, Polk,

Portage, Price, Rusk, St.

Croix, Sawyer, Shawano,

Taylor, Trempealeau,

Vernon, Vilas, Washburn,

Wood

48,194 91 48,285

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Group Health

Cooperative Of South

Central WI

Group Health

Cooperative

County: Dane 5,435 14 5,449

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Independent Care

(iCare)

iCare Counties: Adams, Brown,

Door, Fond du Lac, Grant,

Green, Jackson, Juneau,

Kenosha, Kewaunee, La

Crosse, Manitowoc,

Marinette, Milwaukee,

Monroe, Oconto,

Outagamie, Ozaukee,

Racine, Sheboygan,

Trempealeau, Vernon,

Walworth, Washington,

Waukesha, Waupaca,

Winnebago

15,921 18 15,939

176

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

MHS of Wisconsin MHS of Wisconsin Counties: Ashland, Adams,

Barron, Bayfield, Brown,

Buffalo, Calumet, Chippewa,

Clark, Crawford, Dane,

Dodge, Door, Douglas,

Dunn, Eau Claire, Fond du

Lac, Forest, 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,

Sawyer, Shawano,

Sheboygan, St. Croix, Sauk,

Taylor, Trempealeau,

Vernon, Vilas, Walworth,

Washburn, Washington,

Waukesha, Waupaca,

Waushara, Winnebago,

Wood

32,431 37 32,468

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

MercyCare Insurance

Company

Mercy Care Counties: Dane, Green,

Jefferson, Rock, Walworth

12,310 28 12,338

177

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Molina Health Plan Molina Healthcare Counties: Brown, Calumet,

Clark, Dodge, Door,

Florence, Fond du Lac,

Forest, Green Lake,

Jefferson, Kenosha,

Kewaunee, Langlade,

Lincoln, Manitowoc,

Marathon, Marinette,

Marquette, Milwaukee,

Oconto, Oneida, Outagamie,

Ozaukee, Portage, Racine,

Shawano, Sheboygan,

Taylor, Vilas, Walworth,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

56,542 23 56,565

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Network Health Plan Network Health

Plan

Counties: Ashland, Bayfield,

Brown, Calumet, Chippewa,

Clark, Crawford, Dodge,

Door, Douglas, Eau Claire,

Fond du Lac, Forest, Green

Lake, Iron, Jefferson,

Kenosha, Kewaunee,

Langlade, Lincoln,

Manitowoc, Marathon,

Marinette, Marquette,

Menominee, Milwaukee,

Oconto, Oneida, Outagamie,

Ozaukee, Polk, Portage,

Price, Racine, Rock, Rusk,

Sawyer, Shawano,

Sheboygan, Taylor, Vilas,

Walworth, Washburn,

Waukesha, Waupaca,

Waushara, Winnebago,

Wood

33,530 31 33,561

178

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Physicians Plus Health

Plan

Physicians Plus

Health Plan

County: Dane 9,314 17 9,331

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Security Health Plan Security Health

Plan

Counties: Adams, Ashland,

Barron, Bayfield, Burnett,

Chippewa, Clark, Douglas,

Dunn, Eau Claire, Forest,

Iron, Jackson, Juneau,

Langlade, Lincoln,

Marathon, Monroe, Oneida,

Pepin, Portage, Price, Rusk,

Sawyer, Shawano, Taylor,

Trempealeau, Vilas,

Washburn, Waupaca,

Waushara, Wood

55,634 94 55,728

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Trilogy Health

Insurance

Trilogy Health

Insurance

Counties: Brown, Dodge,

Green Lake, Kenosha,

Marinette, Milwaukee,

Oconto, Outagamie,

Ozaukee, Racine, Shawano,

Sheboygan, Washington,

Waukesha, Waupaca,

Waushara, Winnebago

10,787 6 10,793

179

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

UnitedHealthcare

Community Plan

UnitedHealthcare Counties: Adams, Ashland,

Barron, Bayfield, Brown,

Burnett, Calumet,

Chippewa, Columbia,

Crawford, Dane, Dodge,

Door, Douglas, Eau Claire,

Florence, Fond du Lac,

Forest, Green, Green Lake,

Jefferson, Kenosha,

Kewaunee, La Crosse,

Langlade, Lincoln,

Manitowoc, Marathon,

Marinette, Marquette,

Menominee, Milwaukee,

Monroe, Oconto, Oneida,

Outagamie, Ozaukee,

Pierce, Polk, Portage, Price,

Racine, Rock, St. Croix,

Sauk, Sawyer, Shawano,

Sheboygan, Taylor,

Trempealeau, Vernon, Vilas,

Walworth, Washburn,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

144,764 191 144,955

Wisconsin BadgerCare Plus

(Comprehensive

MCO)

Quartz Quartz Counties: Buffalo, Columbia,

Crawford, Dane, Dodge,

Fond du Lac, Grant, Green,

Jackson, Jefferson, Juneau,

La Crosse, Monroe, Rock,

Sauk, Trempealeau, Vernon

29,797 42 29,839

180

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Anthem Blue Cross

Blue Shield

Anthem BCBS Counties: Brown, Calumet,

Dane, Dodge, Door,

Florence, Fond du Lac,

Forest, Green Lake,

Jefferson, Kenosha,

Kewaunee, Langlade,

Manitowoc, Marinette,

Marquette, Menominee,

Milwaukee, Oconto,

Outagamie, Ozaukee, Polk,

Portage, Racine, Rock,

Shawano, Sheboygan,

Taylor, Walworth,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

4,977 654 5,631

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Care Wisconsin Community Care

Health Plan (WI)

Counties: Adams, Calumet,

Clark, Columbia, Crawford,

Dane, Dodge, Fond du Lac,

Grant, Green, Green Lake,

Iowa, Jackson, Jefferson,

Juneau, La Crosse,

Lafayette, Marquette,

Monroe, Outagamie,

Ozaukee, Richland, Rock,

Trempealeau, Vernon,

Waukesha, Waupaca,

Waushara, Winnebago

2,426 369 2,795

181

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Group Health

Cooperative Of Eau

Claire

Group Health

Cooperative

Counties: Ashland, Buffalo,

Chippewa, Columbia,

Crawford, Douglas, Eau

Claire, Forest, Grant, Green,

Iowa, Iron, Jackson, Juneau,

La Crosse, Lafayette,

Langlade, Lincoln,

Marathon, Oneida, Pepin,

Polk, Portage, Price,

Richland, Shawano,

Trempealeau, Vernon, Vilas

Washburn, Wood

2,674 640 3,314

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Independent Care

(iCare)

iCare Counties: Adams, Brown,

Dane, Dodge, Door, Fond

Du Lac, Grant, Green,

Jackson, Jefferson, Juneau,

Kenosha, Kewaunee, La

Crosse, Manitowoc,

Marinette, Milwaukee,

Monroe, Oconto,

Outagamie, Ozaukee,

Racine, Rock, Sheboygan,

Trempealeau, Vernon,

Walworth, Washington,

Waukesha, Waupaca,

Winnebago

6,387 3,906 10,293

182

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin SSI Managed Care

(Comprehensive

MCO)

MHS of Wisconsin MHS of Wisconsin Counties: Ashland, Bayfield,

Brown, Calumet, Chippewa,

Clark, Dodge, Door,

Douglas, Eau Claire, Fond

du Lac, Forest, Green Lake,

Iron, Jefferson, Kenosha,

Kewaunee, Langlade,

Lincoln, Manitowoc,

Marathon, Marinette,

Marquette, Menominee,

Milwaukee, Oconto, Oneida,

Outagamie, Ozaukee, Polk,

Portage, Price, Racine,

Rock, Rusk, Sawyer,

Shawano, Sheboygan,

Taylor, Vilas, Walworth,

Washburn, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

4,834 1,346 6,180

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Molina Health Plan Molina Healthcare Counties: Brown, Calumet,

Clark, Dodge, Door,

Florence, Fond du Lac,

Forest, Green Lake,

Jefferson, Kenosha,

Kewaunee, Langlade,

Lincoln, Manitowoc,

Marathon, Marinette,

Marquette, Milwaukee,

Oconto, Oneida, Outagamie,

Ozaukee, Portage, Racine,

Shawano, Sheboygan,

Taylor, Vilas, Walworth,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

2,593 595 3,188

183

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin SSI Managed Care

(Comprehensive

MCO)

Network Health Plan Network Health

Plan

Counties: Ashland, Bayfield,

Brown, Calumet, Chippewa,

Clark, Dodge, Door,

Douglas, Eau Claire, Fond

du Lac, Forest, Green Lake,

Iron, Jefferson, Kenosha,

Kewaunee, Langlade,

Lincoln, Manitowoc,

Marathon, Marinette,

Marquette, Menominee,

Milwaukee, Oconto, Oneida,

Outagamie, Ozaukee, Polk,

Portage, Price, Racine,

Rock, Rusk, Sawyer,

Shawano, Sheboygan,

Taylor, Vilas, Walworth,

Washburn, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

3,052 785 3,837

184

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin SSI Managed Care

(Comprehensive

MCO)

UnitedHealthcare

Community Plan

UnitedHealthcare Counties: Adams, Ashland,

Barron, Bayfield, Brown,

Burnett, Calumet,

Chippewa, Columbia,

Crawford, Dane, Dodge,

Door, Douglas, Eau Claire,

Florence, Fond du Lac,

Forest, Green, Green Lake,

Jefferson, Kenosha,

Kewaunee, La Crosse,

Langlade, Lincoln,

Manitowoc, Marathon,

Marinette, Marquette,

Menominee, Milwaukee,

Monroe, Oconto, Oneida,

Outagamie, Ozaukee,

Pierce, Polk, Portage, Price,

Racine, Rock, St. Croix,

Sauk, Sawyer, Shawano,

Sheboygan, Taylor,

Trempealeau, Vernon,

Vilas,

Walworth, Washburn,

Washington, Waukesha,

Waupaca, Waushara,

Winnebago, Wood

13,187 5,727 18,914

Wisconsin Family Care

Partnership Program

(Comprehensive MCO

+ MLTSS)

Care Wisconsin Community Care

Health Plan (WI)

Counties: Columbia, Dane,

Dodge, Jefferson, Ozaukee,

Sauk, Waukesha

273 1,534 1,807

Wisconsin Family Care

Partnership Program

(Comprehensive MCO

+ MLTSS)

Community Care, Inc. Community Care

Health Plan (WI)

Counties: Calumet,

Kenosha, Milwaukee,

Outagamie, Ozaukee,

Racine, Washington,

Waukesha, Waupaca

145 483 628

185

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin Family Care

Partnership Program

(Comprehensive MCO

+ MLTSS)

Independent Care

(iCare)

iCare Counties: Dane, Kenosha,

Milwaukee, Racine

299 633 932

Wisconsin Family Care (MLTSS

only (PIHP and/or

PAHP))

Care Wisconsin Community Care

Health Plan (WI)

Counties: Brown, Buffalo,

Chippewa, Clark, Columbia,

Crawford, Dodge, Door,

Dunn, Eau Claire, Grant,

Green, Green Lake, Iowa,

Jackson, Jefferson, Juneau,

Kewaunee, La Crosse,

Lafayette, Marinette,

Marquette, Menominee,

Monroe, Oconto, Ozaukee,

Pepin, Pierce, Richland, St.

Croix, Sauk, Shawano,

Sheboygan, Taylor,

Trempealeau, Vernon,

Walworth, Washington,

Waukesha, Waushara

1,587 6,894 8,481

Wisconsin Family Care (MLTSS

only (PIHP and/or

PAHP))

Community Care, Inc. Community Care

Health Plan (WI)

Counties: Calumet, Fond du

Lac, Kenosha, Milwaukee,

Manitowoc, Outagamie,

Ozaukee, Racine,

Sheboygan, Walworth,

Washington, Waukesha,

Waupaca, Winnebago

2,429 8,459 10,888

186

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin Family Care (MLTSS

only (PIHP and/or

PAHP))

CommunityLink

(became Inclusa in

September 2017)

CommunityLink

(became Inclusa in

September 2017)

Counties: Ashland, Barron,

Bayfield, Buffalo, Burnett,

Chippewa, Clark, Columbia,

Crawford, Dodge, Douglas,

Dunn, Eau Claire, Florence,

Forest, Grant, Green, Green

Lake, Iowa, Iron, Jackson,

Jefferson, Juneau, La

Crosse, Lafayette,

Langlade, Lincoln,

Marathon, Marquette,

Monroe, Oneida, Pepin,

Pierce, Polk, Portage, Price,

Richland, Rock, Rusk, Sauk,

Sawyer, St. Croix,

Trempealeau, Vernon, Vilas,

Washington, Waukesha,

Washburn, Waushara,

Wood

2,442 12,527 14,969

Wisconsin Family Care (MLTSS

only (PIHP and/or

PAHP))

My Choice Family Care My Choice Family

Care

Counties: Kenosha,

Milwaukee, Ozaukee,

Racine, Rock, Sheboygan,

Walworth, Washington,

Waukesha

1,575 7,074 8,649

Wisconsin Family Care (MLTSS

only (PIHP and/or

PAHP))

Lakeland Care District Lakeland Care

District

Counties: Brown, Calumet,

Door, Florence, Fond du

Lac, Forest, Kewaunee,

Langlade, Lincoln,

Manitowoc, Marathon,

Marinette, Menominee,

Oconto, Oneida, Outagamie,

Portage, Shawano, Vilas,

Waupaca, Winnebago,

Wood

1,002 4,579 5,581

187

State

Program Name

(Type) Plan Name

Parent

Organization

Geographic Region (state-

defined areas, counties, or

zip codes)

Medicaid-Only

Enrollment

Dual

Enrollment

Total

Enrollment

Wisconsin Children Come First

(CCF) (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

Children Come First Children Come

First

County: Dane 122 0 122

Wisconsin WrapAround

Milwaukee (Behavioral

Health Organization

(BHO) only (PIHP

and/or PAHP))

WrapAround

Milwaukee

WrapAround

Milwaukee

County: Milwaukee 1,071 3 1,074

Wisconsin Care4Kids (Other

Prepaid Health Plan

(PHP) (limited

benefits))

Children's Community

Health Plan

Children's

Community Health

Plan

Counties: Milwaukee,

Kenosha, Racine,

Washington, Ozaukee,

Waukesha

3,141 0 3,141

Wisconsin Program of All-

inclusive Care for the

Elderly (PACE)

(Program of All-

inclusive Care for the

Elderly (PACE))

Community Care, Inc. Community Care

Health Plan (WI)

Counties: Milwaukee and

Waukesha

30 543 573

Wyoming Care Management

Entity for Emotionally

Disturbed Children

(Other Prepaid Health

Plan (PHP) (limited

benefits))

CME Statewide Magellan Health Statewide 234 0 234

Wyoming Wyoming PACE at

Cheyenne Medical

Center (Program of

All-inclusive Care for

the Elderly (PACE))

Cheyenne Regional

Medical Center PACE

Cheyenne

Regional Medical

Center

Laramie County 4 132 136

1. The information in this table was provided by state officials. In some cases, program or plan names in this table differ from those used in publicly available

sources. Questions regarding state-specific information in this table should be directed to State/territorial Medicaid officials.

2. Beneficiaries can simultaneously enroll in Alabama's Patient 1st and Health Homes plans. The de-duplicated Patient 1st plan enrollment is 380,285.

188

3. Colorado reported plan level enrollment as 0 for plans that had less than 30 beneficiaries. As a result, reported plan-level enrollment in PACE may be lower than

actual enrollment.

4. Colorado's comprehensive MCOs, Rocky Mountain Health Plans PRIME and Denver Health Medicaid Choice, are contracted under Regional Accountable

Entity (RAE) 1 and RAE 5 of the state's PCCM Entity program, Accountable Care Collaborative.

5. Georgia is unable to provide separate counts of Medicaid-only and dually eligible beneficiaries for their NEMT program. As a result, Medicaid-only and total

enrollment counts presented in this table include both Medicaid-only and Medicare-Medicaid beneficiaries.

6. Beneficiaries can concurrently enroll in Ohana Community Care Service and another medical or dental plan under the Quest program. The de-duplicated

comprehensive MCO enrollment is 351,685.

7. Michigan is not able to provide dual-eligible enrollment for the Specialty Prepaid Inpatient Health plan.

8. Oregon Health Plan includes (1) Coordinated Care Organizations (CCOs); (2) Dental Care Organizations (DCOs), like Access Dental Plan, LLC; Advantage

Dental Services; Capitol Dental Care, Inc.; CareOregon Dental; Family Dental Care; Managed Dental Care or Oregon; and ODS Community Health, Inc., or (3) the

Mental Health Organization called Greater Oregon Behavioral Health, Inc. CCO enrollees receive physical, dental and mental health services and may be enrolled

in more than one plan type simultaneously.

9. Beneficiaries can simultaneously enroll in (1) Magellan Health services, (2) DentaQuest USA Insurance Company, and (3) another comprehensive MCO. The

de-duplicated comprehensive MCO enrollment is 1,386,664.

10. The Department of Vermont Health Access, a state agency, acts as Vermont's single MCO entity. Vermont pays for Medicaid services for dually eligible

enrollees on a FFS basis. Dually eligible enrollees reported in the Global Commitment to Health Demonstration are Medicaid enrollees who have become newly

eligible for Medicare and, as of July 1, have not yet transferred out of the program.

11. The 22,412 enrollees reported in the Health Home program excludes 72,261 beneficiaries who are enrolled in both comprehensive MCO programs and the

Health Home program.

12. Washington is unable to provide separate counts of Medicaid-only and dual enrollment for their NEMT, BHSO, and PACE programs. As a result, Medicaid-only

and total enrollment counts presented in this table include both Medicaid-only and Medicare-Medicaid beneficiaries.

189

Table 6. Medicaid Managed Long Term Services and Supports (MLTSS) Program Users or Enrollees, as of

July 1, 2018

1.2

State or Territory

Total Medicaid

Enrollment in

Any Type of

Managed Care

Comprehensive

Managed Care Including

LTSS

: Number of

Enrollees Using LTSS

3,4

Comprehensive

Managed Care Including

LTSS

: Percent of Total

Managed LTSS (MLTSS)

Only: Number of

Enrollees Using LTSS

3,4

Managed LTSS (MLTSS)

Only: Percent of Total

TOTALS 66,107,287 1,025,522 1.6% 278,891 0.4%

Alabama 638,221 0 0.0% 0 0.0%

Alaska 0 0 0.0% 0 0.0%

American Samoa n/a n/a n/a n/a n/a

Arizona 1,560,593 60,015 3.8% 0 0.0%

Arkansas 871,262 0 0.0% 0 0.0%

California 10,670,306 346,031 3.2% 0 0.0%

Colorado 1,171,171 0 0.0% 0 0.0%

Connecticut 0 0 0.0% 0 0.0%

Delaware 208,802 13,542 6.5% 0 0.0%

District of Columbia 189,363 0 0.0% 0 0.0%

Florida

3,178,981 0 0.0% 101,524 3.2%

Georgia

1,485,250 0 0.0% 0 0.0%

Guam n/a n/a n/a n/a n/a

Hawaii

351,685 9,466 2.7% 0 0.0%

Idaho

272,979 3,799 1.4% 0 0.0%

Illinois

2,176,902 28,756 1.3% 31,143 1.4%

Indiana 1,126,425 0 0.0% 0 0.0%

Iowa 580,507 41,421 7.1% 0 0.0%

Kansas

358,225 29,083 8.1% 0 0.0%

Kentucky 1,259,525 0 0.0% 0 0.0%

190

State or Territory

Total Medicaid

Enrollment in

Any Type of

Managed Care

Comprehensive

Managed Care Including

LTSS

: Number of

Enrollees Using LTSS

3,4

Comprehensive

Managed Care Including

LTSS

: Percent of Total

Managed LTSS (MLTSS)

Only: Number of

Enrollees Using LTSS

3,4

Managed LTSS (MLTSS)

Only: Percent of Total

Louisiana 1,504,540 0 0.0% 0 0.0%

Maine 234,327 0 0.0% 0 0.0%

Maryland 1,169,708 0 0.0% 0 0.0%

Massachusetts 1,211,485 61,367 5.1% 0 0.0%

Michigan

4,608,988 0 0.0% 19,055 0.4%

Minnesota

892,137 33,382 3.7% 0 0.0%

Mississippi 441,782 0 0.0% 0 0.0%

Missouri 954,603 0 0.0% 0 0.0%

Montana 215,475 0 0.0% 0 0.0%

Nebraska 249,024 0 0.0% 0 0.0%

Nevada 588,111 0 0.0% 0 0.0%

New Hampshire 133,829 0 0.0% 0 0.0%

New Jersey

1,569,344 44,715 2.8% 0 0.0%

New Mexico 666,050 28,957 4.3% 0 0.0%

New York

4,764,261 11,144 0.2% 211,268 4.4%

North Carolina 1,581,469 0 0.0% 0 0.0%

North Dakota 48,957 0 0.0% 0 0.0%

Northern Mariana Islands n/a n/a n/a n/a n/a

Ohio

2,450,031 20,050 0.8% 0 0.0%

Oklahoma 649,023 0 0.0% 0 0.0%

Oregon 847,570 0 0.0% 0 0.0%

Pennsylvania

2,627,563 22,523 0.9% 0 0.0%

Puerto Rico 1,505,610 0 0.0% 0 0.0%

191

State or Territory

Total Medicaid

Enrollment in

Any Type of

Managed Care

Comprehensive

Managed Care Including

LTSS

: Number of

Enrollees Using LTSS

3,4

Comprehensive

Managed Care Including

LTSS

: Percent of Total

Managed LTSS (MLTSS)

Only: Number of

Enrollees Using LTSS

3,4

Managed LTSS (MLTSS)

Only: Percent of Total

Rhode Island 302,407 0 0.0% 0 0.0%

South Carolina 1,195,703 0 0.0% 0 0.0%

South Dakota 92,184 0 0.0% 0 0.0%

Tennessee 1,386,664 24,289 1.8% 0 0.0%

Texas 3,845,916 124,552 3.2% 0 0.0%

Utah 271,137 0 0.0% 0 0.0%

Vermont 123,310 202 0.2% 0 0.0%

Virgin Islands n/a n/a n/a n/a n/a

Virginia 875,351 212,460 24.3% 0 0.0%

Washington 1,781,048 0 0.0% 0 0.0%

West Virginia 407,193 0 0.0% 0 0.0%

Wisconsin 811,920 3,395 0.4% 48,568 6.0%

Wyoming 370 0 0.0% 0 0.0%

1. Enrollment and user counts include both Medicaid-only and Medicare-Medicaid (“dual”) enrollees. For both types of enrollees, Medicaid covers LTSS. For dual

enrollees, Medicaid may also cover Medicare cost-sharing for acute, primary care, and specialty services covered by Medicare, and other non-LTSS services that

are not covered by Medicare.

