2009 MEDICAID MANAGED CARE ENROLLMENT REPORT SUMMARY STATISTICS AS OF JUNE 30, 2009 This report is composed annually by the Finance, Systems, and Budget Group (FSBG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a plan-specific basis as of June 30, 2009. County level data is not collected. The information was collected from State Medicaid agencies and CMS Regional Offices. Data is presented for all States, the District of Columbia, Puerto Rico, and the Virgin Islands. Data is not presented for the following territories: Guam, Northern Mariana Islands, and American Somoa. Special Thanks to Loan Swisher and Carolyn Lawson of DSG for developing this publication and Joseph Del Pilar of DSG for designing this publication. Please Contact Carolyn Lawson at 410-786-0704; E-mail: [email protected]or Loan Swisher at 410-786-4650; E-mail: [email protected], if you have any questions concerning this report.
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2009 MEDICAID MANAGED CARE ENROLLMENT REPORT SUMMARY STATISTICS AS OF JUNE 30, 2009
This report is composed annually by the Finance, Systems, and Budget Group (FSBG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a plan-specific basis as of June 30, 2009. County level data is not collected. The information was collected from State Medicaid agencies and CMS Regional Offices. Data is presented for all States, the District of Columbia, Puerto Rico, and the Virgin Islands. Data is not presented for the following territories: Guam, Northern Mariana Islands, and American Somoa. Special Thanks to Loan Swisher and Carolyn Lawson of DSG for developing this publication and Joseph Del Pilar of DSG for designing this publication. Please Contact Carolyn Lawson at 410-786-0704; E-mail: [email protected] or Loan Swisher at 410-786-4650; E-mail: [email protected], if you have any questions concerning this report.
Medicaid Managed Care Enrollment Report as of June 30, 2009
Table of Contents
Managed Care Trends (2000-2009) and National Breakout of Managed Care Entities and Enrollment charts ....................................... Page 1 Total Medicaid Population (in percentages) Distribution by Year: Managed Care versus “Other” from 2004-2009 .................... Page 2 Total Medicaid Population (in millions) Distribution by Year: Managed Care versus “Other” from 2004-2009 ..................... Page 3 Medicaid Managed Care Penetration Rates by State.............................. Page 4 Managed Care Entity Type Enrollment by State .................................... Page 5 Number of Managed Care Entities by State ........................................... Page 6 Top 20 Medicaid Managed Care States ................................................. Page 7 Regional Breakout of Medicaid Managed Care Enrollment & States with Comprehensive Health Care Reform Demonstrations ...... Page 8 Prepaid Ambulatory Health Plans (PAHPs) and Enrollment by State ... Page 9 Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State .......... Page 10 Medicaid Dual Eligible Enrollment by State .......................................... Page 11 Dual Eligible Enrollment by Managed Care Entity Type ...................... Page 12 Dual Eligible Enrollment by Plan ........................................................... Page 13 Medicaid Managed Care Enrollment Plan level data by State .............. Page 22 Facts Sheet (Major changes from 6/30/2008-6/30/2009)………………Page 75 New Medicaid Managed Care Plans……………………………………Page 77 Terminated Medicaid Managed Care Plans…………………………….Page 79 Glossary…………………………………………………………………Page 80
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT AS OF JUNE 30, 2009
1
TOTAL MEDICAID MANAGED CARE OTHER % MANAGED CAREYEAR POPULATION POPULATION POPULATION ENROLLMENT
2009 50,471,859 36,202,281 14,269,578 71.73%
2008 47,142,791 33,427,582 13,715,209 70.91%
2007 45,962,271 29,463,098 16,499,173 64.10%
2006 45,652,642 29,830,406 15,822,236 65.34%
2005 45,392,325 28,575,585 16,816,740 62.95%
2004 44,355,955 26,913,570 17,442,385 60.68%
2003 42,740,719 25,262,873 17,477,846 59.11%
2002 40,147,539 23,117,668 17,029,871 57.58%
2001 36,562,567 20,773,813 15,788,754 56.82%
2000 33,690,364 18,786,137 14,904,227 55.76%
These figures represent point-in-time enrollment as of June 30th for each reporting year.
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits. This table also provides unduplicated national figures for the Total Medicaid population and
Other population. The statistics also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
NATIONAL BREAKOUT OF MANAGED CARE ENTITIES
AND ENROLLMENT AS OF JUNE 30, 2009
MANAGED CARE ENTITY TYPE # OF PLANS # OF ENROLLEES
Health Insuring Organization 4 601,662
Commercial Managed Care Organization
159 10,284,082
Medicaid-only Managed Care Organization
159 13,176,581
Primary Care Case Management 36 7,275,241
Prepaid Inpatient Health Plan 152 8,593,773
Prepaid Ambulatory Health Plan 60 7,866,947
Program of ALL-inclusive Care for the Elderly
67 17,091
Other 9 2,113,534
TOTAL 646 49,928,911
This table provides duplicated figures by plan type. The total number of enrollees include 13,726,630 individuals who were individuals who were enrolled in more than one managed care plan. It also includes individuals enrolled in State healthcare reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
MANAGED CARE TRENDS
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT
2
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
2004 2005 2006 2007 2008 2009
60.68% 62.95% 65.34% 64.10%70.91% 71.73%
39.32% 37.05% 34.66% 35.90%29.09% 28.27%
Perc
ent o
f Tot
al Me
dica
id P
opul
atio
n
Year
Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009
Other
Managed Care
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT
* Note: Numbers may not add up to totals due to rounding.