2. Comprehensive Managed Care Including LTSS does not include PACE programs.

3. Some comprehensive managed care programs enroll beneficiaries who may be at risk of needing LTSS but do not receive any LTSS. The counts of LTSS users

only include individuals that receive LTSS. States differ in their ability to report individuals who use MLTSS versus those who are enrolled (and may or may not be

using LTSS). This table reports MLTSS users unless otherwise noted.

4. Florida, Hawaii, Idaho, Illinois, Kansas, and Pennsylvania report the number of enrollees in their MLTSS programs, some of whom may not be using MLTSS.

The totals in this column do not include those six states because it is a count of users, not enrollees.

5. Georgia's Total Medicaid Enrollment in Any Type of Managed Care does not include 1,626,252 NEMT enrollees; a portion of these enrollees are simultaneously

enrolled in other managed care programs.

6. 7,760 of Michigan's MLTSS users are receiving capitated HCBS under the state's Specialty Prepaid Inpatient Health Plan, a BHO. The remainder are receiving

MLTSS under MI Choice, an MLTSS Only program.

7. Minnesota's MLTSS user count includes 3,867 dually eligible Medicare-Medicaid beneficiaries who received skilled nursing visits in the home, some of which

may be paid for by Medicare rather than Medicaid.

192

8. LTSS users in New Jersey are enrolled in either the FamilyCare program or the FIDE SNP program. Total LTSS users include enrollees from both of these

program who use LTSS services.

9. New York provides LTSS services through a comprehensive MCO+MLTSS program and a separate MLTSS-only program.

10. Since 2014, Ohio has operated an MLTSS program for dually eligible beneficiaries who chose not to participate in (i.e., opt out of) the MyCare Financial

Alignment Demonstration. Ohio began reporting the MyCare Opt-Out as an MLTSS program in 2016.

Note: "n/a" indicates that a state or territory was not able to report data.

U.S.

Total

(including

FL,

HI,

ID,

IL,

KS,

and

data)*

1,530,707

U.S.

Total

(excluding

FL,

HI,

ID,

IL,

KS,

and

data)

1,304,413

*This

map

presents

the

number

MLTSS

users,

not

enrollees

(which

could

include

non-users

LTSS,

most

whom

are

dual

eligible).

Six

states

(Florida,

Hawaii,

Idaho,

Illinois,

Kansas,

and

Pennsylvania)

were

not

able

report

data

MLTSS

users

and

instead

report

enrollment

counts.

Based

the

number

MLTSS

users

each

reported

2016,

and

the

overall

increase

enrollment

comprehensive

managed

care

reported

since

2017,

have

assumed

the

number

MLTSS

users

2018

between

1-5,000

for

Idaho,

between

5,001-20,000

for

Hawaii,

between

20,001-50,000

for

Kansas

and

Pennsylvania,

and

greater

than

50,000

for

Florida

and

Illinois.

The

map

assigns

the

aforementioned

categories

when

totaling

the

number

states

with

MLTSS

users.

This

assumption,

however,

may

not

accurate;

readers

should

interpret

this

map

with

caution.

Source:

Medicaid

Managed

Care

Enrollment

and

Program

Characteristics,

2018.

193

Map of State Counts of Users* of Managed Long-Term Services and Supports, as of July 1, 2018

194

Table 7. Number of Managed Care Programs Enrolling Certain Populations on a Mandatory or Voluntary

Basis, at any point in 2018

Features

(N = total number of

programs)

Enrollment

(M=Mandatory,

V=Voluntary)1

Comprehen-

sive MCO

with or

without

MLTSS

(76):

Comprehen-

sive MCO

with or

without

MLTSS

(76):

PCCM

(13):

PCCM

(13):

PCCM

Entity

(4):

PCCM

Entity

(4):

MLTSS

(5):

MLTSS

(5):

BHO (PIHP

and/or

PAHP)

(15):

BHO (PIHP

and/or

PAHP)

(15):

Dental

(12):

Dental

(12):

Transporta-

tion

(18):

Transporta-

tion

(18):

Other

PHP

(7):

Other

PHP

(7):

PACE

(31):

PACE

(31):

Low-income Adults 40 4 6 1 4 0 1 0 9 0 7 2 11 3 0 2 0 0

Aged, Blind or Disabled

Children or Adults

45 13 10 2 3 1 2 1 11 0 8 2 15 3 1 1 0 24

Non-Disabled Children

(excluding children in foster

care or receiving adoption

assistance)

43 3 10 1 4 0 1 0 9 0 8 2 13 3 1 2 0 0

Individuals receiving Limited

Benefits

12 2 4 1 1 0 0 0 3 0 2 2 7 3 1 2 0 0

Low-income adults not

otherwise eligible and

covered prior to 2014 under

a waiver or other authority

39 5 4 1 2 0 0 0 8 0 5 2 9 1 0 1 0 0

Full Duals 26 25 0 1 2 1 3 2 9 2 5 2 13 3 0 1 0 30

Partial Duals 6 5 0 1 0 0 0 1 4 2 3 0 6 2 0 1 0 20

Children with Special Health

Care Needs

32 14 4 3 3 1 1 0 8 4 6 3 14 3 1 2 0 0

Native American/Alaskan

Natives

23 42 4 7 2 1 2 2 5 7 5 7 7 5 0 5 0 23

Foster Care and Adoption

Assistance Children

32 19 2 6 2 2 1 0 8 4 6 2 14 0 0 4 0 1

Exempt populations

(NA/AN=Native

American/Alaskan Native,

FC/AA=Foster Care and

Adoption Assistance

Children)

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

NA/AN

FC/AA

1. In some cases, the sum of mandatory and voluntary enrollment populations for any given program type is greater than the total number of programs of that type. That is because a state may treat individuals within a specific group, such as

aged, blind, or disabled adults, differently. For example, a state can mandate enrollment of aged adults, while allowing blind and disabled adults to enroll voluntarily.

2. Certain federal statutory authorities do not allow enrollment of American Indians/Alaska Natives or Foster Care Children. Where states use these authorities to operate Medicaid managed care, American Indians/Alaska Natives or Foster Care

Children are considered "exempt.

195

Table 8. Number of Managed Care Program Types, by Quality Assurance Requirements, Performance

Incentives, and Provider Value-Based Purchasing Status, at any point in 2018

Features

(total number of programs)

Comprehensive

MCO with or

without MLTSS

(76)

PCCM

(13)

PCCM Entity

(4)

MLTSS

(5)

BHO (PIHP

and/or PAHP)

(15)

Dental

(12)

Transportation

(18)

Other PHP

(7)

PACE

(31)

Quality Assurance and Data

Collection: HEDIS data

required

68 3 2 1 8 8 0 3 2

Quality Assurance and Data

Collection: CAHPS data

required

66 3 2 1 4 9 0 3 1

Quality Assurance and Data

Collection: Accreditation

required

39 0 0 2 8 3 0 1 1

Quality Assurance and Data

Collection: EQRO contractor

used

71 3 2 4 9 6 1 3 2

Performance incentives:

Payment bonuses/differentials

to reward MCOs

30 2 1 3 4 1 2 1 1

Performance incentives:

Preferential auto-enrollment to

reward MCOs

20 0 0 1 0 0 0 0 0

Performance incentives: Public

reports comparing MCO

performance on key metrics

42 2 2 1 4 4 1 0 0

Performance incentives:

Withholds tied to performance

metrics

35 1 1 2 3 4 0 1 0

Performance incentives:

MCOs/PHPs required or

encouraged to pay providers

for value/quality outcomes

using shared-risk or shared-

savings methods

45 0 2 1 3 4 0 0 0

194

State Tables

Alabama Managed Care Program Features, as of 2018

Features Maternity Care Program PACE Patient 1st

Program type Other Prepaid Health Plan (PHP)

(limited benefits)

Program of All-inclusive Care for the

Elderly (PACE)

Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide Mobile and Baldwin County Statewide

Federal operating authority 1915(b) PACE 1932(a)

Program start date 09/01/1988 01/01/2012 10/01/2004

Waiver expiration date (if applicable) 08/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory Mandatory

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

195

Features Maternity Care Program PACE Patient 1st

Populations enrolled: Children with

Special Health Care Needs

Mandatory Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt

Populations enrolled: Enrollment choice

period

Pre-assigned N/A N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Open enrollment begins the first of

every month, and disenrollment is

effective the last day of the chosen

month.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices

196

Features Maternity Care Program PACE Patient 1st

Benefits covered: EPSDT

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Freestanding birth centers Other medically necessary services as

determined by the interdiscplinary team

Quality assurance and improvement:

HEDIS data required?

No No No

197

Features Maternity Care Program PACE Patient 1st

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Maternity Care Plan Mercy Life of Alabama Patient 1st

Notes: Program notes This is only a maternity care program. It

is a PAHP only program. Maternity

services are provided FFS, not under

1915(b) authority in the above excluded

counties.

198

Alabama Managed Care Program Features, as of 2018 (2 of 2)

Features Health Homes

Program type Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide

Federal operating authority 1945 Health Homes

Program start date 04/01/2015

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary

199

Features Health Homes

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

200

Features Health Homes

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

201

Features Health Homes

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Health Homes

Notes: Program notes To be eligible for the Health Home, a

recipient must be enrolled in Patient 1st

and their assigned PMP must also be

participating in the Health Home.

202

Arizona Managed Care Program Features, as of 2018

Features

Arizona Health Care Cost

Containment System

Program type Comprehensive MCO + MLTSS

efStatewide or region-specific? Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

Program start date 07/13/1982

Waiver expiration date (if applicable) 09/30/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

203

Features

Arizona Health Care Cost

Containment System

Populations enrolled: Native

American/Alaskan Natives

Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

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.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

204

Features

Arizona Health Care Cost

Containment System

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Freestanding birth centers & podiatry

Quality assurance and improvement:

HEDIS data required?

Yes

205

Features

Arizona Health Care Cost

Containment System

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

Please note that HEDIS and CAHPS

are run by the EQRO not the MCO.

CAHPS is completed by our EQRO, but

AHCCCS does not request that every

population be evaluated every year.

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program United Healthcare Plan; Care1st Health

Plan; DCS/CMDP; DES/Division of

Developmental Disabilities (MLTSS);

United Healthcare Plan (MLTSS);

Health Choice Arizona; Health Net

Access; Mercy Care Plan; Mercy Care

Plan (MLTSS); University Family Care;

Mercy Maricopa Integrated Care;

Cenpatico Integrated Care; Health

Choice Integrated Care; Banner

University Family Care (MLTSS)

206

Features

Arizona Health Care Cost

Containment System

Notes: Program notes 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 30 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.

207

Arkansas Managed Care Program Features, as of 2018 (1 of 2)

Features Connect Care PACE

Provider-Led Arkansas Shared

Savings Entity (PASSE) Program

Program type Primary Care Case Management

(PCCM)

Program of All-inclusive Care for the

Elderly (PACE)

Primary Care Case Management Entity

(PCCM Entity)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1932(a) PACE 1915(b)

Program start date 01/01/2014 04/01/2016 02/01/2018

Waiver expiration date (if applicable) 03/01/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

208

Features Connect Care PACE

Provider-Led Arkansas Shared

Savings Entity (PASSE) Program

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

N/A N/A Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X X X

209

Features Connect Care PACE

Provider-Led Arkansas Shared

Savings Entity (PASSE) Program

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Capitated comprehensive medical and

social services in adult day health

centers and in-home and referral

services according to the participants

needs.

Quality assurance and improvement:

HEDIS data required?

No No No

210

Features Connect Care PACE

Provider-Led Arkansas Shared

Savings Entity (PASSE) Program

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

No Yes No

Quality assurance and improvement:

Accrediting organization

Health Management Plan (CMS)

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Multiple primary care providers Complete Health; Total Life Healthcare Summit Community Care; Arkansas

Total Care; Empower Healthcare

Solutions; Forevercare

211

Features Connect Care PACE

Provider-Led Arkansas Shared

Savings Entity (PASSE) Program

Notes: Program notes The PASSE is designed to address the

needs of Medicaid beneficiaries who

have complex behavioral health and

intellectual and developmental

disabilities service needs. Providers of

specialty and medical services will enter

into pa

rtnerships with each other and an

experienced organization that performs

administrative functions similar to

insurance companies. Providers retain

majority ownership of each PASSE.

The

governing body of each PASSE must

include several types of providers

including a Developmental Disabilities

Services provider, a Behavioral Health

Services provider, a hospital, a

physician, and a pharmacist. There are

2 phases of implementation. Phase I,

which began on February 1, 2018, is

when each PASSE is responsible for

providing care coordination to every

individual that has been assigned to

them. Phase II, which began March 1,

2019, is when the PASSE entered into a

full-risk contract as an MCO.

212

Arkansas Managed Care Program Features, as of 2018 (2 of 2)

Features Arkansas Dental Managed Care

Arkansas Non-Emergency Medical

Transport (NET)

Program type Dental only (PAHP) Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b) 1915(b),1902(a)(70) NEMT

Program start date 01/01/2018 03/01/1998

Waiver expiration date (if applicable) 12/31/2022 09/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

213

Features Arkansas Dental Managed Care

Arkansas Non-Emergency Medical

Transport (NET)

Populations enrolled: Native

American/Alaskan Natives

Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

214

Features Arkansas Dental Managed Care

Arkansas Non-Emergency Medical

Transport (NET)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

215

Features Arkansas Dental Managed Care

Arkansas Non-Emergency Medical

Transport (NET)

Quality assurance and improvement:

Accreditation required?

Yes No

Quality assurance and improvement:

Accrediting organization

URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Delta Dental of Arkansas; Managed

Care of North America (MCNA) Dental

Southeasttrans; Central Arkansas

Development Council; Area Agency on

Aging of Western Arkansas; Mid-Delta;

Area Agency on Aging of Southeast

Arkansas

216

Features Arkansas Dental Managed Care

Arkansas Non-Emergency Medical

Transport (NET)

Notes: Program notes In early December 2017, all Arkansas

Medicaid beneficiaries who are eligible

for dental benefits were randomly and

evenly assigned to one of the two dental

managed care plans. Members were

able to access plan providers starting

January 1, 2018 for covered dental

services. If members wish to switch

plans, they have 90 days to do so. The

vendors will serve all members who

receive dental services through

Medicaid except for those residing in

Human Development Centers,

individuals enrolled in the Program for

All Inclusive Care for the Elderly

(PACE), members who reside in a

nursing home setting, and individuals

who are eligible for Medicaid only after

incurring medical expenses that cause

them to “spend down” to Medicaid

eligibility levels.

217

California Managed Care Program Features, as of 2018 (1 of 4)

Features Positive Healthcare/Los Angeles

Family Mosaic Program/San

Francisco

Health Plan of San Mateo CCS

Demo/San Mateo

Program type Other Prepaid Health Plan (PHP)

(limited benefits)

Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Comprehensive MCO

Statewide or region-specific? Los Angeles San Francisco San Mateo

Federal operating authority 1937 Alt Benefit Plan 1915(a) 1115(a) (Medicaid demonstration

waivers)

Program start date 04/01/2002 12/01/1992 06/01/2012

Waiver expiration date (if applicable) 04/01/2018

If the program ended in 2018, indicate

the end date

04/01/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary Mandatory

218

Features Positive Healthcare/Los Angeles

Family Mosaic Program/San

Francisco

Health Plan of San Mateo CCS

Demo/San Mateo

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X X X

Benefits covered: Case management X X X

219

Features Positive Healthcare/Los Angeles

Family Mosaic Program/San

Francisco

Health Plan of San Mateo CCS

Demo/San Mateo

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes No No

220

Features Positive Healthcare/Los Angeles

Family Mosaic Program/San

Francisco

Health Plan of San Mateo CCS

Demo/San Mateo

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Positive Healthcare/Los Angeles Family Mosaic Project/San Francisco Health Plan of San Mateo CCS Demo

Notes: Program notes

221

California Managed Care Program Features, as of 2018 (2 of 4)

Features

County Organized Health Systems

(COHS) Model Two-Plan Model Regional Model

Program type Comprehensive MCO + MLTSS Comprehensive MCO + MLTSS Comprehensive MCO

Statewide or region-specific? Del Norte, Humboldt, Lake, Lassen,

Marin, Medocino, Merced, Modoc,

Monterey, Napa, Orange, San Luis

Obispo, San Mateo, Santa Barbara,

Santa Cruz, Shasta, Siskiyou, Solano,

Sonoma, Trinity, Ventura, Yolo

Alameda, Contra Costa, Fresno, Kern,

Kings, Los Angeles, Madera, Riverside,

San Bernardino, San Francisco, San

Joaquin, Santa Clara, Stanislaus,

Tulare

Alpine, Amador, Butte, Calaveras,

Colusa, El Dorado, Glenn, Imperial,

Inyo, Mariposa, Mono, Nevada, Placer,

Plumas, San Benito, Sierra, Sutter,

Tehama, Tuolumne, Yuba

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers),1915(b)/1915(c)

1115(a) (Medicaid demonstration

waivers)

Program start date 10/01/1995 01/01/1996 10/02/2013

Waiver expiration date (if applicable) 12/31/2020 12/31/2020 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Varies Varies Voluntary

Populations enrolled: Partial Duals Mandatory

222

Features

County Organized Health Systems

(COHS) Model Two-Plan Model Regional Model

Populations enrolled: Children with

Special Health Care Needs

Mandatory Voluntary Voluntary

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary Voluntary

Populations enrolled: Enrollment

choice period

Pre-assigned Other Other

Populations enrolled: Enrollment

broker name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Approximately 45 days Approximately 45 days

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

223

Features

County Organized Health Systems

(COHS) Model Two-Plan Model Regional Model

Benefits covered: EPSDT X X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver

services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

224

Features

County Organized Health Systems

(COHS) Model Two-Plan Model Regional Model

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes Yes

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

X X

Performance incentives: Public reports

comparing plan performance on key

metrics

X X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

225

Features

County Organized Health Systems

(COHS) Model Two-Plan Model Regional Model

Participating plans: Plans in Program 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 Health

Plan/Southeast; Partnership Health

Plan/Southwest; Central California

Alliance for Health/Merced; Central

California Alliance for Health/Monterey

Santa Cru

z; CalOptima/Orange; Gold

Coast Health Plan/Ventura

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; L.A. Care

Health Plan/Los Angeles; Contra Costa

Health Plan; Alameda Alliance for

Health; Inland Empire Health

Plan/Riverside; Inland Empire Health

Plan/S

an 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

California Health & Wellness

Plan/Imperial; California Health &

Wellness Plan/Region 1; California

Health & Wellness Plan/Region 2;

Molina Healthcare of CA Partner

Plan/Imperial; Anthem Blue Cross

Partnership Plan/Region 1; Anthem

Blue Cross Partner

ship Plan/Region 2;

KP Cal LLC/Amador; KP Cal LLC/El

Dorado; KP Cal LLC/Placer

Notes: Program notes Full duals are mandatory for managed

care enrollment in CCI Counties

(Orange and San Mateo) and voluntary

for all other Counties.

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).

226

California Managed Care Program Features, as of 2018 (3 of 4)

Features

Geographic Managed Care (GMC)

Model Senior Care Action Network (SCAN)

Program of All-Inclusive Care for the

Elderly (PACE)

Program type Comprehensive MCO + MLTSS Comprehensive MCO + MLTSS Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Sacramento, San Diego Los Angeles, Riverside, San

Bernardino

Alameda, Contra Costa, Fresno,

Humboldt, Los Angeles, Orange,

Riverside, Sacramento, San

Bernardino, San Diego, San Francisco,

Santa Clara

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 06/01/1991 01/01/1996 06/01/1991

Waiver expiration date (if applicable) 12/31/2020 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Varies Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary

227

Features

Geographic Managed Care (GMC)

Model Senior Care Action Network (SCAN)

Program of All-Inclusive Care for the

Elderly (PACE)

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Exempt Exempt

Populations enrolled: Enrollment

choice period

Other N/A

Populations enrolled: Enrollment

broker name (if applicable)

Health Care Options (Maximus)

Populations enrolled: Notes on

enrollment choice period

Approximately 45 days

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

228

Features

Geographic Managed Care (GMC)

Model Senior Care Action Network (SCAN)

Program of All-Inclusive Care for the

Elderly (PACE)

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X X

Benefits covered: HCBS waiver

services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

229

Features

Geographic Managed Care (GMC)

Model Senior Care Action Network (SCAN)

Program of All-Inclusive Care for the

Elderly (PACE)

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

230

Features

Geographic Managed Care (GMC)

Model Senior Care Action Network (SCAN)

Program of All-Inclusive Care for the

Elderly (PACE)

Participating plans: Plans in Program Care 1st Partner Plan/San Diego;

Community Health Group Partnership

Plan/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; Aetna

Better Health of CA/Sacramento;

UnitedHealthcare Community

Plan/Sacramento

SCAN Health Plan/Los Angeles; SCAN

Health Plan/Riverside; SCAN Health

Plan/San Bernardino; SCAN Health

Plan (Nurs hm cert)/Los Angeles;

SCAN Health Plan (Nurs hm

cert)/Riverside; SCAN Health Plan

(Nurs hm cert)/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;

Fres

no PACE; InnovAge

PACE/Riverside; InnovAge PACE/San

Bernardino County; On Lok

Lifeways/Alameda; On Lok

Lifeways/Santa Clara; On Lok

Lifeways/San Francisco

Notes: Program notes Full duals are mandatory for managed

care enrollment in CCI Counties (San

Diego) and voluntary for all other

counties (Sacramento).

231

California Managed Care Program Features, as of 2018 (4 of 4)

Features Dental Managed Care/Los Angeles Dental Managed Care/Sacramento

Program type Dental only (PAHP) Dental only (PAHP)

Statewide or region-specific? Los Angeles Sacramento

Federal operating authority 1915(a)/1915(i) 1115(a) (Medicaid demonstration

waivers)

Program start date 04/01/1998 12/01/1998

Waiver expiration date (if applicable) 12/31/2020 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary Voluntary

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

232

Features Dental Managed Care/Los Angeles Dental Managed Care/Sacramento

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary

Populations enrolled: Enrollment choice

period

60 days 60 days

Populations enrolled: Enrollment broker

name (if applicable)

Health Care Operations (Maximus) Health Care Operations (Maximus)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT X X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

233

Features Dental Managed Care/Los Angeles Dental Managed Care/Sacramento

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

234

Features Dental Managed Care/Los Angeles Dental Managed Care/Sacramento

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Health Net Dental Plan/Los Angeles;

Access Dental Plan/Los Angeles;

LIBERTY Dental Plan/Los Angeles

Health Net Dental Plan/Sacramento;

Access Dental Plan/Sacramento;

LIBERTY Dental Plan/Sacramento

Notes: Program notes

235

Colorado Managed Care Program Features, as of 2018 (1 of 2)

Features

Program of All-Inclusive Care for the

Elderly

Accountable Care Collaborative

(ACC)

Colorado Medicaid Community

Behavioral Health Services Program

Program type Program of All-inclusive Care for the

Elderly (PACE)

Primary Care Case Management Entity

(PCCM Entity)

Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Adams, Arapahoe, Broomfield, Denver,

Jefferson, Boulder, Weld (Southwest),

Pueblo, El Paso, Delta, Montrose

Statewide Statewide

Federal operating authority PACE 1915(b) 1915(b)

Program start date 10/01/1991 07/01/2018 07/01/1995

Waiver expiration date (if applicable) 06/30/2023 06/30/2019

If the program ended in 2018, indicate

the end date

06/30/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Voluntary Mandatory Mandatory

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

236

Features

Program of All-Inclusive Care for the

Elderly

Accountable Care Collaborative

(ACC)

Colorado Medicaid Community

Behavioral Health Services Program

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Mandatory Mandatory

Populations enrolled: Enrollment choice

period

N/A Other Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Health Services, Inc. Maximus Health Services, Inc.

Populations enrolled: Notes on

enrollment choice period

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.

Beneficiaries are passively enrolled and

can choose their primary care provider

at any time.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

237

Features

Program of All-Inclusive Care for the

Elderly

Accountable Care Collaborative

(ACC)

Colorado Medicaid Community

Behavioral Health Services Program

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

X X

238

Features

Program of All-Inclusive Care for the

Elderly

Accountable Care Collaborative

(ACC)

Colorado Medicaid Community

Behavioral Health Services Program

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

PACE is an all-inclusive program. Some

of the other available services include

optometry, podiatry, rehabilitative

services, adult day health center

services, and transportation.

All members enrolled in ACC are

eligible for all 1932(a) state plan

benefits. They also get benefits covered

under the 1915(b) waiver. All plans are

responsible for providing behavioral

health benefits under the 1915(b)

waiver.

Quality assurance and improvement:

HEDIS data required?

No Yes No

Quality assurance and improvement:

CAHPS data required?

No Yes No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group, Inc.

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

239

Features

Program of All-Inclusive Care for the

Elderly

Accountable Care Collaborative

(ACC)

Colorado Medicaid Community

Behavioral Health Services Program

Participating plans: Plans in Program Rocky Mountain Health Care Services

(PACE); Total Longterm Care - Pueblo

DBA Innovage Greater Colorado PACE;

Total Longterm Care - Innovage Aurora

(PACE); Volunteers of America

(VOANS) PACE DBA Senior

Community Care; Total Longterm Care -

Innovage Loveland (PACE); TRU

Community Care; Total Longterm Care -

Innovage Lakewood (PACE); Total

Longterm Care - Innovage Thornton

(PACE)

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

Colorado Health Partnerships;

Behavioral Healthcare, Inc.; Foothills

Behavioral Health Partners; Access

Behavioral Care - Denver; Access

Behavioral Care - Northeast

Notes: Program notes 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.

The Colorado Medicaid Community

Behavioral Health Services Program

contracts with BHOs to arrange for or

provide medically necessary mental

health services to clients in five service

areas. In each area, the program is

managed by a different behavioral

health organization BHO. Medicaid

members are assigned to a BHO based

on where they live.

240

Colorado Managed Care Program Features, as of 2018 (2 of 2)

Features Denver Health Medicaid Choice

Accountable Care Collaborative:

Rocky Mountain Health Plans Prime

Program type Comprehensive MCO Comprehensive MCO

Statewide or region-specific? Denver, Arapahoe, Adams, Jefferson

Counties

Garfield, Gunnison, Mesa, Montrose,

Pitkin, Rio Blanco Counties

Federal operating authority 1915(a) 1932(a)

Program start date 01/01/1997 09/01/2014

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

241

Features Denver Health Medicaid Choice

Accountable Care Collaborative:

Rocky Mountain Health Plans Prime

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary

Populations enrolled: Enrollment choice

period

Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Health Services, Inc. Maximus Health Services, Inc.

Populations enrolled: Notes on

enrollment choice period

Clients are passively enrolled with 90

days to opt-out after enrollment. Each

year, clients are given notice 60 days

prior to the first day of their birth month

that they can disenroll.

Clients are passively enrolled with 90

days to opt-out after enrollment. Each

year, clients are given notice 60 days

prior to the first day of their birth month

that they can disenroll.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices

242

Features Denver Health Medicaid Choice

Accountable Care Collaborative:

Rocky Mountain Health Plans Prime

Benefits covered: EPSDT X X

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Durable medical equipment Durable medical equipment

Quality assurance and improvement:

HEDIS data required?

Yes Yes

243

Features Denver Health Medicaid Choice

Accountable Care Collaborative:

Rocky Mountain Health Plans Prime

Quality assurance and improvement:

CAHPS data required?

Yes Yes

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group, Inc. Health Services Advisory Group, Inc.

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Denver Health Medicaid Choice Accountable Care Collaborative: Rocky

Mountain Health Plans Prime

Notes: Program notes Denver Health Medicaid Choice is

contracted and operates under RAE 5

(Colorado Access) of the Accountable

Care Collaborative program.

Rocky Mountain Health Plans Prime is

contracted and operates under RAE 1

(Rocky Mountain Health Plans) of the

Accountable Care Collaborative

program.

244

Delaware Managed Care Program Features, as of 2018

Features

LogistiCare/Circulation Non-

Emergency Medical Transportation Diamond State Health Plan Saint Francis Life

Program type Non-Emergency Medical Transportation Comprehensive MCO + MLTSS Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide New Castle County

Federal operating authority 1902(a)(70) NEMT 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 07/01/2002 01/01/1996 02/01/2013

Waiver expiration date (if applicable) 07/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

245

Features

LogistiCare/Circulation Non-

Emergency Medical Transportation Diamond State Health Plan Saint Francis Life

Populations enrolled: Native

American/Alaskan Natives

Exempt Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Exempt

Populations enrolled: Enrollment choice

period

Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

DXC Technology DXC Technology

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

246

Features

LogistiCare/Circulation Non-

Emergency Medical Transportation Diamond State Health Plan Saint Francis Life

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Freestanding birth centers, home-

delivered meals, emergency response

system, home modifications

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes Yes

247

Features

LogistiCare/Circulation Non-

Emergency Medical Transportation Diamond State Health Plan Saint Francis Life

Quality assurance and improvement:

Accreditation required?

No Yes No, but accreditation considered in plan

selection criteria

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Mercer Government Human Services

Consulting

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program LogistiCare/Circulation Non-Emergency

Medical Transportation

Highmark Health Options of Delaware;

AmeriHealth Caritas of Delaware

Saint Francis Life

Notes: Program notes AmeriHealth Caritas contract began on

1/1/2018.

248

District of Columbia Managed Care Program Features, as of 2018

Features DC Healthy Families

Child and Adolescent Supplemental

Security Income Program (CASSIP)

Non-Emergency Medical

Transportation (NEMT)

Program type Comprehensive MCO Comprehensive MCO Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1932(a),1945 Health Homes 1915(a) 1902(a)(70) NEMT

Program start date 04/01/1994 01/01/1996 10/01/2007

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Voluntary Voluntary Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary Exempt

249

Features DC Healthy Families

Child and Adolescent Supplemental

Security Income Program (CASSIP)

Non-Emergency Medical

Transportation (NEMT)

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Voluntary Mandatory

Populations enrolled: Enrollment choice

period

30 days Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus

Populations enrolled: Notes on

enrollment choice period

Enrollment is voluntary. All other

beneficiaries stay in fee-for-service.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

250

Features DC Healthy Families

Child and Adolescent Supplemental

Security Income Program (CASSIP)

Non-Emergency Medical

Transportation (NEMT)

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Freestanding birth centers Freestanding birth centers

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes No

Quality assurance and improvement:

Accreditation required?

Yes No No

251

Features DC Healthy Families

Child and Adolescent Supplemental

Security Income Program (CASSIP)

Non-Emergency Medical

Transportation (NEMT)

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qlarant

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program AmeriHealth Caritas District of

Columbia; Amerigroup District of

Columbia; Trusted Health Plan

Health Services for Children with

Special Needs

Medical Transportation Management,

Inc.

Notes: Program notes 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. DC Healthy Families

was previously reported as the Medicaid

Managed Care Program.

Aged, blind, or disabled children and

adults are eligible up to the age of 26.

CASSIP was previously reported as

Health Services for Children with

Special Needs.

The DC Department of Health Care

Finance pays for non-emergency

medical transportation only for its fee-

for-service members. Non-emergency

medical transportation for managed

care members is paid by the District's

Medicaid managed care organizations

for low-income adults and children.

252

Florida Managed Care Program Features, as of 2018

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Program type Comprehensive MCO MLTSS only (PIHP and/or PAHP) Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1915(b)/1915(c) PACE

Program start date 08/01/2014 03/01/2014 01/01/2003

Waiver expiration date (if applicable) 06/30/2022 12/27/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

253

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Exempt

Populations enrolled: Enrollment choice

period

Other 60 days N/A

Populations enrolled: Enrollment broker

name (if applicable)

Automated Health Systems Automated Health Systems Automated Health Systems

Populations enrolled: Notes on

enrollment choice period

Beneficiaries are enrolled immediately

after determined eligible. Beneficiaries

are then given 120 days to pick a plan.

Continuous while slots are available

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

254

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

255

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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 can include,

but are not necessarily limited to,

expanded adult dental services,

expanded outpatient hospital visits,

physician home visits, nutritional

counseling, and home and community-

based services.

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(c).

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 nursing

facilities.

All other FL Medicaid covered services

and other services as determined by the

multidisciplinary team

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

Yes Yes No

Quality assurance and improvement:

Accrediting organization

NCQA, AAAHC, Nationally recognized

accrediting organizations

NCQA, AAAHC, Nationally recognized

accrediting organizations

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

256

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Participating plans: Plans in Program Amerigroup Florida, Inc.; Better Health,

Inc.; Aetna DBA Coventry Healthcare of

FL, Inc.; Humana Medical Plan; Molina

Healthcare of Florida, Inc.; Prestige

Health Choice; South Florida

Community Care Network DBA

Community Care Plan; Simply

Healthcare Plans, Inc.; Wellcare Health

Plan of Florida DBA Staywell; Centene

DBA Sunshine State Health Plan, Inc.;

United Healthcare of Florida, Inc.; AIDS

Healthcare Foundation DBA Positive

Healthcare, Inc.; Freedom Health, Inc.;

Magellan Complete Care, LLC; Simply

Healthcare Plans DBA Clear Health

Alliance; Sunshine State Health Plan,

Inc.; Children's Medical Services

Amerigroup Florida, Inc.; Aetna DBA

Coventry Healthcare of FL, Inc.; Molina

Healthcare of FL, Inc.; Centene DBA

Sunshine State Health Plan, Inc.; United

Healthcare of FL, Inc.; Humana Medical

Plan, Inc.

Florida PACE Center; Hope Select

Care; Morselife Home Care, Inc.;

Suncoast Neighborly Care, Inc.

257

Features

Managed Medical Assistance

Program Long-term Care Program

Program of All-Inclusive Care for the

Elderly

Notes: Program notes The following populations are enrolled

automatically in the Managed Medical

Assistance (MMA) program. Pregnant

women who meet all other criteria for

Medicaid eligibility are automatically

enrolled, however presumptively eligible

pregna

nt women are excluded. Full dual

recipients receiving fee-for-service

Medicare or beneficiareis who are

enrolled in a Medicare Advantage plan

are automatically enrolled, however

duals who are not fully liable but who

are enrolled in a fully liable Medicare

Advantage plan or in a Medicare

Advantage Special Needs plan are

excluded. The MMA program includes

MMA specialty plans for recipients in the

child welfare system, recipients under

the age of 21 with chronic conditions,

recipients with HIV or AIDS, recipients

with a serious mental illness, and adults

with chronic conditions who have both

Medicare and full Medicaid (also called

“full duals”). The MMA specialty plans

cover the same health care services as

the standard MMA plans.

A recipient must be 18 years of age or

older and meet Nursing Facility level of

care in order to enroll in the Long-term

Care program. Recipients aged 18 to

64 must be eligible for Medicaid by

reason of a disability as determined by

the Social Security Administration in

order to enroll in the Long-term Care

program. In addition to the 60 day

enrollment period, once a recipient is

enrolled with a plan they have 120 days

to change plans if they wish to do so.

258

Georgia Managed Care Program Features, as of 2018 (1 of 2)

Features Georgia Families Georgia Families 360 Planning for Healthy Babies (P4HB)

Program type Comprehensive MCO Comprehensive MCO Other Prepaid Health Plan (PHP)

(limited benefits)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1932(a)/1915(i) 1932(a),1932(a)/1915(i) 1115(a) (Medicaid demonstration

waivers)

Program start date 06/01/2006 03/03/2014 01/01/2011

Waiver expiration date (if applicable) 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary Voluntary

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

259

Features Georgia Families Georgia Families 360 Planning for Healthy Babies (P4HB)

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Mandatory Exempt

Populations enrolled: Enrollment choice

period

30 days 30 days Other

Populations enrolled: Enrollment broker

name (if applicable)

maximus Maximus

Populations enrolled: Notes on

enrollment choice period

Women who are enrolled in the P4HB

program are granted a 30 days period to

select a care management organization

(CMO) of their choice. Furthermore,

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

autoassigned to a CMO, in order to

receive P4HB services, based on the

state's auto-assignment algorithm.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

260

Features Georgia Families Georgia Families 360 Planning for Healthy Babies (P4HB)

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

261

Features Georgia Families Georgia Families 360 Planning for Healthy Babies (P4HB)

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry, nurse midwife

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes Yes

Quality assurance and improvement:

Accreditation required?

Yes Yes No

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA, JCAHO, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup Community Care;

CareSource - Georgia; Peach State

Health Plan; WellCare of Georgia

Amerigroup Amerigroup; CareSource- Georgia;

Peach State Health Plan; WellCare of

Georgia

262

Features Georgia Families Georgia Families 360 Planning for Healthy Babies (P4HB)

Notes: Program notes Georgia Families is a program that

delivers health care services to

members of Medicaid and PeachCare

for Kids. (PeachCare for Kids is an S-

CHIP program. The enrollment data

provided in this report do not include

enrollment data for PeachCare 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. Dually

eligible beneficiaries are not eligible to

enroll in Georgia Families. However, if

an individual becomes dually eligible

while already enrolled in a Georgia

Families plan, a short delay in

disenrollment results in the inclusion of

a small number of dually eligible

enrollees in Georgia Families plans.

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.

263

Georgia Managed Care Program Features, as of 2018 (2 of 2)

Features

Non-Emergency Medical

Transportation (NEMT)

Program type Non-Emergency Medical Transportation

Statewide or region-specific? Statewide

Federal operating authority 1902(a)(70) NEMT

Program start date 10/07/1997

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Exempt

264

Features

Non-Emergency Medical

Transportation (NEMT)

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

265

Features

Non-Emergency Medical

Transportation (NEMT)

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

266

Features

Non-Emergency Medical

Transportation (NEMT)

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Southeast Trans; Logisticare

Notes: Program notes To provide the necessary non-

emergency medical transportation, DCH

utilizes a brokerage system and it is

these two Brokers, 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.

267

Hawaii Managed Care Program Features, as of 2018

Features Hawaii QUEST Integration

Program type Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

Program start date 09/01/1994

Waiver expiration date (if applicable) 07/31/2024

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory

268

Features Hawaii QUEST Integration

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

30 days

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

269

Features Hawaii QUEST Integration

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Yes

Quality assurance and improvement:

Accrediting organization

NCQA

270

Features Hawaii QUEST Integration

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program AlohaCare QUEST; Hawaii Medical

Service Association (HMSA) QUEST;

Kaiser Permanente QUEST; Ohana

Health Plan QUEST; UnitedHealthcare

Community Plan QUEST; AlohaCare

ABD; HMSA ABD; Kaiser ABD; Ohana

ABD; UnitedHealth ABD; Ohana

Community Care Service (BHS)

Notes: Program notes

271

Idaho Managed Care Program Features, as of 2018 (1 of 2)

Features Idaho Behavioral Health Plan Healthy Connections Medicare/Medicaid Coordinated Plan

Program type Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Primary Care Case Management

(PCCM)

Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Statewide Counties

Federal operating authority 1915(b),1915(b)/1915(i) 1932(a) 1915(a)/1915(c)

Program start date 09/01/2013 10/01/2006 07/01/2014

Waiver expiration date (if applicable) 03/21/2022 12/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary Voluntary

272

Features Idaho Behavioral Health Plan Healthy Connections Medicare/Medicaid Coordinated Plan

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Voluntary Exempt

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

273

Features Idaho Behavioral Health Plan Healthy Connections Medicare/Medicaid Coordinated Plan

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Peer support; family support Medicaid-Primary services not covered

by Medicare

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

Yes No Yes

274

Features Idaho Behavioral Health Plan Healthy Connections Medicare/Medicaid Coordinated Plan

Quality assurance and improvement:

Accrediting organization

NCQA For those participating at tiers 3 or 4 of

our PCMH model, national accreditation

is required.

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Telligen

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program Idaho Behavioral Health Plan Healthy Connections Medicare/Medicaid Coordinated Plan

Notes: Program notes HCBS Services are not covered under

this program.

275

Idaho Managed Care Program Features, as of 2018 (2 of 2)

Features Idaho Smiles

Non-Emergency Medical

Transportation

Program type Dental only (PAHP) Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b) 1902(a)(70) NEMT

Program start date 08/01/2010 09/01/2010

Waiver expiration date (if applicable) 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory

276

Features Idaho Smiles

Non-Emergency Medical

Transportation

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

277

Features Idaho Smiles

Non-Emergency Medical

Transportation

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

No No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

No No

278

Features Idaho Smiles

Non-Emergency Medical

Transportation

Quality assurance and improvement:

Accrediting organization

NCQA, AAAHC URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Idaho Smiles Non-Emergency Medical Transportation

Notes: Program notes

279

Illinois Managed Care Program Features, as of 2018

Features HealthChoice Illinois

HealthChoice Illinois - Managed

Long-Term Services and Supports

Program type Comprehensive MCO + MLTSS MLTSS only (PIHP and/or PAHP)

Statewide or region-specific? Statewide Cook, DuPage, Kane, Kankakee, Lake

and Will counties

Program start date 01/01/2018 01/01/2018

Waiver expiration date (if applicable) 07/11/2021 12/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

280

Features HealthChoice Illinois

HealthChoice Illinois - Managed

Long-Term Services and Supports

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt

Populations enrolled: Enrollment choice

period

60 days 60 days

Populations enrolled: Enrollment broker

name (if applicable)

MAXIMUS MAXIMUS

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

281

Features HealthChoice Illinois

HealthChoice Illinois - Managed

Long-Term Services and Supports

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Ambulatory surgical treatment center,

assisted living, assistive/augmentative

communication devices, audiology,

behavioral, blood and blood

components, chiropractic, durable

medical equipment, environmental

accessibility, immunization,

physical/occupational and speech

therapy, podiatry, renal, specialized

medical equipment and supplies, vision

Non-Medicare behavioral health

282

Features HealthChoice Illinois

HealthChoice Illinois - Managed

Long-Term Services and Supports

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes

Quality assurance and improvement:

Accreditation required?

Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program Blue Cross Blue Shield of Illinois;

CountyCare; IlliniCare Health Plan;

Meridian Health Plan; Molina Healthcare

of Illinois; NextLevel Health Partners;

Harmony Health Plan

Blue Cross Blue Shield of Illinois;

CountyCare; Harmony Health Plan;

IlliniCare Health Plan; Meridian Health

Plan; Molina Healthcare of Illinois;

NextLevel Health Partners

283

Features HealthChoice Illinois

HealthChoice Illinois - Managed

Long-Term Services and Supports

Notes: Program notes HealthChoice Illinois is a statewide

program, effective 1/1/2018, comprised

of the populations 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 enrolled

mandatorily in this program. Pursuant to

305 ILCS 5/5-30 (a) and (h), if a

managed care organization (MCO) is

serving at least 5,000 SPDs (Seniors 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 achieve

accreditation by the NCQA within two

(2) years after the date the MCO

became eligible for accreditation.

HealthChoice Illinois enrolls several

populations through 1915(c) waiver

authority, via five different 1915(c)

waivers, each of which has a different

start and expiration date. The current

Persons with Disabilities 1915(c) waiver

began on 7/12/2016 and will expire on

7/11/2021; the current Elderly 1915(c)

waiver began on 11/1/2016 and will

expire on 10/31/2021; the current

Traumatic Brain Injury 1915(c) waiver

began on 7/1/2017 and will expire on

6/30/2022; the current Supportive Living

Facility 1915(c) waiver began on

10/23/2017 and will expire on

10/22/2022; and the current HIV/AIDS

1915© waiver began on 10/1/2018 and

will expire on 9/30/2023.

Dually eligible adults enrolled in the

state’s Financial Alignment Initiative

Demonstration (MMAI) are not allowed

to enroll in this program. Pursuant to

305 ILCS 5/5-30 (a) and (h), if a

managed care organization (MCO) is

serving at least 5,000 SPDs (Seniors 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 achieve

accreditation by the NCQA within two

(2) years after the date the MCO

became eligible for accreditation.

284

Indiana Managed Care Program Features, as of 2018 (1 of 2)

Features PACE Hoosier Care Connect Hoosier Healthwise

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO Comprehensive MCO

Statewide or region-specific? Lake and Johnson Counties, and the

following zip codes: 46107, 46201,

46202, 46203, 46204, 46217, 46218,

46219, 46221, 46222, 46225, 46227,

46229, 46237, 46239, 46241, 46259,

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

Statewide Statewide

Federal operating authority PACE 1915(b) 1932(a)

Program start date 10/01/2012 04/01/2015 01/01/2000

Waiver expiration date (if applicable) 06/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

285

Features PACE Hoosier Care Connect Hoosier Healthwise

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Voluntary Exempt

Populations enrolled: Enrollment choice

period

N/A Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

If members do select a health plan upon

application, they are auto-assigned.

They have a 90-day window to change

their health plan.

If members do select a health plan upon

application, they are auto-assigned.

They have a 90-day window to change

their health plan.

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

286

Features PACE Hoosier Care Connect Hoosier Healthwise

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry Podiatry

287

Features PACE Hoosier Care Connect Hoosier Healthwise

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes Yes

Quality assurance and improvement:

Accreditation required?

No Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Burns and Associates Burns and Associates

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program Franciscan Senior Health and Wellness;

Saint Joseph PACE

Anthem; Managed Health Services of

Indiana

Anthem; Caresource Indiana, Inc;

Managed Health Services of Indiana;

MDWise

Notes: Program notes

288

Indiana Managed Care Program Features, as of 2018 (2 of 2)

Features Healthy Indiana Plan (2.0)

Program type Comprehensive MCO

Statewide or region-specific? Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

Program start date 02/01/2015

Waiver expiration date (if applicable) 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary

289

Features Healthy Indiana Plan (2.0)

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus

Populations enrolled: Notes on

enrollment choice period

If members do select a health plan upon

application, they are auto-assigned.

They have a 60-day window to change

their health plan. Members cannot

change plans after having made a

POWER account contribution.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

290

Features Healthy Indiana Plan (2.0)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Yes

291

Features Healthy Indiana Plan (2.0)

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Burns and Associates

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Anthem; Caresource Indiana, Inc;

Managed Health Services of Indiana;

MDWise

Notes: Program notes

292

Iowa Managed Care Program Features, as of 2018 (1 of 2)

Features IA Healthlink Dental Wellness Plan PACE

Program type Comprehensive MCO + MLTSS Dental only (PAHP) Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide Harrison, Mills, Pottawattamie,

Cherokee, Monona, Plymouth,

Woodbury, Boone, Dallas, Jasper,

Marshall, Madison, Marion, Polk, Story,

and Warren Counties

Federal operating authority 1915(b)/1915(c),1937 Alt Benefit

Plan,1945 Health Homes

1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 04/01/2016 05/01/2014 09/01/2009

Waiver expiration date (if applicable) 03/31/2021 01/01/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Mandatory Voluntary

Populations enrolled: Partial Duals Mandatory

293

Features IA Healthlink Dental Wellness Plan PACE

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt Exempt

Populations enrolled: Enrollment choice

period

Pre-assigned Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

Maximus (Iowa Medicaid Member

Services contractor)

Maximus (Iowa Medicaid Member

Services contractor)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

294

Features IA Healthlink Dental Wellness Plan PACE

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver

services

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

295

Features IA Healthlink Dental Wellness Plan PACE

Quality assurance and improvement:

Accreditation required?

Yes No No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

Participating plans: Plans in Program UnitedHealthcare; Amerigroup of Iowa,

Inc.

Delta Dental of Iowa; MCNA Dental

Plans, Inc.

PACE

Notes: Program notes

296

Iowa Managed Care Program Features, as of 2018 (2 of 2)

Features NEMT

Program type Non-Emergency Medical Transportation

Statewide or region-specific? Statewide

Federal operating authority 1902(a)(70) NEMT

Program start date 01/01/2009

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary

297

Features NEMT

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

298

Features NEMT

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

299

Features NEMT

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Access2Care, LLC

Notes: Program notes

300

Kansas Managed Care Program Features, as of 2018

Features KanCare PACE

Program type Comprehensive MCO + MLTSS Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Dickinson, Douglas, Ellsworth, Harvey,

Jackson, Jefferson, Leavenworth,

Lincoln, Lyon, Marion, Marshall,

McPherson, Nemaha, Osage, Ottawa,

Reno, Rice, Saline, Sedgwick,

Shawnee, Pottawatomie, Wabaunsee

and Wyandotte counties

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 01/01/2013 08/01/2002

Waiver expiration date (if applicable) 12/31/2018

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

301

Features KanCare PACE

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt

Populations enrolled: Enrollment choice

period

60 days N/A

Populations enrolled: Enrollment broker

name (if applicable)

DXC Technology DXC Technologies

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

302

Features KanCare PACE

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Adult day care, recreational therapy,

meals, social services, social work

counseling, etc.

Quality assurance and improvement:

HEDIS data required?

Yes No

303

Features KanCare PACE

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Kansas Foundation for Medical Care

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup Kansas, Inc.; Sunflower

State Health Plan; United HealthCare

Community Plan of Kansas

Via Christi; Midland Care; Bluestem

Pace, Inc.

Notes: Program notes Kansas operates Kancare under the

1115(a) demonstration waiver

concurrently with seven 1915(c)

waivers. Personal Care Benefits are

covered through one or more of the

1915(c) waivers.

304

Kentucky Managed Care Program Features, as of 2018

Features Kentucky Managed Care

Kentucky Non-Emergency Medical

Transportation

Program type Comprehensive MCO Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b) 1915(b)

Program start date 11/01/2011 12/01/1998

Waiver expiration date (if applicable) 09/30/2019 09/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory Mandatory

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

305

Features Kentucky Managed Care

Kentucky Non-Emergency Medical

Transportation

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

306

Features Kentucky Managed Care

Kentucky Non-Emergency Medical

Transportation

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

307

Features Kentucky Managed Care

Kentucky Non-Emergency Medical

Transportation

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Aetna Better Health of Kentucky;

Anthem Blue Cross Blue Shield

Medicaid; Humana-Caresource;

Passport Health Plan; WellCare of

Kentucky

NEMT - Human Services Transportation

Delivery

Notes: Program notes

308

Louisiana Managed Care Program Features, as of 2018 (1 of 2)

Features Healthy Louisiana Healthy Louisiana BHO Coordinated System of Care

Program type Comprehensive MCO Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1932(a) 1915(b) 1915(b)/1915(c)

Program start date 02/01/2012 12/01/2015 03/01/2012

Waiver expiration date (if applicable) 10/31/2022 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Varies Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Exempt Exempt

309

Features Healthy Louisiana Healthy Louisiana BHO Coordinated System of Care

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Other Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Health Services Maximus Health Services

Populations enrolled: Notes on

enrollment choice period

The enrollee has the opportunity to

choose an MCO at the time of

application. If they do not choose an

MCO, the enrollee is pre-assigned.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X X X

Benefits covered: Case management X X X

310

Features Healthy Louisiana Healthy Louisiana BHO Coordinated System of Care

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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. Personal care (state plan

option) services are available to

enrollees aged 0 - 20.

Youth Support and Training (YST);

Parent Support and Training (PST);

short-term respite; Independent

Living/Skills Building (ILSB) services;

mental health rehabilitation services

including: psychosocial rehabilitation,

crisis intervention, crisis stabilization.

311

Features Healthy Louisiana Healthy Louisiana BHO Coordinated System of Care

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes No

Quality assurance and improvement:

Accreditation required?

Yes Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

IPRO IPRO

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program Aetna Better Health; AmeriHealth

Caritas of Louisiana; Healthy Blue;

Louisiana Healthcare Connections;

UnitedHealthcare Community Plan

Aetna Better Health; AmeriHealth

Caritas of Louisiana; Healthy Blue;

Louisiana Healthcare Connections;

UnitedHealthcare Community Plan

Magellan

312

Features Healthy Louisiana Healthy Louisiana BHO Coordinated System of Care

Notes: Program notes Some of the disabled children

population can voluntarily opt out of

enrolling.

This is a limited benefit MCO program,

which is reported as a BHO since 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.

313

Louisiana Managed Care Program Features, as of 2018 (2 of 2)

Features Dental Benefit Management Program PACE

Program type Dental only (PAHP) Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Baton Rouge, Greater New Orleans,

Lafayette

Federal operating authority 1915(b) PACE

Program start date 07/01/2014 09/01/2007

Waiver expiration date (if applicable) 06/30/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary

314

Features Dental Benefit Management Program PACE

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

315

Features Dental Benefit Management Program PACE

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

All specialized services authorized by

IDT, including podiatry.

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

316

Features Dental Benefit Management Program PACE

Quality assurance and improvement:

EQRO contractor name (if applicable)

Myers & Stauffer LC

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program MCNA of Louisiana Baton Rouge; Greater New Orleans;

Lafayette

Notes: Program notes

317

Maine Managed Care Program Features, as of 2018

Features MaineCare NET

Program type Primary Care Case Management

(PCCM)

Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1932(a) 1915(b)

Program start date 05/01/1999 08/01/2011

Waiver expiration date (if applicable) 03/31/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory

318

Features MaineCare NET

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Mandatory

Populations enrolled: Enrollment choice

period

N/A Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

28 days

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

319

Features MaineCare NET

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

320

Features MaineCare NET

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Multiple Primary Care Providers Logisticare; MidCoast Connector;

Penquis CAP

Notes: Program notes

321

Maryland Managed Care Program Features, as of 2018

Features HealthChoice Hopkins Elder Plus

Program type Comprehensive MCO Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide 21052, 21202, 21205, 21206, 21213,

21214, 21217, 21218, 21219, 21220,

21221, 21222, 21224, 21227, 21231,

21237

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 06/02/1997 11/01/2002

Waiver expiration date (if applicable) 12/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory

322

Features HealthChoice Hopkins Elder Plus

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt

Populations enrolled: Enrollment choice

period

Other N/A

Populations enrolled: Enrollment broker

name (if applicable)

Maryland Health Connection

Populations enrolled: Notes on

enrollment choice period

If participants don't choose at the time

of application they are auto-assigned.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

323

Features HealthChoice Hopkins Elder Plus

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Nurse midwife, freestanding birthing

centers, podiatry (routine foot care

under 21 and diabetics)

All benefits listed under 42 CFR 460.90

- 460.106

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

324

Features HealthChoice Hopkins Elder Plus

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qlarant

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup Community Care; Aetna

Better Health of Maryland; Jai Medical

Systems; Kaiser Permanete; Maryland

Physician's Care; MedStar; Priority

Partners; United HealthCare; University

of Maryland Health Partners

Hopkins Elder Plus

Notes: Program notes

325

Massachusetts Managed Care Program Features, as of 2018 (1 of 3)

Features MassHealth Managed Care

Primary Care Clinician Program (PCC

Plan)

Primary Care Accountable Care

Organizations (Primary Care ACO)

Program type Comprehensive MCO Primary Care Case Management

(PCCM)

Primary Care Case Management Entity

(PCCM Entity)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

Program start date 07/07/1998 01/01/1995 03/01/2018

Waiver expiration date (if applicable) 06/30/2019 06/30/2022 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory Mandatory

326

Features MassHealth Managed Care

Primary Care Clinician Program (PCC

Plan)

Primary Care Accountable Care

Organizations (Primary Care ACO)

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary Voluntary

Populations enrolled: Enrollment choice

period

Other N/A Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

14 days with a 90 day plan selection

period.

14 days

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X

327

Features MassHealth Managed Care

Primary Care Clinician Program (PCC

Plan)

Primary Care Accountable Care

Organizations (Primary Care ACO)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

328

Features MassHealth Managed Care

Primary Care Clinician Program (PCC

Plan)

Primary Care Accountable Care

Organizations (Primary Care ACO)

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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,

SNF, chronic or rehab, others

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

Yes No No

Quality assurance and improvement:

Accrediting organization

NCQA Voluntary participation in EQR

performance measure validation

Quality assurance and improvement:

EQRO contractor name (if applicable)

Innovative Resource Group, LLC D/B/A

KEPRO

Innovative Resource Group, LLC D/B/A

KEPRO

Innovative Resource Group, LLC D/B/A

KEPRO

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

329

Features MassHealth Managed Care

Primary Care Clinician Program (PCC

Plan)

Primary Care Accountable Care

Organizations (Primary Care ACO)

Participating plans: Plans in Program Tufts Health Plan; Boston Medical

Center Health Plan

Multiple Primary Care Providers Community Care Cooperative; Partners

HealthCare Choice; Steward Health

Choice

Notes: Program notes Services provided in this program are

covered by total cost of care rather than

capitation.

330

Massachusetts Managed Care Program Features, as of 2018 (2 of 3)

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Bristol, Essex, Franklin, Hampden,

Hampshire, Middlesex, Norfolk,

Plymouth, Suffolk, Worcestor

Statewide Statewide

Federal operating authority PACE 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

Program start date 07/10/1990 03/01/2018 07/01/1997

Waiver expiration date (if applicable) 06/30/2022 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

331

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary

Populations enrolled: Enrollment

choice period

N/A Other Other

Populations enrolled: Enrollment

broker name (if applicable)

Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

Enrollment open all year, effective the

first day of the next month following

the date on which the member elects

to enroll.

14 days with 90 day plan selection

period.

Daily

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial

hospitalization

X X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X

332

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Benefits covered: EPSDT X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver

services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

X X

333

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

The PACE program covers all

medically necessary services for the

enrolled population, including but not

limited to all covered Medicare and

Medicaid services.

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, SNF up to 100 days

per contract year, chronic or rehab,

and Home Health (nursing and

therapies). LTSS are covered through

FFS. (Note: this list is not fully

inclusive).

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 Care Unit (TCU),

Community Support Program (CSP),

Partial Hospitalization, Psychiatric Day

Treatment, Structure Outpatient

Addiction Program (SOAP), Program

of Assertive Community Treatment,

and Intensive Outpatient Treatment,

Transitional Support Services (TSSW)

for Substance Use Disorders,

Residential Rehabilitation Services for

Substance Use Disorder and

Enhanced Residential Rehabilitation

Services for Dually Diagnosed.

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes No

Quality assurance and improvement:

Accreditation required?

No Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Innovative Resource Group, LLC

D/B/A KEPRO

Innovative Resource Group, DBA

KEPRO

Performance incentives: Payment

bonuses/differentials to reward plans

334

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds

tied to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

Participating plans: Plans in Program Elder Service Plan of Cambridge

Health Alliance; Upham's Elder

Service Plan; Elder Service Plan of

Harbor Health; Fallon Health Summit

Eldercare; Element Care Inc; Serenity

Care PACE Program; Mercy Life Inc;

Neighborhood PACE

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);

Cambridge Health Alliance (CHA) in

partnership with Tufts Health Public

Plans (THPP); Merrimack Valley ACO

in partnership with AllWays Health

Partners; 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; Baystate Health

Care Alliance in partnership with

Health New England

Massachusetts Behavioral Health

Partnership

335

Features

Program of All-Inclusive Care for

the Elderly (PACE)

Accountable Care Partnership

Plans MassHealth BH/SUD PIHP

Notes: Program notes Enrollment numbers do not include

private pay enrollees, if any.

Full duals are only enrolled

mandatorily if less than 21 years of

age. The 1915(b) waiver provides

managed behavioral health benefits

for participants enrolled in the MFP-

and MFP-RS 1915(c) waivers. All

other 1915(c) waiver HCBS are

provided on a fee-for-service basis.

336

Massachusetts Managed Care Program Features, as of 2018 (3 of 3)

Features

Money Follows the Person-

Behavioral Health Supports (MFP-

BH) Senior Care Options

Program type Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Counties of Barnstable, Bristol, Essex,

Franklin, Hampden, Hampshire,

Middlesex, Norfolk, Plymouth, Suffolk,

Worcester and Berkshire

Program start date 04/01/2013 07/01/2004

Waiver expiration date (if applicable) 03/31/2018 12/31/2018

If the program ended in 2018, indicate

the end date

03/31/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals Mandatory Voluntary

337

Features

Money Follows the Person-

Behavioral Health Supports (MFP-

BH) Senior Care Options

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

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.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

338

Features

Money Follows the Person-

Behavioral Health Supports (MFP-

BH) Senior Care Options

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

339

Features

Money Follows the Person-

Behavioral Health Supports (MFP-

BH) Senior Care Options

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Emergency Services Program and

Diversionary Services, Community

Crisis Stabilization, Acute Treatment

Services (ATS) for Substance Use

Disorders (Level III-7), Clinical Support

Services (CSS) for Substance Use

Disorders (Level III-5) and Transitional

Care Unit (TCU), Community Support

Program (CSP), Partial Hospitalization,

Partial Psychiatric Day Treatment,

Structure Outpatient Addiction Program

(SOAP), Program of Assertive

Community Treatment and Intensive

Outpatient Treatment

All MassHealth covered LTSS and all

services described in the

Commonwealth 1915(c) Frail Elder

Waiver

Quality assurance and improvement:

HEDIS data required?

No Yes

Quality assurance and improvement:

CAHPS data required?

No Yes

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

KEPRO

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

340

Features

Money Follows the Person-

Behavioral Health Supports (MFP-

BH) Senior Care Options

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Money Follows the Person- Behavioral

Health Supports (MFP-BH)

Boston Medical Center Healthnet Plan;

Commonwealth Care Alliance; Navicare

HMO; Senior Whole Health; Tufts

Health Plan; United Healthcare

Notes: Program notes MassHealth members enrolled in the

two 1915(c) MFP Waivers who are not

otherwise eligible for the 1115

demonstration were mandatorily

enrolled in this 1915(b) Waiver. The

1915(c) waivers included both the MFP

Community Living (MFP-CL, waiver

control number MA.1027) and the MFP

Residential Supports (MFP-RS, waiver

control number MA.1028) Waivers. The

MFP-BH Waiver (MFP-BH, waiver

control number MA.0002) ran

concurrently with these 1915(c) waivers.

MFP waiver participants must be age

18-64 with disabilities or age 65 or over

and must be on MassHealth Standard.

The SCO Program is a voluntary

program offered to MassHealth

members age 65 and older residing in

the service area of a Senior Care

Oganization. The SCO program is

available in 12 of the 14 counties in

Massachusetts. The SCO program

covers all medically necessary Medicaid

and Medicare covered services through

its provider network. Each enrollee

selects a PCP upon enrollment,

receives care coordination, and

participates in and signs off on the

development of his/her care plan. Each

Senior Care Organization is also

designated by CMS as a Medicare

Advantage Special Needs Plan for

individuals dually eligible for Medicare

and Medicaid.

341

Michigan Managed Care Program Features, as of 2018 (1 of 2)

Features MI Choice Managed Care Plan Division Healthy Michigan Plan

Program type MLTSS only (PIHP and/or PAHP) Comprehensive MCO Comprehensive MCO

Statewide or region-specific? Statewide Statewide Statewide

waivers)

Program start date 10/01/2003 07/01/1997 04/01/2014

Waiver expiration date (if applicable) 09/30/2019 12/31/2019 12/31/2023

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary Voluntary

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

342

Features MI Choice Managed Care Plan Division Healthy Michigan Plan

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Mandatory Exempt

Populations enrolled: Enrollment choice

period

Other Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Michigan Enrolls Michigan Enrolls

Populations enrolled: Notes on

enrollment choice period

Enrollments and disenrollments are

allowed at any time. Enrollments are

always voluntary for qualified

individuals. Must meet NFLOC to

qualify.

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.

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.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

343

Features MI Choice Managed Care Plan Division Healthy Michigan Plan

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

344

Features MI Choice Managed Care Plan Division Healthy Michigan Plan

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Adult Day Health, chore, community

living support, community transition,

counseling, home modifications, fiscal

intermediary, goods and services, home

delivered meals, non-medical

transportation, nursing services, PERS,

private duty nursing, respite, specialized

medical equipment and supplies,

supports coordination and trainers

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, vision services

Ambulance and other emergency

medical transportation, certified midwife

services, chiropractic services, DME

and supplies, emergency services, end

stage renal disease services, health

educa

tion, 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, vision services

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes Yes

Quality assurance and improvement:

Accreditation required?

No Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

X X

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

345

Features MI Choice Managed Care Plan Division Healthy Michigan Plan

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program 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;

Senior Services Inc.; The Information

Center; The Senior Alliance; Tri County

Office on Aging; UPCAP Area Agency

on Aging; Valley Area Agency on Aging;

A & D Home Health Care, Inc.; Area

Agency on Aging 1-B; Area Agency on

Aging of NW Michigan; Area Agency on

Aging of Western Michigan; Detroit Area

Agency on Aging; MORC Home Care

Inc.

Aetna Better Health of Michigan; Blue

Cross Complete of Michigan; Harbor

Health Plan; HAP Midwest Health Plan;

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

Aetna Better Health; Blue Cross

Complete of Michigan; Harbor Health

Plan; HAP Midwest Health Plan;

McLaren Health Plan; Meridian Health

Plan of Michigan; Molina Healthcare of

Michigan; Priority Health Choice; Total

Health Choice; UnitedHealthcare

Community Plan; Upper Peninsula

Health Plan

Notes: Program notes Cover HCBS only. Must be elderly or

disabled adult (at least age 18), meet

Nursing Facility Level of Care (NFLOC),

and require supports coordination and

at least one additional waiver service to

qualify. Accreditation is not required, but

some plans do this voluntarily.

In order to provide greater access and

to support coordination of care for

behavioral health services, the Michigan

Department of Health and Human

Services (MDHHS) has removed the 20-

visit maximum limitation for outpatient

behavioral health 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.

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 (MDHHS) 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.

346

Michigan Managed Care Program Features, as of 2018 (2 of 2)

Features Healthy Kids Dental

Specialty Prepaid Inpatient Health

Plan PACE

Program type Dental only (PAHP) Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1915(b) 1915(b)/1915(c) PACE

Program start date 04/01/2009 10/01/1998 11/01/2003

Waiver expiration date (if applicable) 09/30/2020 09/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Exempt

347

Features Healthy Kids Dental

Specialty Prepaid Inpatient Health

Plan PACE

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Exempt

Populations enrolled: Enrollment choice

period

Other Other N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Does not apply because the State only

contracts with one managed care entity.

No lock-in period.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

348

Features Healthy Kids Dental

Specialty Prepaid Inpatient Health

Plan PACE

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Assertive community treatment,

assessments, assistive technology,

behavior management review, child

therapy, clubhouse, community living

supports, crisis interventions, crisis

residential, enhanced pharmacy,

environmental modifications

Transportation

Quality assurance and improvement:

HEDIS data required?

No No No

Quality assurance and improvement:

CAHPS data required?

No No No

349

Features Healthy Kids Dental

Specialty Prepaid Inpatient Health

Plan PACE

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Healthy Kids Dental Lakeshore Regional Entity; Macomb

County CMH Services; Mid-State Health

Network; Northcare Network; Northern

Michigan Regional Entity; Oakland

County CMH Authority; Region 10;

Southwest Michigan Behavioral Health;

CMH Partnership of Southeast

Michigan; Detroit Wayne Mental Health

Authority

Care Resources; Community PACE;

Genesys PACE; Great Lakes PACE;

Huron Valley PACE; Life Circles; PACE

of Southeast MI; PACE of Southwest

MI; Senior Care Partners; Senior

Community Care; Thome PACE

350

Features Healthy Kids Dental

Specialty Prepaid Inpatient Health

Plan PACE

Notes: Program notes 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 contractor

mimic the dental services provided

through the Fee-For-Service Medicaid

program. Medicaid beneficiaries have

access to dentists through the

contractor's participating dental

networks. Beneficiaries must see a

dentist who participates with the Healthy

Kids Dental contract.

7,760 beneficiaries received HCBS

services as of 07/01/18.

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.

351

Minnesota Managed Care Program Features, as of 2018 (1 of 2)

Features Special Needs Basic Care (SNBC)

Prepaid Medical Assistance Plan

Plus (PMAP+) Minnesota Senior Care Plus (MSC+)

Program type Comprehensive MCO + MLTSS Comprehensive MCO + MLTSS Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1915(a),1945 Health Homes 1915(b),1932(a),1945 Health Homes 1915(b)/1915(c),1945 Health Homes

Program start date 01/01/2008 07/01/1985 06/01/2005

Waiver expiration date (if applicable) 06/30/2021 06/30/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Mandatory

352

Features Special Needs Basic Care (SNBC)

Prepaid Medical Assistance Plan

Plus (PMAP+) Minnesota Senior Care Plus (MSC+)

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Mandatory Exempt

Populations enrolled: Enrollment choice

period

30 days 30 days 30 days

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

X X X

353

Features Special Needs Basic Care (SNBC)

Prepaid Medical Assistance Plan

Plus (PMAP+) Minnesota Senior Care Plus (MSC+)

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes Yes

Quality assurance and improvement:

Accreditation required?

No No No

354

Features Special Needs Basic Care (SNBC)

Prepaid Medical Assistance Plan

Plus (PMAP+) Minnesota Senior Care Plus (MSC+)

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Michigan Peer Review Organization Michigan Peer Review Organization Michigan Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

X X X

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X X

Participating plans: Plans in Program Health Partners; Hennepin Health;

Medica; Prime West; South Country; U

Care

Blue Plus; Health Partners; Hennepin

Health; Itasca Medical Care; Prime

West; South Country; U Care

Blue Plus; Health Partners; Itasca

Medical Care; Medica; Prime West;

South Country; U Care

Notes: Program notes

355

Minnesota Managed Care Program Features, as of 2018 (2 of 2)

Features

Minnesota Senior Health Option

(MSHO)

Program type Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide

Federal operating authority 1915(a)/1915(c),1945 Health Homes

Program start date 03/01/1997

Waiver expiration date (if applicable) 12/31/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary

356

Features

Minnesota Senior Health Option

(MSHO)

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

30 days

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

357

Features

Minnesota Senior Health Option

(MSHO)

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

358

Features

Minnesota Senior Health Option

(MSHO)

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Michigan Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Blue Plus; Health Partners; Itasca

Medical Care; Medica; Prime West;

South Country; U Care

Notes: Program notes

359

Mississippi Managed Care Program Features, as of 2018

Features

Mississippi Coordinated Access

Network (MississippiCAN)

Program type Comprehensive MCO

Statewide or region-specific? Statewide

Federal operating authority 1932(a)

Program start date 01/01/2011

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary

360

Features

Mississippi Coordinated Access

Network (MississippiCAN)

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

Conduent

Populations enrolled: Notes on

enrollment choice period

Members are allowed 30 days to

choose an MCO or be autoassigned.

After MCO assignment, members are

allowed to change MCO during initial 90

days.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

361

Features

Mississippi Coordinated Access

Network (MississippiCAN)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

362

Features

Mississippi Coordinated Access

Network (MississippiCAN)

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in plan

selection criteria

Quality assurance and improvement:

Accrediting organization

NCQA, JCAHO, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

The Carolinas Center for Medical

Excellence

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Magnolia Health Plan; UnitedHealthcare

of Mississippi Community Plan

Notes: Program notes A third MCO was added to the

MississippiCAN program on October 1,

2018: Molina Healthcare of Mississippi.

363

Missouri Managed Care Program Features, as of 2018

Features MO HealthNet Managed Care/1915b

Non-Emergency Medical

Transportation Program (NEMT)

Program type Comprehensive MCO Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b) 1902(a)(70) NEMT

Program start date 09/01/1995 10/01/2006

Waiver expiration date (if applicable) 06/30/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory

364

Features MO HealthNet Managed Care/1915b

Non-Emergency Medical

Transportation Program (NEMT)

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

WIPRO Infocrossing Medicaid State Plan

Populations enrolled: Notes on

enrollment choice period

Pregnant Women have 7 days while the

rest of the population has 15 days.

Children in the care and custody of the

State of Missouri are enrolled the same

day.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

365

Features MO HealthNet Managed Care/1915b

Non-Emergency Medical

Transportation Program (NEMT)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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

366

Features MO HealthNet Managed Care/1915b

Non-Emergency Medical

Transportation Program (NEMT)

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Primaris Holdings, Inc.

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Home State Health Eastern; Home

State Health Central; Home State

Health Western; Home State Health

Southwest; Missouri Care Eastern;

Missouri Care Central; Missouri Care

Western; Missouri Care Southwest;

United Healthcare Eastern; United

Healthcare Central; United Healthcare

Western; United Healthcare Southwest

Logisticare Solutions

Notes: Program notes

368

Montana Managed Care Program Features, as of 2018

Features Passport to Health

Program type Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide

Federal operating authority 1915(b)

Program start date 01/01/1994

Waiver expiration date (if applicable) 03/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory

369

Features Passport to Health

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Conduent

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

370

Features Passport to Health

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

371

Features Passport to Health

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Multiple Primary Care Providers

Notes: Program notes Montana has four programs that operate

under the authority of the 1915(b)

waiver. The Passport to Health

program is the Primary Care Case

Management (PCCM) program. Benefits

covered include those that are covered

by both the monthly PMPM and FFS

benefits that could be delivered by a

primary provider participating in the

Passport to Health Program. The Team

Care program is a sub-program of

Passport which began in 2004. The

Health Improvement program, the

EPCCM program, began in 2009 as an

enhancement to Passport. The Tribal

HIP program was created in April 2007

as a partnership between the Tribal,

State and Federal government to

address factors that contribute to health

disparities in American Indians eligible

for Medicaid residing on a reservation.

The Nurse First program is the nurse

advice line that began in 2004.

372

373

Nebraska Managed Care Program Features, as of 2018

Features Dental Benefit Manager Heritage Health

Program of All-Inclusive Care for the

Elderly (PACE)

Program type Dental only (PAHP) Comprehensive MCO Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide 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

Federal operating authority 1915(b) 1915(b) PACE

Program start date 10/01/2017 01/01/2017 05/01/2013

Waiver expiration date (if applicable) 06/30/2019 06/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

374

Features Dental Benefit Manager Heritage Health

Program of All-Inclusive Care for the

Elderly (PACE)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory Mandatory

Populations enrolled: Full Duals Mandatory Mandatory

Populations enrolled: Partial Duals Mandatory Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

Automated Health Systems (AHS)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

375

Features Dental Benefit Manager Heritage Health

Program of All-Inclusive Care for the

Elderly (PACE)

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

376

Features Dental Benefit Manager Heritage Health

Program of All-Inclusive Care for the

Elderly (PACE)

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry, hearing, immunization, speech

therapy, physical therapy, vision,

chiropractic, durable medical

equipment, occupational therapy,

freestanding birth center

Quality assurance and improvement:

HEDIS data required?

No Yes No

Quality assurance and improvement:

CAHPS data required?

No Yes No

Quality assurance and improvement:

Accreditation required?

Yes Yes No

Quality assurance and improvement:

Accrediting organization

URAC NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program MCNA Nebraska UnitedHealthcare Community Plan of

Nebraska; WellCare of Nebraska;

Nebraska Total Care

Immanuel Pathways

377

Features Dental Benefit Manager Heritage Health

Program of All-Inclusive Care for the

Elderly (PACE)

Notes: Program notes Voluntary program in select zip codes

throughout Cass, Dodge, Douglas,

Sarpy, Saunders, and Washington

Counties.

378

Nevada Managed Care Program Features, as of 2018 (1 of 2)

Features Non-Emergency Transportation

Health Care Guidance Program

(HCGP) Dental Benefits Administrator

Program type Non-Emergency Medical Transportation Primary Care Case Management

(PCCM)

Dental only (PAHP)

Statewide or region-specific? Statewide Statewide Sufficiently populated Urban Zip Codes

in Washoe and Clark counties.

Federal operating authority 1902(a)(70) NEMT 1115(a) (Medicaid demonstration

waivers)

1932(a),1937 Alt Benefit Plan

Program start date 10/01/2003 07/01/2014 01/01/2018

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

06/30/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory Voluntary

379

Features Non-Emergency Transportation

Health Care Guidance Program

(HCGP) Dental Benefits Administrator

Populations enrolled: Native

American/Alaskan Natives

Mandatory Exempt Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt Exempt

Populations enrolled: Enrollment choice

period

N/A 30 days

Populations enrolled: Enrollment broker

name (if applicable)

DXC

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X

380

Features Non-Emergency Transportation

Health Care Guidance Program

(HCGP) Dental Benefits Administrator

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No No Yes

381

Features Non-Emergency Transportation

Health Care Guidance Program

(HCGP) Dental Benefits Administrator

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in plan

selection criteria

No, but accreditation considered in plan

selection criteria

No, but accreditation considered in plan

selection criteria

Quality assurance and improvement:

Accrediting organization

Any vetted accreditation that relates to

plan’s transportation mission

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Medical Transportation Management

(MTM Nevada)

Liberty Dental Plan of Nevada

Notes: Program notes Contract ended 06/30/2018; no

enrollees 07/01/2018.

382

Nevada Managed Care Program Features, as of 2018 (2 of 2)

Features

Mandatory Health Maintenance

Program

Program type Comprehensive MCO

Statewide or region-specific? Sufficiently populated Urban Zip Codes

in Washoe and Clark counties.

Federal operating authority 1932(a)

Program start date 10/31/1988

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

06/30/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary

383

Features

Mandatory Health Maintenance

Program

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

30 days

Populations enrolled: Enrollment broker

name (if applicable)

DXC

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

384

Features

Mandatory Health Maintenance

Program

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in plan

selection criteria

385

Features

Mandatory Health Maintenance

Program

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Health Plan of Nevada (HPN); Anthem

Blue Cross Blue Shield of Nevada;

Silver Summit Health Plan

Notes: Program notes

386

New Hampshire Managed Care Program Features, as of 2018

Features

New Hampshire Medicaid Care

Management

New Hampshire Health Protection

Program Medicaid Care Management

ABP

Program type Comprehensive MCO Comprehensive MCO

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b),1932(a) 1932(a),1937 Alt Benefit Plan

Program start date 12/01/2013 08/01/2014

Waiver expiration date (if applicable) 03/31/2020

If the program ended in 2018, indicate

the end date

12/31/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory

387

Features

New Hampshire Medicaid Care

Management

New Hampshire Health Protection

Program Medicaid Care Management

ABP

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

60 days 60 days

Populations enrolled: Enrollment broker

name (if applicable)

Maximus

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

388

Features

New Hampshire Medicaid Care

Management

New Hampshire Health Protection

Program Medicaid Care Management

ABP

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

X X

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Nurse midwife, non-nurse midwife,

freestanding birth centers, podiatry,

PT/OT/ST, ambulance, adult medical

day care, DME, eyeglasses, full

substance use disorder treatment

Nurse midwife, non-nurse midwife,

freestanding birth centers, podiatry,

PT/OT/ST, ambulance, adult medical

day care, DME, eyeglasses,

chiropractic, full substance use disorder

treatment

Quality assurance and improvement:

HEDIS data required?

Yes Yes

389

Features

New Hampshire Medicaid Care

Management

New Hampshire Health Protection

Program Medicaid Care Management

ABP

Quality assurance and improvement:

CAHPS data required?

Yes Yes

Quality assurance and improvement:

Accreditation required?

Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program New Hampshire Healthy Families; Well

Sense Health Plan

New Hampshire Healthy Families; Well

Sense Health Plan

Notes: Program notes Individuals in the New Hampshire

Medicaid Care Management program

can be enrolled under either a 1915(b)

waiver or a 1932(a) federal operating

authority.

390

New Jersey Managed Care Program Features, as of 2018 (1 of 2)

Features NJFamilyCare FIDE SNP

Non-Emergency Medical

Transportation

Program type Comprehensive MCO + MLTSS Comprehensive MCO + MLTSS Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Atlantic, Bergen, Burlington, Camden,

Cumberland, Essex, Gloucester,

Hudson, Hunterdon, Mercer, Middlesex,

Monmouth, Morris, Ocean, Passaic,

Salem, Somerset, Sussex, Union, and

Warren counties.

Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers),1937 Alt Benefit Plan

1115(a) (Medicaid demonstration

waivers)

1902(a)(70) NEMT

Program start date 09/01/1995 01/01/2012 07/01/2009

Waiver expiration date (if applicable) 06/30/2022 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary Mandatory

Populations enrolled: Partial Duals Mandatory

391

Features NJFamilyCare FIDE SNP

Non-Emergency Medical

Transportation

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Exempt Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt Mandatory

Populations enrolled: Enrollment choice

period

10 days Other

Populations enrolled: Enrollment broker

name (if applicable)

Conduent

Populations enrolled: Notes on

enrollment choice period

Enrollee may enroll or disenroll without

cause once per quarter for the first three

quarters of the year. Annual enrollment

period rules apply thereafter.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

392

Features NJFamilyCare FIDE SNP

Non-Emergency Medical

Transportation

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

X X

393

Features NJFamilyCare FIDE SNP

Non-Emergency Medical

Transportation

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Assistive tech, audiology, chiropractic,

DME, hearing aid, immunization, MDC,

medical supplies, optical appliances,

optometrist, organ transplants, orthotics,

rehab/sp hosp, outpatient rehab, non-

routine podiatrist, post-acute care,

preventive health, spec hosp, vision

Assistive tech, audiology, chiropractic,

DME, hearing aid, immunization, MDC,

medical supplies, optical appliances,

optometrist, organ transplants, orthotics,

rehab/sp hosp, outpatient rehab, non-

routine podiatrist, post-acute care,

preventive health, spec hosp, vision

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes No

Quality assurance and improvement:

Accreditation required?

Yes No No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Aetna Better Health NJ; Amerigroup

New Jersey Inc; Horizon NJ Health;

UnitedHealthcare Community Plan;

WellCare of New Jersey

Amerivantage Dual Coordination (HMO

SNP); Horizon NJ TotalCare (HMO

SNP); UnitedHealthcare Dual Complete

ONE (HMO SNP); WellCare

Liberty (HMO SNP)

Logisticare

394

Features NJFamilyCare FIDE SNP

Non-Emergency Medical

Transportation

Notes: Program notes HCBS services are part of the MLTSS

program which is available to qualified

beneficiaries under NJFamilyCare. All

NJFamilyCare MCOs are statewide

except WellCare, which is not available

in Hunterdon County.

Members may only enroll through

Medicare or with the FIDE SNP plan

directly.

395

New Jersey Managed Care Program Features, as of 2018 (2 of 2)

Features PACE

Program type Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Atlantic, Cape May, Monmouth, and

Mercer Counties. Zip codes: 08028,

08062, 08071, 08094, 08098, 08302,

08311, 08312, 08314, 08316, 08318,

08321, 08322, 08323, 08324, 08327,

08328, 08329, 08332, 08343, 08344,

08345, 08348, 08349, 08352, 08353,

08360, 08361, 08362, 08002, 08003,

08004, 08007, 08009, 08012, 08021,

08026, 08029, 08030, 08031, 08033,

08034, 08035, 08043, 08045, 08049,

08052, 08059, 08065, 08076, 08077,

08078, 08081, 08083, 08084, 08091,

08095, 08099, 08101, 08102, 08103,

08104, 08105, 08106, 08107, 08108,

08109, 08110, 08015, 08016, 08022,

08060, 08068, 08505, 08515, 08518,

08554, 07002, 07030, 07047, 07086,

07087, 07093, 07094, 07302, 07304,

07305, 07306, 07307, 07310, 07311

Federal operating authority PACE

Program start date 04/09/2009

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

396

Features PACE

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

397

Features PACE

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

398

Features PACE

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Atlanticare LIFE; Beacon of LIFE;

Inspira LIFE; LIFE at Lourdes; LIFE St.

Francis; Lutheran Senior Life

Notes: Program notes

400

New Mexico Managed Care Program Features, as of 2018

Features Centennial Care

Program of All-Inclusive Care for the

Elderly (PACE)

Program type Comprehensive MCO + MLTSS Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Bernalillo County, Sandoval County,

Valencia County

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 01/01/2014 07/01/2004

Waiver expiration date (if applicable) 12/31/2018

If the program ended in 2018, indicate

the end date

12/31/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

401

Features Centennial Care

Program of All-Inclusive Care for the

Elderly (PACE)

Populations enrolled: Native

American/Alaskan Natives

Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Other N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Members have 90 days to switch MCO's

when initially enrolled and during

recertification.

Disenrollment permitted every 30 days.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

402

Features Centennial Care

Program of All-Inclusive Care for the

Elderly (PACE)

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

403

Features Centennial Care

Program of All-Inclusive Care for the

Elderly (PACE)

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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

Quality assurance and improvement:

HEDIS data required?

Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

IPRO

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

404

Features Centennial Care

Program of All-Inclusive Care for the

Elderly (PACE)

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Blue Cross Blue Shield of NM; Molina

Healthcare of New Mexico Inc;

Presbyterian Health Plan;

UnitedHealthcare Community Plan

Innovage New Mexico PACE dba Total

Community Care

Notes: Program notes Native American/Alaskan Native

Enrollment would be manditorily

enrolled if receiving LTSS.

405

New York Managed Care Program Features, as of 2018 (1 of 2)

Features Health and Recovery Plans Managed Long Term Care Medicaid Advantage Plus

Program type Comprehensive MCO MLTSS only (PIHP and/or PAHP) Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

Program start date 10/01/2015 01/01/1998 01/01/2007

Waiver expiration date (if applicable) 03/31/2021 03/31/2021 03/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt Exempt

406

Features Health and Recovery Plans Managed Long Term Care Medicaid Advantage Plus

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt Exempt

Populations enrolled: Enrollment choice

period

30 days 60 days 60 days

Populations enrolled: Enrollment broker

name (if applicable)

NY Medicaid Choice/Maximus NY Medicaid Choice/Maximus NY Medicaid Choice/Maximus

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

407

Features Health and Recovery Plans Managed Long Term Care Medicaid Advantage Plus

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

X X X

Benefits covered: HCBS waiver services X X X

Benefits covered: Private duty nursing X X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Midwife Services, audiology, vision,

occupational therapy

Podiatry

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

408

Features Health and Recovery Plans Managed Long Term Care Medicaid Advantage Plus

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

X X

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program 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; YourCare

Health Plan

Aetna Better Health; AgeWell New York;

AlphaCare; ArchCare Community Life;

Centers Plan for Healthy Living;

ElderPlan; ElderServe; ElderWood;

Extended MLTC; Fallon Health

Weinberg; Fidelis Care; GuildNet;

Hamaspik Choice; Health

Advantage/Elant Choice; HealthPlus;

iCircle Care; Independent Care

Systems; Integra; Kalos Health Plan;

MetroPlus; Montefiore; North Shore -

LIJ Health Plan; Prime Health Choice;

Senior Health Partners; Senior Network

Health; Senior Whole Health; United

HealthCare; Village Care; VNA

HomeCare Options; VNS Choice;

WellCare Advocate

ElderPlan; Fidelis Legacy Plan;

GuildNet; HealthFirst; HealthPlus

Advantage Plus; Senior Whole Health;

Village Care; VNS Choice Plus

Notes: Program notes The covered benefit of partial

hospitalization only applies to enrollees

21 years of age and older. CMS has

approved HCBS within the HARP

program under 1115(a) authority.

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.

410

New York Managed Care Program Features, as of 2018 (2 of 2)

Features PACE Medicaid Advantage Medicaid Managed Care

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority PACE 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

Program start date 01/01/2001 10/01/2006 10/01/1997

Waiver expiration date (if applicable) 03/31/2021 03/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt Exempt

411

Features PACE Medicaid Advantage Medicaid Managed Care

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt Mandatory

Populations enrolled: Enrollment choice

period

N/A 60 days 30 days

Populations enrolled: Enrollment broker

name (if applicable)

NY Medicaid Choice/Maximus NY Medicaid Choice/Maximus NY Medicaid Choice/Maximus

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

412

Features PACE Medicaid Advantage Medicaid Managed Care

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

X X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry, physical therapy, occupational

therapy

Podiatry, outpatient rehabilitation,

hearing services, vision care services

Nurse midwife services, vision care, foot

care services

Quality assurance and improvement:

HEDIS data required?

No No Yes

Quality assurance and improvement:

CAHPS data required?

No No Yes

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

413

Features PACE Medicaid Advantage Medicaid Managed Care

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program 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

Affinity; Fidelis Legacy Plan; Liberty

Health Advantage; United HealthCare;

VNS Choice; WellCare

HealthNow; HealthPlus; HIP Combined;

Independent Health/Hudson Valley;

WNY; MetroPlus Health Plan; MetroPlus

Health Plan Special Needs; Molina

Healthcare of New York; MVP Health

Plan; United HealthCare; VNS Choice

Special Needs; WellCare; YourCare

Health Plan; Fidelis Care; HealthFirst;

Affinity Health Plan; Amida Care Special

Needs; Capital District Physician's

Health Plan; Crystal Run Health Plan;

Excellus Health Plan

Notes: Program notes Covered Benefits include non-hospice

palliative care. OB/GYN is mandated

with a minimum age of 55 years. Quality

Assurance measures would include

PACE home health agency, a federally

mandated internal program.

The covered benefit of partial

hospitalization only applies to enrollees

21 years of age and older. Fidelis Care

covers emergency and non-emergency

transportation in Rockland County only.

414

North Carolina Managed Care Program Features, as of 2018

Features Community Care of North Carolina

Program of All Inclusive Care for the

Elderly

1915(b)/(c) Medicaid Waiver for

MH/DD/SA Services

Program type Primary Care Case Management Entity

(PCCM Entity)

Program of All-inclusive Care for the

Elderly (PACE)

Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Statewide Alamance, Alexander, Brunswick,

Burke, Cabarrus, Caldwell, Caswell,

Catawba, Chatham, Cleveland,

Cumberland, Davidson, Davie,

Durham, Gaston, Granville, Guilford,

Harnett, Hoke, Iredell, Lee, Lincoln,

Mecklenburg, Moore, New Hanover,

Orange, Robeson, Rockingham,

Rowan, Stanley, Union, and Wake

counties

Statewide

Federal operating authority 1932(a) PACE 1915(b)/1915(c)

Program start date 04/01/1991 02/01/2008 01/01/2012

Waiver expiration date (if applicable) 06/30/2018

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

415

Features Community Care of North Carolina

Program of All Inclusive Care for the

Elderly

1915(b)/(c) Medicaid Waiver for

MH/DD/SA Services

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary Mandatory

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Voluntary Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Exempt Mandatory

Populations enrolled: Enrollment

choice period

Other N/A Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Beneficiaries have 90 days to enroll

into the PCCM program.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

416

Features Community Care of North Carolina

Program of All Inclusive Care for the

Elderly

1915(b)/(c) Medicaid Waiver for

MH/DD/SA Services

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver

services

X X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

417

Features Community Care of North Carolina

Program of All Inclusive Care for the

Elderly

1915(b)/(c) Medicaid Waiver for

MH/DD/SA Services

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Restorative therapies; nutrition

counseling; recreational therapies;

meals

Outpatient behavioral health services

including services provided by

psychiatrists for recipients with a

diagnosis in the 290-319 range;

psychiatric residential treatment

facilities; therapeutic foster care;

residential child care; hospital

emergency dept

Quality assurance and improvement:

HEDIS data required?

Yes No Yes

Quality assurance and improvement:

CAHPS data required?

Yes No Yes

Quality assurance and improvement:

Accreditation required?

No No Yes

Quality assurance and improvement:

Accrediting organization

NCQA, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Carolina Center for Medical Excellence

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

418

Features Community Care of North Carolina

Program of All Inclusive Care for the

Elderly

1915(b)/(c) Medicaid Waiver for

MH/DD/SA Services

Participating plans: Plans in Program North Carolina Community Care

Carolina Access

Carolina Seniorcare; Community

Carepartners, Inc.; Elderhaus, Inc.; Life

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.; Stay Well Senior

Care; VOANS Senior Community Care

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

Notes: Program notes Plan consists of independently

contracted medical home/primary care

providers who receive a PMPM

management fee for coordinationing

care at the medical home provider

office.

IMD: PACE serves individuals 55 and

over in pre-approved service areas/zip

codes. With regards to inpatient psych

placements, a PACE organization can

be contracted with a particular hospital

or psychiatric clinic in their approved

service area and network. Most

psychiatric inpatient placements placed

participants in local contracted

hospitals that had psychiatric unit/wing

within the facility.

Waiver expiration date (if applicable) -

6/30/2018 (currently under Technical

Extension). All Medicaid recipients are

covered by a Behavioral Healthcare

(BHO). Enrollment in one of seven

plans is based on the enrollee's county

of residence.

419

North Dakota Managed Care Program Features, as of 2018 (1 of 2)

Features Health Management Program PACE PCCM

Program type Other Prepaid Health Plan (PHP)

(limited benefits)

Program of All-inclusive Care for the

Elderly (PACE)

Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide Ward: 58701, 58702, 58703, 58722,

58785. Burleigh: 58501, 58502, 58503,

58504. Morton: 58554. Stark: 58601,

58602, 58630, 58652, 58655, 58656.

Statewide

Federal operating authority 1932(a) PACE 1932(a)/1915(i)

Program start date 08/01/2007 08/01/2008 01/10/1994

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

06/30/2018

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary Mandatory

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

420

Features Health Management Program PACE PCCM

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Exempt

Populations enrolled: Enrollment choice

period

N/A N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Enrollment begins on the first day of the

month following the determination that

they are eligible.

Once enrolled the recipient has 14 days

to choose a PCP or one will be

assigned. They can change PCP

without good cause for the first 90 days

and every 12 months during the 60 day

annual open enrollment period.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

421

Features Health Management Program PACE PCCM

Benefits covered: EPSDT

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

No No No

422

Features Health Management Program PACE PCCM

Quality assurance and improvement:

CAHPS data required?

No No No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

North Dakota

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Health Management PACE Multiple Primary Care Providers

Notes: Program notes Effective July 1, 2018 the Health

Management Program was no longer an

authorized service with it being removed

from North Dakota's Medicaid State

Plan with authority granted by the

Center for Medicare and Medicaid

Services as of August 9, 2019. Thus, no

enrollment as of July 1, 2018.

423

North Dakota Managed Care Program Features, as of 2018 (2 of 2)

Features North Dakota Medicaid Expansion

Program type Comprehensive MCO

Statewide or region-specific? Statewide

Federal operating authority 1915(b),1937 Alt Benefit Plan

Program start date 01/01/2014

Waiver expiration date (if applicable) 12/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Mandatory

424

Features North Dakota Medicaid Expansion

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

425

Features North Dakota Medicaid Expansion

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Up to 30 days SNF within a 12 month

period

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

426

Features North Dakota Medicaid Expansion

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qlarant Quality Solutions

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program ND Medicaid Expansion MCO

427

Features North Dakota Medicaid Expansion

Notes: Program notes In order for the State to provide

Medicaid Expansion MCO through

private carriers including mandatory

enrollment, an initial 1915(b) waiver

allowing managed care enrollment of

the new adult group for Medicaid

expansion was submitted to CMS with

authority granted. The 1915(b) waiver

renewal was submitted to CMS for

2016-2017 and 2018-2019 with

authority granted. In addition, CMS

granted initial authority through an 1115

waiver to ensure compliance related to

having one health plan choice for those

Medicaid Expansion recipeints in urban

areas of the state. CMS extended this

1115 waiver authority until such time

that the Final Medicaid Managed Care

CFR were published (May 6, 2016) -

with the changes noted at 42 CFR §

438.52(b)(1) and (b)(3) the 1115 waiver

was no longer needed thus it was

allowed to expire. Per the Medicare

Advantage Health Service Delivery

(HSD) Reference file for the applicable

calendar year, ND no longer has any

counties designated as being urban

thus the state may limit rural area

residents to a single MCO.

428

Ohio Managed Care Program Features, as of 2018

Features Ohio PACE

Ohio Medicaid Managed Care

Program MyCare Ohio Opt-Out Program

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO Comprehensive MCO + MLTSS

Statewide or region-specific? Cuyahoga County Statewide Central, Northwest, Northeast,

Northeast Central, Southwest, West

Central, East Central

Federal operating authority PACE 1915(b),1932(a) 1915(b)/1915(c)

Program start date 11/01/2002 07/01/2006 05/01/2014

Waiver expiration date (if applicable) 03/31/2020 12/31/2023

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory

429

Features Ohio PACE

Ohio Medicaid Managed Care

Program MyCare Ohio Opt-Out Program

Populations enrolled: Native

American/Alaskan Natives

Exempt Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment

choice period

N/A Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Automated Health Systems, Inc. Automated Health Systems, Inc.

Populations enrolled: Notes on

enrollment choice period

Ohio PACE operates under an open-

enrollment model.

Medicaid enrollees are pre-assigned to

a plan with 90 days to change plans.

Enrollees are pre-assigned to a plan

and have 90 days to change plans.

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

430

Features Ohio PACE

Ohio Medicaid Managed Care

Program MyCare Ohio Opt-Out Program

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver

services

X X

Benefits covered: Private duty nursing X X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

X X

431

Features Ohio PACE

Ohio Medicaid Managed Care

Program MyCare Ohio Opt-Out Program

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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, DME and

medical supplies, ambulance,

ambulette, care management,

telemedicine, respite services for

eligible children receiving SSI, se

rvices

for members with a primary diagnosis

of Autism Spectrum Disorder,

screening and counseling for obesity

Immunizations, nurse midwife services,

freestanding birth centers, care

management, DME and medical

supplies, vision, physical therapy,

speech t

herapy, 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,

screeni

ng and counseling for obesity

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes Yes

Quality assurance and improvement:

Accreditation required?

No Yes Yes

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

X X

432

Features Ohio PACE

Ohio Medicaid Managed Care

Program MyCare Ohio Opt-Out Program

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

X X

Participating plans: Plans in Program McGregor PACE Buckeye Health Plan; CareSource;

Molina Healthcare of Ohio, Inc.;

Paramount Advantage;

UnitedHealthcare Community Plan of

Ohio, Inc.

Aetna Better Health of Ohio; Buckeye

Health Plan; CareSource; Molina

Healthcare of Ohio, Inc.;

UnitedHealthcare Community Plan of

Ohio, Inc.

Notes: Program notes Regarding the coverage of HCBS

services - Ohio has chosen to offer the

same covered benefits in the PACE

program that are available to

individuals enrolled on a 1915(c)

waiver to better ensure the assessed

needs of individuals with an

intermediate level of care are met, and

better pr

omote the health and welfare

of PACE participants.

Ohio Medicaid managed care plans are

responsible for payment of medically

necessary nursing facility services for

ABD and MAGI enrollees until

discharge or until the member is

disenrolled, in accordance w

ith the

processes set forth in rule 5160-26-

02.1 of the Ohio Administrative Code.

For enrollees in the newly eligible

category (ACA Section VIII expansion

group, up to 138% federal poverty

level), nursing facility stays are covered

for the length of time medically

necessary. Individuals enrolled in

1915 (c) receiving HCBS services

through the Ohio Department of

Developmental Disabilities may enroll

in this Medicaid managed care

program voluntarily, with HCBS carved

out to fee-for-

service (not provided

through managed care).

Ohio Medicaid's waiver for this

program was renewed in the second

half of 2018, and the waiver authority

expiration date was changed from

3/31/2019 to 12/31/2023. The

individuals that must enroll in this

program are full duals who are age 18

and older. This includes children in

foster care and children receiving

adoption assistance who are full duals

and age 18 and older.

433

Oklahoma Managed Care Program Features, as of 2018

Features SoonerRide SoonerCare Choice PACE

Program type Non-Emergency Medical Transportation Primary Care Case Management

(PCCM)

Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide 74464, 74441, 74423, 74960, 74427,

74465, 74403, 74457, 74451, 74352,

74434, 74401, 74471, 74364, 74347,

74402, 74444, 74368, 74964, 74446,

74452, 74359, 74965, 74439 74103,

74104, 74105, 74106, 74107, 74110,

74112, 74114, 74115, 74119, 74120,

74126, 74127, 74128, 74129, 74130,

74132, 74133, 74136, 74137, 74145,

74146, 74134, 74135, 74117, 74116,

74108 73008, 73106, 73143, 73003,

73147, 73025, 73134, 73084, 73119,

73140, 73124, 73157, 73170, 73163,

73066, 73150, 73110, 73139, 73105,

73142, 73185, 73109, 73194, 73113,

73169, 73103, 73154, 73121, 73156,

73165, 73127, 73013, 73131, 73198,

73118, 73178, 73141, 73184, 73160,

73146, 73120, 73149, 73083, 73137,

73122, 73155, 73132, 73108, 73162,

73112, 73167, 73102, 73152, 73012,

73179, 73135, 73126, 73190, 73129,

73196, 73117, 73173, 73123, 73153,

73144, 73116, 73148, 73034, 73136,

73120, 73115, 73107, 73159, 73111,

73164, 73101, 73151, 73130, 73145,

73125, 73189, 73128, 73195, 73114,

73172, 73104

Federal operating authority 1902(a)(70) NEMT 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 06/01/2006 01/01/1996 08/01/2008

Waiver expiration date (if applicable) 12/31/2023

If the program ended in 2018, indicate

the end date

434

Features SoonerRide SoonerCare Choice PACE

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Voluntary Exempt

Populations enrolled: Enrollment choice

period

Pre-assigned N/A N/A

Populations enrolled: Enrollment broker

name (if applicable)

Logisticare Maximus

435

Features SoonerRide SoonerCare Choice PACE

Populations enrolled: Notes on

enrollment choice period

Members are enrolled within 72 hours of

application.

Enrollment process takes approximately

4-6 weeks. Members are enrolled on the

14th of every month to be effective the

first day of the following month.

Members go through the PACE

Organizations for the entire enrollment

process.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

436

Features SoonerRide SoonerCare Choice PACE

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry, speech therapy, disease

management, hearing, institutional,

occupational therapy, physical therapy,

skilled nursing facility, vision

Podiatry, speech therapy, disease

management, hearing, institutional,

occupational therapy, physical therapy,

skilled nursing facility, vision

Quality assurance and improvement:

HEDIS data required?

No No No

Quality assurance and improvement:

CAHPS data required?

No No No

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

State Specific PCMH

Quality assurance and improvement:

EQRO contractor name (if applicable)

Telligen

437

Features SoonerRide SoonerCare Choice PACE

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program SoonerRide SoonerCare Choice Cherokee Elder Care (CEC); Life PACE;

Valir PACE

Notes: Program notes PACE members are not eligible for

SoonerRide.

438

Oregon Managed Care Program Features, as of 2018

Features Oregon Health Plan (OHP) PACE

Program type Comprehensive MCO Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Multnomah, Washington, Clatsop,

Clackamas and Tillamook Counties

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 02/01/1994 01/01/1986

Waiver expiration date (if applicable) 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals Voluntary Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory

439

Features Oregon Health Plan (OHP) PACE

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Flexible enrollment eligibility - rolling

enrollment to be effective on the 1st of

the following month.

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

440

Features Oregon Health Plan (OHP) PACE

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Hearing, immunization, vision Medications (OTC and RX), mental

health care, DME,

speech/physical/occupational/

recreational theraputic services,

audiology/optical/podiatry specialty

medical care, occupational and physical

therapy and social services

Quality assurance and improvement:

HEDIS data required?

No No

441

Features Oregon Health Plan (OHP) PACE

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Insight

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

442

Features Oregon Health Plan (OHP) PACE

Participating plans: Plans in Program Access Dental Plan, LLC; Advantage

Dental Services; Capitol Dental Care,

Inc.; CareOregon Dental; Family Dental

Care; Greater Oregon Behavioral

Health, Inc.; Managed Dental Care of

Oregon; ODS Community Health Inc.;

AllCare Health Plan; Cascade Health

Alliance; Columbia Pacific; Eastern

Oregon CCO; HealthShare of Oregon;

InterCommunity Health Network;

Jackson Care Connect; PacificSource

Community Solutions - Central Oregon;

PacificSource Community Solutions -

Columbia Gorge; PrimaryHealth of

Josephine County; Trillium Community

Health Plan; Umpqua Health Alliance;

Advanced Health; Willamette Valley

Community Health; Yamhill Community

Care

Providence Elder Place

Notes: Program notes In the Oregon Health Plan/Medicaid

program, a person can be enrolled

simultaneously in two or three plans.

For example, a client can be enrolled in

the PACE program for physical health, a

dental plan (DCO) for dental care and a

mental health plan (CCO) for mental

health care. FamilyCare (CCO) had

closed to enrollment prior to June 2018.

443

Pennsylvania Managed Care Program Features, as of 2018 (1 of 2)

Features Adult Community Autism Program

MATP (Medical Assistance

Transportation Program) Behavioral Health HealthChoices

Program type Other Prepaid Health Plan (PHP)

(limited benefits)

Non-Emergency Medical Transportation Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Dauphin, Cumberland, Lancaster and

Chester counties

Philadelphia Statewide

Federal operating authority 1915(a) 1902(a)(70) NEMT 1115(a) (Medicaid demonstration

waivers),1915(b)

Program start date 08/01/2009 11/01/2005 01/01/1999

Waiver expiration date (if applicable) 12/31/2021 12/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Voluntary Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary Mandatory

Populations enrolled: Full Duals Voluntary Voluntary Mandatory

Populations enrolled: Partial Duals Voluntary Voluntary Mandatory

Populations enrolled: Children with

Special Health Care Needs

Voluntary Mandatory

444

Features Adult Community Autism Program

MATP (Medical Assistance

Transportation Program) Behavioral Health HealthChoices

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

LogistiCare

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT X

Benefits covered: Case management X

445

Features Adult Community Autism Program

MATP (Medical Assistance

Transportation Program) Behavioral Health HealthChoices

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Podiatry, speech therapy, occupational

therapy, language therapy, counseling,

respite, supported employment

Psychiatric rehabilitation, peer specialist

services

Quality assurance and improvement:

HEDIS data required?

No No Yes

Quality assurance and improvement:

CAHPS data required?

No No No

446

Features Adult Community Autism Program

MATP (Medical Assistance

Transportation Program) Behavioral Health HealthChoices

Quality assurance and improvement:

Accreditation required?

No No Yes

Quality assurance and improvement:

Accrediting organization

NCQA, JCAHO, URAC, for Inpatient,

Outpatient

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

447

Features Adult Community Autism Program

MATP (Medical Assistance

Transportation Program) Behavioral Health HealthChoices

Participating plans: Plans in Program Adult Community Autism Program LogistiCare Allegheny County HealthChoices;

Beaver County HealthChoices;

Behavioral Health Services of Bedford

and Somerset; Berks County

HealthChoices; Blair County

HealthChoices; Bucks County

HealthChoices; Cambria County

HealthChoices; Carbon-Monroe-Pike

Joinder Board; Chester County

HealthChoices; Cumberland County

HealthChoices; Dauphin County

HealthChoices; Delaware County

HealthChoices; Erie County

HealthChoices; Fayette County

HealthChoices; Greene County

(Commonwealth); Lancaster County

HealthChoices; Lebanon County

HealthChoices; Lehigh County

HealthChoices; Lycoming-Clinton

Joinder Board; Montgomery County

HealthChoices; North Central State

Option; Northampton County

HealthChoices; Northeast Behavioral

Health Care Consortium; Northwest

Behavioral Health Partnership; Perry

County HealthChoices; Philadelphia

County HealthChoices; Southwest

Behavioral Health Management;

Tuscarora Managed Care Alliance;

York/Adams County HealthChoices

Notes: Program notes ACAP is a PAHP with MLTSS. 1115(a) authority is for Residential Drug

and Alcohol services.

448

Pennsylvania Managed Care Program Features, as of 2018 (2 of 2)

Features

PA Living Independence for the

Elderly Community HealthChoices HealthChoices - Physical Health

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO + MLTSS Comprehensive MCO

Statewide or region-specific? Statewide Community HealthChoices will be

phased in over a three year period

beginning in Southwest Pennsylvania

on January 1, 2018. The following

counties were included in Phase 1:

Allegheny, Armstrong, Beaver, Bedford,

Blair, Butler, Cambria, Fayette, Greene,

Indiana, Lawrence, Somerset,

Washington and Westmoreland.

Statewide

Program start date 07/24/1998 01/01/2018 02/01/1997

Waiver expiration date (if applicable) 07/01/2020 12/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

449

Features

PA Living Independence for the

Elderly Community HealthChoices HealthChoices - Physical Health

Populations enrolled: Full Duals Voluntary Mandatory Mandatory

Populations enrolled: Partial Duals Voluntary Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt Mandatory

Populations enrolled: Enrollment choice

period

N/A Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

Open enrollment all year. Participants go through choice

counseling at initial enrollment and can

change their plan at any time. Dating

rules affect when the member will be

enrolled.

Consumers have the right to change

MCOs at any time.

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

450

Features

PA Living Independence for the

Elderly Community HealthChoices HealthChoices - Physical Health

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

X X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X X

Benefits covered: Hospice care X X X

Benefits covered: Non-Emergency

Medical Transportation

X X X

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

451

Features

PA Living Independence for the

Elderly Community HealthChoices HealthChoices - Physical Health

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

PACE programs cover specialists of all

disiplines as needed. PACE does not

operate under a waiver.

Chiropractic services, mobile mental

health treatment, maternity services,

podiatrist services

Nurse midwife services, freestanding

birth centers, podiatry, chiropractic

services, optometrists, renal dialysis

centers, ambulatory surgical centers,

medical supplies & equipment, home

health (visiting nurses)

Quality assurance and improvement:

HEDIS data required?

No Yes Yes

Quality assurance and improvement:

CAHPS data required?

No Yes Yes

Quality assurance and improvement:

Accreditation required?

No Yes Yes

Quality assurance and improvement:

Accrediting organization

PACE Quality Assurance and

Performance Improvement (QAPI)

NCQA NCQA, Nationally Recognized

Organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

IPRO Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

452

Features

PA Living Independence for the

Elderly Community HealthChoices HealthChoices - Physical Health

Participating plans: Plans in Program Senior LIFE Greensburg H-2937; Senior

LIFE Johnstown H-3925; Senior LIFE

Altonna 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

UPMC Community HealthChoices;

Pennsylvania Health & Wellness;

Amerihealth Caritas / Keystone First

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

Notes: Program notes 1. Under "Benefits Covered", Private

Duty Nursing is only covered for

children under 21 years old. In addition,

in counties that have not implemented

the Community HealthChoices program,

the first 30 days of nursing facility

services are covered by the

HealthChoices plan. Beneficiaries with

stays beyond the initial 30 days are

disenrolled from HealthChoices and

their stay is covered by FFS. For

counties that have implemented

Community HealthChoices, nursing

facility services for days 31+ are

covered by the Physical HealthChoices

plan up to the day the Member is

enrolled into Community HealthChoices.

2. Under "Enrollment", only those under

21 years of age, Full Dual and Partial

Dual are enrolled mandatorily in

HealthChoices. PA HealthChoices

Physical and Behavioral Health operate

under a single statewide 1915(b) waiver

but are administered separately.

453

Puerto Rico Managed Care Program Features, as of 2018

Features Government Health Plan Medicare Platino

Program type Comprehensive MCO Comprehensive MCO

Statewide or region-specific? Statewide Statewide

Federal operating authority 1932(a),1937 Alt Benefit Plan 1915(b)

Program start date 02/01/1994 01/01/2006

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary

454

Features Government Health Plan Medicare Platino

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt

Populations enrolled: Enrollment choice

period

Pre-assigned Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

No specific time

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

455

Features Government Health Plan Medicare Platino

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

456

Features Government Health Plan Medicare Platino

Quality assurance and improvement:

EQRO contractor name (if applicable)

Island Peer Review Organization Island Peer Review Organization

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program First Medical Plan Inc.; Triple S Salud,

Inc.; Molina Health Care PR, Inc.; MMM

MultiHealth, Inc.

Triple S Advantage; Humana Health

Plan of PR Inc.; MCS Advantage Inc.;

MMM Health Care Inc.; Constellation

Health LLC

Notes: Program notes Medicare Platino is a Medicare

Advantage product that provides

Medicaid wrap around benefits to

enrollees. The benefits above include

those covered by Medicaid and

Medicare.

457

Rhode Island Managed Care Program Features, as of 2018 (1 of 2)

Features PACE

RIte Care, RHP and Medicaid

Expansion Transportation Broker

Program type Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority PACE 1115(a) (Medicaid demonstration

waivers)

1902(a)(70) NEMT

Program start date 11/01/2005 08/01/1994 05/01/2014

Waiver expiration date (if applicable) 12/31/2023

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory Mandatory

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

458

Features PACE

RIte Care, RHP and Medicaid

Expansion Transportation Broker

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

N/A Other Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

90 Days 90 Days

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

459

Features PACE

RIte Care, RHP and Medicaid

Expansion Transportation Broker

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

No No No

Quality assurance and improvement:

CAHPS data required?

No Yes No

460

Features PACE

RIte Care, RHP and Medicaid

Expansion Transportation Broker

Quality assurance and improvement:

Accreditation required?

No Yes No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

iPro

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program PACE Organization of RI Neighborhood Health Plan of RI;

UnitedHealthCare of Rhode Island

Community Plan

Logisticare, Inc.

Notes: Program notes

461

Rhode Island Managed Care Program Features, as of 2018 (1 of 2)

Features Rite Smiles Dental Program

Program type Dental only (PAHP)

Statewide or region-specific? Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

Program start date 05/01/2006

Waiver expiration date (if applicable) 12/31/2023

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory

462

Features Rite Smiles Dental Program

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

463

Features Rite Smiles Dental Program

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Yes

Quality assurance and improvement:

Accrediting organization

NCQA

464

Features Rite Smiles Dental Program

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program UnitedHealthCare Dental of Rhode

Island

Notes: Program notes

465

South Carolina Managed Care Program Features, as of 2018 (1 of 2)

Features

South Carolina Managed Care

Organizations

South Carolina Medical Homes

Network

South Carolina Program for All

Inclusive Care for the Elderly

Program type Comprehensive MCO Primary Care Case Management

(PCCM)

Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide Lexington County, Richland County,

Orangeburg County, Greenville County,

Anderson County, Pickens County

Federal operating authority 1932(a) 1932(a) PACE

Program start date 09/01/1996 08/01/2007 01/01/1990

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary Voluntary

466

Features

South Carolina Managed Care

Organizations

South Carolina Medical Homes

Network

South Carolina Program for All

Inclusive Care for the Elderly

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Voluntary Exempt

Populations enrolled: Enrollment choice

period

Other N/A N/A

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

90 days 90 days

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X

467

Features

South Carolina Managed Care

Organizations

South Carolina Medical Homes

Network

South Carolina Program for All

Inclusive Care for the Elderly

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Nurse midwife, birth centers,

chiropractic services, therapy services

(speech, hearing, language, etc.), vision

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

468

Features

South Carolina Managed Care

Organizations

South Carolina Medical Homes

Network

South Carolina Program for All

Inclusive Care for the Elderly

Quality assurance and improvement:

Accreditation required?

Yes No No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

The Carolina Center for Medical

Excellence

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Select Health of South Carolina;

Absolute Total Care; BlueChoice

Healthplan Medicaid; Molina Healthcare

of South Carolina; WellCare of South

Carolina

South Carolina Solutions Palmetto Senior Care; The Methodist

Oaks; Greenville Health System Senior

Care

Notes: Program notes

469

South Carolina Managed Care Program Features, as of 2018 (2 of 2)

Features

South Carolina Non-Emergency

Medical Transportation

Program type Non-Emergency Medical Transportation

Statewide or region-specific? Statewide

Federal operating authority

Program start date 05/01/2007

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory

470

Features

South Carolina Non-Emergency

Medical Transportation

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Recipient chooses to use transportation

services based on identifying the need

to access service providers.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

471

Features

South Carolina Non-Emergency

Medical Transportation

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

472

Features

South Carolina Non-Emergency

Medical Transportation

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Logisticare

Notes: Program notes

473

South Dakota Managed Care Program Features, as of 2018

Features PRIME

Program type Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide

Federal operating authority 1932(a)

Program start date 10/02/2002

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Mandatory

474

Features PRIME

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management X

Benefits covered: SSA Section 1945-

authorized health home

475

Features PRIME

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

476

Features PRIME

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Multiple Primary Care Providers

Notes: Program notes

477

Tennessee Managed Care Program Features, as of 2018

Features TennCare II

Program of All-Inclusive Care for the

Elderly

Program type Comprehensive MCO + MLTSS Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Hamilton County

Federal operating authority 1115(a) (Medicaid demonstration

waivers),1945 Health Homes

PACE

Program start date 07/01/2002 04/07/1999

Waiver expiration date (if applicable) 06/30/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

478

Features TennCare II

Program of All-Inclusive Care for the

Elderly

Populations enrolled: Native

American/Alaskan Natives

Exempt Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

479

Features TennCare II

Program of All-Inclusive Care for the

Elderly

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Freestanding birth centers, podiatry

services, and other services as

indicated in Tennessee's approved

Medicaid State Plan.

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.

480

Features TennCare II

Program of All-Inclusive Care for the

Elderly

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

Quality assurance and improvement:

Accreditation required?

Yes No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qsource

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup; DentaQuest USA

Insurance Company; Magellan Health

Services; UnitedHealthcare Community

Plan; Volunteer State Health Plan

(BlueCare); Volunteer State Health Plan

(TennCare Select)

Alexian Brothers Community Services

481

Features TennCare II

Program of All-Inclusive Care for the

Elderly

Notes: Program notes Dental services (preventive, diagnostic,

and treatment) are available to

TennCare enrollees under age 21, and

included within the EPSDT benefit. ICF-

IDD benefits are reimbursed outside the

TennCare II Demonstration, although

recipients of the benefit are still enrolled

in managed care for other benefits.

Individuals eligible for coverage solely

by virtue of the TennCare II

Demonstration are not entitled to certain

State Plan services but still receive a

wide range of physical health services,

behavioral health services, and long-

term services and supports. Partial

duals do not qualify for TennCare and,

therefore, are not enrolled in a

TennCare MCO. Most TennCare

members are enrolled in more than one

of the six plans identified. Each member

is enrolled in one Managed Care Entity

(MCE) for physical health services,

behavioral health services, and long-

term services and supports. Adults

(excluding PACE members) are also

enrolled in a second MCE for pharmacy

benefits. Children are enrolled in one

MCE for physical health services,

behavioral health services, and long-

term services and supports; a second

MCE for pharmacy benefits; and a third

MCE for dental benefits.

A segment of Tennessee's PACE

population qualifies for coverage solely

by virtue of the TennCare II

Demonstration (Tennessee's 1115

Medicaid demonstration waiver) and not

via Tennessee's Medicaid State Plan.

TennCare II 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 June 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. Individuals enroll in

the PACE program voluntarily, but, once

enrolled, are required to participate in

managed care. Individuals who enroll in

TennCare but opt not to participate in

PACE are mandatorily enrolled in an

MCO. PACE applicants and recipients

must meet the nursing facility level of

care criteria (i.e., be disabled) to qualify

for the program.

482

Texas Managed Care Program Features, as of 2018 (1 of 3)

Features STAR Health STAR STAR Kids

Program type Comprehensive MCO Comprehensive MCO Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1915(a) 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers),1915(b)/1915(c),1945 Health

Homes

Program start date 04/01/2008 12/11/2011 11/01/2016

Waiver expiration date (if applicable) 09/30/2022 09/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

483

Features STAR Health STAR STAR Kids

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Other 15 days 15 days

Populations enrolled: Enrollment broker

name (if applicable)

MAXIMUS MAXIMUS MAXIMUS

Populations enrolled: Notes on

enrollment choice period

Members are auto-enrolled by the

enrollment broker

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X X

Benefits covered: EPSDT X X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

484

Features STAR Health STAR STAR Kids

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Diagnostic services, podiatrist services,

medical supplies, non-prescription

drugs, eye glasses, preventive services,

nurse midwife services, and pediatric or

family nurse practitioner services

Diagnostic services, podiatrist services,

medical supplies, non-prescription

drugs, eye glasses, preventive services,

nurse midwife services, and pediatric or

family nurse practitioner services

Diagnostic services, podiatrist services,

medical supplies, non-prescription

drugs, eye glasses, preventive services,

nurse midwife services, and pediatric or

family nurse practitioner services

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes Yes

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in plan

selection criteria

No, but accreditation considered in plan

selection criteria

No, but accreditation considered in plan

selection criteria

485

Features STAR Health STAR STAR Kids

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA, URAC NCQA, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Institute for Child Health Policy Institute for Child Health Policy Institute for Child Health Policy

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

X X

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X X

Participating plans: Plans in Program Superior HealthPlan 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.; 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 First Health Plans, Inc.;

Seton Health Plan, Inc., dba Dell

Childrens Health Plan; Health Care

Service Corp. (dba Blue Cross Blue

Shield); SHA. LLC, dba FirstCare Health

Plans; Scott & White Health Plan

Amerigroup Insurance Company;

Superior HealthPlan, Inc.; Aetna Better

Health of Texas Inc.; Community First

Health Plans, Inc.; UnitedHealthcare

Insurance Company, dba United

Healthcare Community Plan; 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); Children’s

Medical Center Health Plan

486

Features STAR Health STAR STAR Kids

Notes: Program notes 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.

STAR population also includes pregnant

women. Dental benefits covered by the

STAR program are administered by

Dental Maintenance Organizations.

1115 and 1915 (c) waivers are applied

to this program.

487

Texas Managed Care Program Features, as of 2018 (2 of 3)

Features STAR+PLUS Children's Medicaid Dental Services PACE

Program type Comprehensive MCO + MLTSS Dental only (PAHP) Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1115(a) (Medicaid demonstration

waivers)

PACE

Program start date 12/11/2011 12/11/2011 06/01/2001

Waiver expiration date (if applicable) 09/30/2022 09/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

488

Features STAR+PLUS Children's Medicaid Dental Services PACE

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt

Populations enrolled: Enrollment

choice period

15 days 15 days N/A

Populations enrolled: Enrollment broker

name (if applicable)

MAXIMUS MAXIMUS

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

489

Features STAR+PLUS Children's Medicaid Dental Services PACE

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver

services

X X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

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

490

Features STAR+PLUS Children's Medicaid Dental Services PACE

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Diagnostic services, podiatrist services,

medical supplies, non-prescription

drugs, eye glasses, preventive

services, nurse midwife services, and

pediatric or family nurse practitioner

services

Adult day care/adult foster care,

nursing, restorative therapies: physical,

occupational, and recreational

therapies, meals and nutrition

counseling, social work/social services,

medical supplies/adaptive aids and

minor home modifications,

transportation to and from medical

appointments, medical specialists,

such as 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

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes No

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in

plan selection criteria

No, but accreditation considered in

plan selection criteria

Quality assurance and improvement:

Accrediting organization

NCQA, URAC NCQA, URAC

Quality assurance and improvement:

EQRO contractor name (if applicable)

Institute for Child Health Policy Institute for Child Health Policy

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

491

Features STAR+PLUS Children's Medicaid Dental Services PACE

Performance incentives: MCOs/PHPs

required or encouraged to pay

providers for value/quality outcomes

X X

Participating plans: Plans in Program 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.

MCNA Insurance Company;

DentaQuest USA Insurance Company,

Inc.

Bienvivir Senior Health Services (El

Paso); Silver Star Health Network

(Lubbock); Werner (Amarillo)

Notes: Program notes

492

Texas Managed Care Program Features, as of 2018 (3 of 3)

Features Medical Transportation Program

Program type Non-Emergency Medical Transportation

Statewide or region-specific? Statewide

Federal operating authority 1915(b)

Program start date 09/01/2014

Waiver expiration date (if applicable) 03/31/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Voluntary

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Voluntary

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary

493

Features Medical Transportation Program

Populations enrolled: Foster Care and

Adoption Assistance Children

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization

Benefits covered: Physician

Benefits covered: Nurse practitioner

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services

Benefits covered: Lab and x-ray

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices

Benefits covered: EPSDT

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

494

Features Medical Transportation Program

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

495

Features Medical Transportation Program

Quality assurance and improvement:

EQRO contractor name (if applicable)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program American Medical Response;

LogistiCare; Medical Transportation

Management; Project Armistad

Notes: Program notes Based on the client's county of

residence, the client is assigned to the

single broker in the region.

496

Utah Managed Care Program Features, as of 2018 (1 of 2)

Features Prepaid Mental Health Dental UNI HOME

Program type Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Dental only (PAHP) Comprehensive MCO

Statewide or region-specific? Based on state counties and some

multi-county partnerships

Statewide Statewide

Federal operating authority 1915(b) 1915(b) 1915(a)

Program start date 07/01/1991 09/01/2013 07/01/2011

Waiver expiration date (if applicable) 06/30/2022 12/31/2023 06/30/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory Mandatory Voluntary

Populations enrolled: Partial Duals Mandatory Mandatory Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory Voluntary

Populations enrolled: Native

American/Alaskan Natives

Mandatory Mandatory Voluntary

497

Features Prepaid Mental Health Dental UNI HOME

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Exempt Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

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.

No enrollment period. There is a waiting

list for the program. Enrollees apply. If

there is room, they are enrolled.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

498

Features Prepaid Mental Health Dental UNI HOME

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Vision, podiatry, dialysis, DME, inpatient

medical detox, nurse midwife services,

freestanding birth centers, ambulatory

surgical centers

Quality assurance and improvement:

HEDIS data required?

Yes Yes Yes

Quality assurance and improvement:

CAHPS data required?

Yes Yes Yes

499

Features Prepaid Mental Health Dental UNI HOME

Quality assurance and improvement:

Accreditation required?

No No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Bear River Mental Health; Central Utah

Mental Health; Davis Behavioral Health;

Four Corners Community Behavioral

Health; Northeastern Counseling;

Optum Health; Southwest Behavioral

Health; Valley Behavioral Health;

Wasatch Mental Health; Weber Mental

Health

Premier Access; Delta Dental HOME

Notes: Program notes Pregnant women are also covered

through this program.

500

Utah Managed Care Program Features, as of 2018 (2 of 2)

Features Choice of Health Care Delivery Transportation

Program type Comprehensive MCO Non-Emergency Medical Transportation

Statewide or region-specific? Statewide Statewide

Federal operating authority 1915(b) 1902(a)(70) NEMT

Program start date 03/23/1983 07/12/2001

Waiver expiration date (if applicable) 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Varies

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Varies

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Varies Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Varies Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Varies

Populations enrolled: Full Duals Varies Mandatory

Populations enrolled: Partial Duals Varies Mandatory

Populations enrolled: Children with

Special Health Care Needs

Varies Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Voluntary

501

Features Choice of Health Care Delivery Transportation

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Other Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

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.

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

502

Features Choice of Health Care Delivery Transportation

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Vision, podiatry, dialysis, DME, inpatient

medical detox, nurse midwife services,

freestanding birth centers, ambulatory

surgical centers

Quality assurance and improvement:

HEDIS data required?

Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No

503

Features Choice of Health Care Delivery Transportation

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Healthy U; Molina; Health Choice;

SelectHealth

Logisticare Solutions

Notes: Program notes Enrollment is mandatory in the following

13 counties: Box Elder, Cache, Davis,

Iron, Morgan, Rich, Salt Lake, Summit,

Tooele, Utah, Wasatch, Washington,

and Weber. Enrollment is voluntary in all

other counties.

Specific Native American 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 covered

through this program.

504

Vermont Managed Care Program Features, as of 2018

Features

Global Commitment to Health

Demonstration

Program type Comprehensive MCO + MLTSS

Statewide or region-specific? Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers),1937 Alt Benefit Plan,1945

Health Homes

Program start date 10/01/2005

Waiver expiration date (if applicable) 12/31/2021

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals Mandatory

Populations enrolled: Children with

Special Health Care Needs

505

Features

Global Commitment to Health

Demonstration

Populations enrolled: Native

American/Alaskan Natives

Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X

506

Features

Global Commitment to Health

Demonstration

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Nurse midwives, chiropractic,

PT/OT/SP, tobacco cessation

counseling, optometrist services, high

tech nursing services, optician services,

naturopathic physician services, and

behavioral health services

Quality assurance and improvement:

HEDIS data required?

Yes

507

Features

Global Commitment to Health

Demonstration

Quality assurance and improvement:

CAHPS data required?

Quality assurance and improvement:

Accreditation required?

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

Health Services Advisory Group

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Department of Vermont Health Access

Notes: Program notes Health homes provide coordinated,

systemic, whole-person care to VT

Medicaid beneficiaries who receive

medication assisted therapy (MAT) for

opiod dependency.

508

Virginia Managed Care Program Features, as of 2018

Features

CCC Plus

Medallion 3.0

DMAS PACE

Program type

Comprehensive MCO + MLTSS

Comprehensive MCO

Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific?

Statewide

22901 22902 22903 22904 22911

22920 22922 22923 22931 22932

22935 22936 22937 22938 22940

22942 22943 22946 22947 22949

22958 22959 22963 22964 22967

22968 22969 22971 22973 22974

22976 23022 23024 23055 23065

23084 23093 23117 24464 24562

24590 23002 23004 23027 23040

23083 23123 23824 23894 23901

23909 23921 23922 22901 22902

22903 22904 22911 22920 22922

22923 22931 22932 22935 22936

22937 22938 22940 22942 22943

22946 22947 22949 22958 22959

22963 22964 22967 22968 22969

22971 22973 22974 22976 23022

23024 23055 23065 23084 23093

23117 24464 24562 24590 23002

23004 23027 23040 23083 23123

23824 23894 23901 23909 23921

23922 23923 23930 23934 23936

23937 23939 23941 23942 23943

23947 23952 23954 23955 23958

23959 23960 23963 23966 23974

23976 24599 24501 24502 24503

24504 24521 24522 24523 24536

24538 24550 24551 24553 24554

24556 24570 24572 24574 24588

24593 24054 24055 24069 24078

24082 24089 24102 24104 24112

509

Features CCC Plus Medallion 3.0 DMAS PACE

Statewide or region-specific? (cont.) Statewide Statewide 24137 24139 24146 24148 24161

24165 24168 24517 24527 24528

24530 24531 24540 24541 24549

24557 24563 24565 24566 24569

24571 24586 24594 24133 24176

24543 24576 24011 24012 24013

24014 24015 24016 24017 24018

24019 24020 24059 24060 24064

24065 24066 24067 24070 24073

24077 24079 24083 24087 24090

24092 24095 24101 24121 24122

24138 24149 24151 24153 24162

24174 24175 24176 24179 24184

23112 23113 23114 23120 23124

23129 23139 23140 23141 23146

23173 23181 23221 23224 23225

23226 23227 23228 23231 23232

23234 23235 23236 23237 23238

23240 23241 23249 23260 23261

23269 23273 23274 23276 23278

23279 23282 23284 23285 23286

23289 23290 23291 23293 23295

22546 23005 23009 23011 23015

23030 23039 23047 23058 23059

23060 23069 23075 23086 23089

23102 23103 23106 23111 23116

23150 23162 23192 23218 23219

23220 23222 23223 23229

510

Features CCC Plus Medallion 3.0 DMAS PACE

Statewide or region-specific? (cont.) Statewide Statewide 23230 23233 23242 23250 23255

23288 23801 23803 23804 23805

23806 23830 23831 23832 23833

23834 23836 23838 23840 23841

23842 23850 23860 23875 23882

23885 23601 23605 23607 23651

23661 23662 23663 23664 23665

23666 23669 23602 23603 23604

23606 23608 23692 23693 23696

23320 23321 23322 23323 23324

23325 23432 23433 23434 23435

23436 23437 23438 23701 23702

23703 23704 23707 23709 23314

23315 23430 23487 23846 23851

23883 23898 23451 23452 23453

23454 23455 23456 23457 23459

23460 23461 23462 23463 23464

23502 23503 23504 23505 23507

23508 23509 23510 23511 23513

23517 23518 23521 23523 23529

24215 24216 24218 24219 24221

24230 24243 24244 24245 24246

24248 24250 24251 24258 24263

24265 24271 24273 24277 24279

24281 24282 24283 24290 24293

24217 24220 24224 24225 24226

24228 24237 24239 24256 24260

24266 24269 24272 24280 24377

24601 24602 24603 24604 24605

24606 24607 24608 24609 24612

24613 24614 24619 24620 24622

24624 24627 24628 24630 24631

24634 24635 24637 24639 24640

24641 24646 24647 24649 24651

24656 24657 24658

Program start date 08/01/2017 07/01/2017 11/01/2007

Waiver expiration date (if applicable) 07/01/2022 06/30/2019

511

Features CCC Plus Medallion 3.0 DMAS PACE

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory Exempt Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory

Populations enrolled: Enrollment choice

period

Pre-assigned Pre-assigned N/A

Populations enrolled: Enrollment broker

name (if applicable)

Maximus Maximus

Populations enrolled: Notes on

enrollment choice period

512

Features CCC Plus Medallion 3.0 DMAS PACE

Benefits covered: Inpatient hospital

physical health

X X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X X

Benefits covered: Nurse practitioner X X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X X

Benefits covered: Lab and x-ray X X X

Benefits covered: Prescription drugs X X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X X

513

Features CCC Plus Medallion 3.0 DMAS PACE

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes Yes No

Quality assurance and improvement:

Accreditation required?

Yes Yes No

Quality assurance and improvement:

Accrediting organization

NCQA NCQA JCAHO

Quality assurance and improvement:

EQRO contractor name (if applicable)

HSAG HSAG

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

514

Features CCC Plus Medallion 3.0 DMAS PACE

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

X X

Participating plans: Plans in Program Aetna Better Health for Virginia; Anthem

HealthKeepers; Magellan Complete

Care of Virginia; Optima Health; United

Health Care; Virginia Premier

Virginia Premier Health Plan; Anthem;

Intotal Health; Kaiser; Optima Health

Care; Coventry Health Plan

Innovage; Mountain Empire/All Care

PACE; INOVA PACE; Riverside PACE;

Innovage PACE; Centra PACE; Sentara

PACE

Notes: Program notes

515

Washington Managed Care Program Features, as of 2018 (1 of 3)

Features

Washington State Integrated

Community Mental Health Program

(ICMH) NEMT Apple Health

Program type Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Non-Emergency Medical Transportation Comprehensive MCO

Statewide or region-specific? Statewide Statewide Statewide

Federal operating authority 1115(a) (Medicaid demonstration

waivers)

1902(a)(70) NEMT 1932(a)

Program start date 10/01/2014 10/01/2008 07/01/1994

Waiver expiration date (if applicable) 12/31/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Mandatory Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory Mandatory Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Mandatory

Populations enrolled: Full Duals Mandatory Mandatory

Populations enrolled: Partial Duals Mandatory Mandatory

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory Mandatory

516

Features

Washington State Integrated

Community Mental Health Program

(ICMH) NEMT Apple Health

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Mandatory Mandatory Voluntary

Populations enrolled: Enrollment choice

period

Pre-assigned Other

Populations enrolled: Enrollment broker

name (if applicable)

Regional Support Networks

Populations enrolled: Notes on

enrollment choice period

Enrollment open continuously

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X X

517

Features

Washington State Integrated

Community Mental Health Program

(ICMH) NEMT Apple Health

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

No No Yes

518

Features

Washington State Integrated

Community Mental Health Program

(ICMH) NEMT Apple Health

Quality assurance and improvement:

CAHPS data required?

No No Yes

Quality assurance and improvement:

Accreditation required?

Yes No Yes

Quality assurance and improvement:

Accrediting organization

Regional support network's contract with

accredited community mental health

agencies.

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qualis Health Qualis

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program BHO Multiple Transportation Brokers Amerigroup; Community Health Plan of

Washington; Coordinated Care of

Washington; Molina Health Care of

Washington; United Health Care

519

Features

Washington State Integrated

Community Mental Health Program

(ICMH) NEMT Apple Health

Notes: Program notes Effective 07/01/2017: The AI/AN

population was removed from

mandatory enrollment in behavioral

health managed care. That meant the

majority of AI/AN individuals were

transferred to the FFS system for

behavioral health. That FFS system is

not part of the waiver. The 1115 waiver

(an amendment to the larger 1115) that

allows us to use federal funds in SUD

IMDs was effective 7/1/2018.

Brokers are based on county. NEMT is

provided for anyone covered on

Medicaid that meet the enrollment

criteria.

Please note managed care plans only

cover rehabilitation care in nursing

home facilities. Custodial care is is

covered under FFS.

520

Washington Managed Care Program Features, as of 2018 (2 of 3)

Features Healthy Options - Blind Disabled

Behavioral Health Services Only

(BHSO) PCCM

Program type Comprehensive MCO Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Primary Care Case Management

(PCCM)

Statewide or region-specific? Statewide Chelan, Clark, Douglas, Grant, and

Skamania Counties

Clallam, Grays Harbor, King,

Snohomish, Whatcom, Okanogan,

Ferry, Stevens, Lincoln, Spokane,

Benton and Yakima Counties

Federal operating authority 1932(a) 1915(b) 1932(a)

Program start date 07/01/2012 04/01/2016 07/01/1995

Waiver expiration date (if applicable) 06/30/2022

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Mandatory

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Mandatory Voluntary

521

Features Healthy Options - Blind Disabled

Behavioral Health Services Only

(BHSO) PCCM

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Exempt Voluntary

Populations enrolled: Enrollment choice

period

Other Other N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Enrollment open continuously Enrollment open continuously Enrollment open continuously

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

522

Features Healthy Options - Blind Disabled

Behavioral Health Services Only

(BHSO) PCCM

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

Yes No No

523

Features Healthy Options - Blind Disabled

Behavioral Health Services Only

(BHSO) PCCM

Quality assurance and improvement:

Accreditation required?

Yes Yes No

Quality assurance and improvement:

Accrediting organization

NCQA NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qualis Qualis

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup; Community Health Plan of

WA; Coordinated Care of Washington;

Molina Health Care; United Health Care

Amerigroup; Coordinated Care of

Washington; Molina Health Care;

Community Health Care Plan of WA

Multiple Primary Care Providers

Notes: Program notes Please note managed care plans only

cover rehabilitation care in nursing

home facilities. Custodial care is is

covered under FFS.

IHS administers this program for

Yakima, Spokane, and Confederated

Tribes of the Colville Reservation. There

are two FQHCs: Seattle Indian Health

Board and Native Project. The tribal

clinics are as follows: Lower Elwha

Klallam, Lummi Nation, Nooksack Tribe,

Tulalip Nation, Confederated Tribes of

the Colville Reservation (non-IHS

managed facility), Puyallup Tribe,

Quileute Tribe, Quinault Indian Nation

and Port Gamble S'Klallam Tribe.

524

Washington Managed Care Program Features, as of 2018 (3 of 3)

Features

Fully Integrated Managed Care

(FIMC) PACE

Apple Health/Healthy Options Health

Home Program

Program type Comprehensive MCO Program of All-inclusive Care for the

Elderly (PACE)

Comprehensive MCO

Statewide or region-specific? Chelan, Clark, Douglas, Grant, and

Skamania Counties

Statewide Statewide

Federal operating authority 1932(a),1945 Health Homes PACE 1945 Health Homes

Program start date 04/01/2016 01/01/1997 07/01/2013

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Voluntary

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory Voluntary

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory Voluntary

525

Features

Fully Integrated Managed Care

(FIMC) PACE

Apple Health/Healthy Options Health

Home Program

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt Exempt

Populations enrolled: Enrollment choice

period

Other N/A Pre-assigned

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Enrollment open continuously

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X

526

Features

Fully Integrated Managed Care

(FIMC) PACE

Apple Health/Healthy Options Health

Home Program

Benefits covered: SSA Section 1945-

authorized health home

X X

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Comfort Care and Podiatry

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

Yes No No

527

Features

Fully Integrated Managed Care

(FIMC) PACE

Apple Health/Healthy Options Health

Home Program

Quality assurance and improvement:

Accreditation required?

Yes No No

Quality assurance and improvement:

Accrediting organization

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qualis

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Amerigroup; Coordinated Care of

Washington; Community Health Plan of

Washington; Molina Health Care

Providence Elder Place Multiple Sites

Notes: Program notes Please note managed care plans only

cover rehabilitation care in nursing

home facilities. Custodial care is is

covered under FFS.

Washington delivers the optional Health

Home Medicaid/Medical Benefit both in

the fee-for-service system and through

MCOs. For individuals in Apple Health

comprehensive MCOs, the MCOs are at

risk for health home services plus a

broad array of benefits including

inpatient, outpatient, physician services,

pharmacy, etc. For individuals in

PCCMs, the MCOs administer health

homes services separate from the

PCCM program.

528

529

West Virginia Managed Care Program Features, as of 2018

Features Mountain Health Trust

Program type Comprehensive MCO

Statewide or region-specific? Statewide

Federal operating authority 1915(b)

Program start date 09/01/1996

Waiver expiration date (if applicable) 06/30/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Mandatory

Populations enrolled: Native

American/Alaskan Natives

Mandatory

530

Features Mountain Health Trust

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt

Populations enrolled: Enrollment choice

period

Other

Populations enrolled: Enrollment broker

name (if applicable)

MAXIMUS

Populations enrolled: Notes on

enrollment choice period

45-60 days depending on packet

receival date

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management

Benefits covered: SSA Section 1945-

authorized health home

531

Features Mountain Health Trust

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Quality assurance and improvement:

HEDIS data required?

Yes

Quality assurance and improvement:

CAHPS data required?

Yes

Quality assurance and improvement:

Accreditation required?

Yes

Quality assurance and improvement:

Accrediting organization

NCQA

532

Features Mountain Health Trust

Quality assurance and improvement:

EQRO contractor name (if applicable)

Qlarant (formerly Delmarva)

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Aetna Better Health of WV; The Health

Plan; Unicare; West Virginia Family

Health

Notes: Program notes

533

Wisconsin Managed Care Program Features, as of 2018 (1 of 3)

Features BadgerCare Plus Care4Kids Children Come First (CCF)

Program type Comprehensive MCO Other Prepaid Health Plan (PHP)

(limited benefits)

Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Statewide or region-specific? Statewide Kenosha, Milwaukee, Ozaukee, Racine,

Washington, and Washington Counties

County: Dane

Federal operating authority 1932(a) 1937 Alt Benefit Plan 1915(a)

Program start date 02/01/2008 01/01/2014 04/01/1993

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Mandatory

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Mandatory

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Mandatory

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary Voluntary Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Voluntary

534

Features BadgerCare Plus Care4Kids Children Come First (CCF)

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Voluntary Voluntary

Populations enrolled: Enrollment choice

period

Other Other Other

Populations enrolled: Enrollment broker

name (if applicable)

MAXIMUS MAXIMUS

Populations enrolled: Notes on

enrollment choice period

90 days open enrollment period Open enrollment period as long as child

remains in out of home care and resides

in eligible placement setting/county.

Enrollment may occur at any time

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X X

Benefits covered: Case management X X X

Benefits covered: SSA Section 1945-

authorized health home

535

Features BadgerCare Plus Care4Kids Children Come First (CCF)

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Prosthetic devices, nurse midwife

services, podiatry, chiropractic (varies

by plan), and dental (varies by

geographic region)

Prosthetic devices, nurse midwife

services, and podiatry

Quality assurance and improvement:

HEDIS data required?

Yes Yes No

Quality assurance and improvement:

CAHPS data required?

No No No

Quality assurance and improvement:

Accreditation required?

No No No

536

Features BadgerCare Plus Care4Kids Children Come First (CCF)

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

MetaStar, Inc. MetaStar, Inc. MetaStar, Inc.

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Anthem Blue Cross Blue Shield;

Children’s Community Health Plan;

Dean Health Plan; Group Health

Cooperative Of Eau Claire; Group

Health Cooperative Of South Central

WI; Independent Care (iCare); MHS of

Wisconsin; MercyCare Insurance

Company; Molina Health Plan; Network

Health Plan; Physicians Plus Health

Plan; Security Health Plan; Trilogy

Health Insurance; UnitedHealthcare

Community Plan; Quartz

Children's Community Health Plan Children Come First

Notes: Program notes

537

Wisconsin Managed Care Program Features, as of 2018 (2 of 3)

Features SSI Managed Care WrapAround Milwaukee

Program of All-inclusive Care for the

Elderly (PACE)

Program type Comprehensive MCO Behavioral Health Organization (BHO)

only (PIHP and/or PAHP)

Program of All-inclusive Care for the

Elderly (PACE)

Statewide or region-specific? Statewide County: Milwaukee Milwaukee Racine and Waukesha

Counties

Federal operating authority 1932(a) 1915(a) PACE

Program start date 04/01/2005 03/01/1997 11/01/1990

Waiver expiration date (if applicable)

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Mandatory Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

Voluntary

538

Features SSI Managed Care WrapAround Milwaukee

Program of All-inclusive Care for the

Elderly (PACE)

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary Exempt

Populations enrolled: Foster Care and

Adoption Assistance Children

Voluntary Exempt

Populations enrolled: Enrollment choice

period

Other Other N/A

Populations enrolled: Enrollment broker

name (if applicable)

Automated Health Systems

Incorporated (AHSI)

Populations enrolled: Notes on

enrollment choice period

90 days open enrollment period Voluntary enrollment can occur at any

time

Open enrollment

Benefits covered: Inpatient hospital

physical health

X X

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Outpatient hospital

physical health

X X

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

X X

Benefits covered: Clinic services X X

Benefits covered: Lab and x-ray X X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X X

539

Features SSI Managed Care WrapAround Milwaukee

Program of All-inclusive Care for the

Elderly (PACE)

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X X

Benefits covered: Dental services

(medical/surgical)

X X

Benefits covered: Dental (preventative

or corrective)

X X

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Nurse midwife services, podiatry and

chiropractic, and dental varies by

geographic region

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,

and vision care

540

Features SSI Managed Care WrapAround Milwaukee

Program of All-inclusive Care for the

Elderly (PACE)

Quality assurance and improvement:

HEDIS data required?

Yes No No

Quality assurance and improvement:

CAHPS data required?

No No No

Quality assurance and improvement:

Accreditation required?

No, but accreditation considered in plan

selection criteria

No No

Quality assurance and improvement:

Accrediting organization

Majority of HMOs are accredited by

NCQA

Quality assurance and improvement:

EQRO contractor name (if applicable)

MetaStar, Inc. MetaStar, Inc. MetaStar Inc

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Anthem Blue Cross Blue Shield; Care

Wisconsin; Group Health Cooperative

Of Eau Claire; Independent Care

(iCare); MHS of Wisconsin; Molina

Health Plan; Network Health Plan;

UnitedHealthcare Community Plan

WrapAround Milwaukee Community Care, Inc.

Notes: Program notes

541

Wisconsin Managed Care Program Features, as of 2018 (3 of 3)

Features Family Care Partnership Program Family Care

Program type Comprehensive MCO + MLTSS MLTSS only (PIHP and/or PAHP)

Statewide or region-specific? Calumet, Columbia, Dane, Dodge,

Jefferson, Kenosha, Milwaukee.

Outagamie, Ozaukee, Racine, Sauk,

Washington, Waukesha, and Waupaca

Counties

Statewide

Program start date 02/01/1995 02/01/2000

Waiver expiration date (if applicable) 12/31/2019 12/31/2019

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary Mandatory

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary Voluntary

Populations enrolled: Partial Duals

Populations enrolled: Children with

Special Health Care Needs

542

Features Family Care Partnership Program Family Care

Populations enrolled: Native

American/Alaskan Natives

Voluntary Mandatory

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Exempt

Populations enrolled: Enrollment choice

period

Other Other

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Open enrollment Open enrollment

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

X X

Benefits covered: Partial hospitalization X X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT X

Benefits covered: Case management X X

543

Features Family Care Partnership Program Family Care

Benefits covered: SSA Section 1945-

authorized health home

Benefits covered: Health home care

(services in home)

X X

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

X X

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing X X

Benefits covered: ICF-IDD X X

Benefits covered: Nursing facility

services

X X

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

X X

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

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

and language pathology, vision care

Community mental health services,

durable medical equipment and medical

supplies, occupational therapy, physical

therapy, respiratory care for ventilator

dependent persons, and speech and

language pathology

544

Features Family Care Partnership Program Family Care

Quality assurance and improvement:

HEDIS data required?

No No

Quality assurance and improvement:

CAHPS data required?

No No

Quality assurance and improvement:

Accreditation required?

No No

Quality assurance and improvement:

Accrediting organization

Quality assurance and improvement:

EQRO contractor name (if applicable)

MetaStar Inc MetaStar, Inc

Performance incentives: Payment

bonuses/differentials to reward plans

X X

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

X X

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Care Wisconsin; Community Care, Inc.;

Independent Care (iCare)

Care Wisconsin; Community Care, Inc.;

CommunityLink (became Inclusa in

September 2017); My Choice Family

Care; Lakeland Care District

Notes: Program notes

545

Wyoming Managed Care Program Features, as of 2018

Features

Wyoming PACE at Cheyenne Medical

Center

Care Management Entity for

Emotionally Disturbed Children

Program type Program of All-inclusive Care for the

Elderly (PACE)

Other Prepaid Health Plan (PHP)

(limited benefits)

Statewide or region-specific? Laramie County Statewide

Federal operating authority PACE 1915(b)/1915(c)

Program start date 02/01/2013 09/01/2015

Waiver expiration date (if applicable) 06/30/2020

If the program ended in 2018, indicate

the end date

Populations enrolled: Low-income

adults not covered under ACA Section

VIII (excludes pregnant women and

people with disabilities)

Populations enrolled: Low-income

adults covered under ACA Section VIII

(excludes pregnant women and people

with disabilities)

Populations enrolled: Aged, Blind or

Disabled Children or Adults

Voluntary

Populations enrolled: Non-Disabled

Children (excludes children in foster

care or receiving adoption assistance)

Populations enrolled: Individuals

receiving Limited Benefits (excludes

partial duals)

Populations enrolled: Full Duals Voluntary

Populations enrolled: Partial Duals Voluntary

Populations enrolled: Children with

Special Health Care Needs

Voluntary

Populations enrolled: Native

American/Alaskan Natives

Voluntary Voluntary

546

Features

Wyoming PACE at Cheyenne Medical

Center

Care Management Entity for

Emotionally Disturbed Children

Populations enrolled: Foster Care and

Adoption Assistance Children

Exempt Voluntary

Populations enrolled: Enrollment choice

period

N/A

Populations enrolled: Enrollment broker

name (if applicable)

Populations enrolled: Notes on

enrollment choice period

Benefits covered: Inpatient hospital

physical health

Benefits covered: Inpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Outpatient hospital

physical health

Benefits covered: Outpatient hospital

behavioral health (MH and/or SUD)

Benefits covered: Partial hospitalization X

Benefits covered: Physician X

Benefits covered: Nurse practitioner X

Benefits covered: Rural health clinics

and FQHCs

Benefits covered: Clinic services X

Benefits covered: Lab and x-ray X

Benefits covered: Prescription drugs X

Benefits covered: Prosthetic devices X

Benefits covered: EPSDT

Benefits covered: Case management X X

Benefits covered: SSA Section 1945-

authorized health home

547

Features

Wyoming PACE at Cheyenne Medical

Center

Care Management Entity for

Emotionally Disturbed Children

Benefits covered: Health home care

(services in home)

Benefits covered: Family planning X

Benefits covered: Dental services

(medical/surgical)

Benefits covered: Dental (preventative

or corrective)

Benefits covered: Personal care (state

plan option)

Benefits covered: HCBS waiver services X X

Benefits covered: Private duty nursing

Benefits covered: ICF-IDD

Benefits covered: Nursing facility

services

Benefits covered: Hospice care X

Benefits covered: Non-Emergency

Medical Transportation

Benefits covered: Institution for Mental

Disease inpatient treatment for people

ages 21-64 defined by 42 CFR

§438.6(e) as an 'in lieu of' benefit

Benefits covered: Other (e.g., nurse

midwife services, freestanding birth

centers, podiatry, etc.)

Any other service determined by the

interdisciplinary team (IDT) as

necessary to meet the participant’s

needs and which improve or maintain

the participant’s overall health status.

Targeted case management State Plan

Authority including family care

coordinators, youth peer support

partners, and family support partners.

All individuals receive respite.

Quality assurance and improvement:

HEDIS data required?

No No

Quality assurance and improvement:

CAHPS data required?

No No

548

Features

Wyoming PACE at Cheyenne Medical

Center

Care Management Entity for

Emotionally Disturbed Children

Quality assurance and improvement:

Accreditation required?

No Yes

Quality assurance and improvement:

Accrediting organization

NCQA, JCAHO, URAC, Council on

Accreditation COA

Quality assurance and improvement:

EQRO contractor name (if applicable)

Navigant

Performance incentives: Payment

bonuses/differentials to reward plans

Performance incentives: Preferential

auto-enrollment to reward plans

Performance incentives: Public reports

comparing plan performance on key

metrics

Performance incentives: Withholds tied

to performance metrics

Performance incentives: MCOs/PHPs

required or encouraged to pay providers

for value/quality outcomes

Participating plans: Plans in Program Cheyenne Regional Medical Center

PACE

CME Statewide

Notes: Program notes