3
0.00
10.00
20.00
30.00
40.00
50.00
60.00
2004 2005 2006 2007 2008 2009
26.91 28.58 29.83 29.4633.43 36.20
17.44 16.82 15.82 16.5013.72
14.27
Tota
l Med
icaid
Pop
ulat
ion
(in m
illion
s)
Year
Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009
Other
Managed Care
4
ROW STATE MEDICAID MANAGED CARE PERCENT IN NUMBER ENROLLMENT ENROLLMENT MANAGED CARE
1 ALABAMA 812,220 540,093 66.50%2 ALASKA 101,702 0 0.00%3 ARIZONA 1,223,271 1,096,365 89.63%4 ARKANSAS 645,389 511,014 79.18%5 CALIFORNIA 6,955,761 3,632,547 52.22%6 COLORADO 467,556 444,819 95.14%7 CONNECTICUT 455,878 342,784 75.19%8 DELAWARE 170,562 126,089 73.93%9 DISTRICT OF COLUMBIA 153,779 150,406 97.81%
TOTALS 50,471,859 36,202,281 71.73%The unduplicated Medicaid enrollment figures include individuals in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards. The unduplicated managed care enrollment figures includes enrollees receiving comprehensive and limited benefits.
MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009
NUMBER OF MANAGED CARE ENTITIES BY STATE AS OF JUNE 30, 2009
7
MEDICAID MANAGED CARE ENROLLMENT AS OF 6/30/09STATES 1-10
Rank States Waiver Type Managed Care Enrollment1 California 1915(b), 1932(a), 1915(a), PACE 3,632,5472 New York 1115(a), 1915(a), PACE 2,926,9503 Texas 1915(b), 1932(a), 1915(a), 1915(b)/(c), PACE 2,161,2104 Florida 1915(b), 1115(a), 1915(b)/(c), 1915(a)/(c), PACE 1,600,5505 Pennsylvania 1915(b), 1915(a), 1902(a)(70), PACE 1,576,5236 Michigan 1915(b), PACE 1,447,3737 Ohio 1932(a), PACE 1,374,5208 Illinois 1932(a), 1915(a) 1,278,2009 Georgia 1932(a), 1902(a)(70) 1,274,823
10 Tennessee 1115(a), PACE 1,230,750Subtotal 18,503,446National Managed Care Grand Total 36,202,143Percentage 51.11%
STATES 11-2011 Arizona 1115(a) 1,096,36512 North Carolina 1915(b)/(c), 1932(a), PACE 1,012,47413 Puerto Rico 1915(a) 977,64814 Washington 1915(b), 1932(a), PACE 949,26315 Missouri 1915(b), 1902(a)(70), PACE 883,42316 South Carolina 1915(b), 1932(a), 1902(a)(70), PACE 763,22517 Massachusetts 1115(a), PACE 731,12318 New Jersey 1915(b), 1932(a), PACE 725,61419 Indiana 1915(b), 1115(a) 711,63620 Louisiana 1932(a), PACE 692,048
Subtotal 8,542,819National Managed Care Grand Total 36,202,143Percentage 23.60%
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.
REGIONAL BREAK-OUT OF MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009
REGION MEDICAID MANAGED CARE % REGION BENEFICIARIES % NATIONAL MANAGED ENROLLMENT ENROLLMENT ENROLLED IN MANAGED CARE CARE ENROLLMENT
I - Boston 2,422,117 1,596,782 65.93% 4.41%
II - New York 6,411,933 4,630,212 72.21% 12.79%
III - Philadelphia 4,172,314 3,143,509 75.34% 8.68%
IV - Atlanta 9,502,729 7,572,794 79.69% 20.92%
V - Chicago 8,544,009 5,844,247 68.40% 16.14%
VI - Dallas 6,085,870 4,262,634 70.04% 11.77%
VII - Kansas City 1,804,889 1,650,296 91.43% 4.56%
VIII - Denver 1,022,495 832,127 81.38% 2.30%
IX - San Francisco 8,627,675 5,135,797 59.53% 14.19%
X - Seattle 1,877,828 1,533,883 81.68% 4.24%
TOTALS 50,471,859 36,202,281 71.73% 100.00%
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.
This table also provides unduplicated Medicaid enrollment figures by region. The enrollment figures include individuals
enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
STATES WITH COMPREHENSIVE HEALTH CARE REFORM DEMONSTRATIONS AS OF JUNE 30, 2009
STATE MEDICAID EXPANSION MANAGED CARE % ENROLLEDENROLLMENT ENROLLMENT ENROLLMENT IN MANAGED CARE
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.This table also provides unduplicated Medicaid and Expansion enrollment figures. The enrollment figures includeindividuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibilitystandards.
This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include invididuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
13
State Plan Managed Care Entity EnrollmentAR Total Life Healthcare PACE 19AR Non-Emergency Transportation Transportation PAHP 45,645AZ AZ Physicians IPA (HP) Medicaid-only MCO 15,360AZ Bridgeway Health Solution (HP) Medicaid-only MCO 1,665AZ Bridgeway Health Solution (PC) Medicaid-only MCO 2,173AZ Care 1st Health Plan Medicaid-only MCO 2,834AZ Cochise Co. Dept. of Health Services (PC) Medicaid-only MCO 844
AZDepartment of Economic Security/Division of Developmental Disabilities (PC) Medicaid-only MCO 4,773
AZ Evercare Select (PC) Medicaid-only MCO 3,117AZ Health Choice Arizona (HP) Medicaid-only MCO 12,019AZ Maricopa County Health Plan (HP) Medicaid-only MCO 3,250AZ Mercy Care Plan (HP) Medicaid-only MCO 19,107AZ Mercy Care Plan (PC) Medicaid-only MCO 6,658AZ Phoenix Health Plan/Community Connection (HP) Medicaid-only MCO 9,741AZ Pima Health System (HP) Medicaid-only MCO 137AZ Pima Health System (PC) Medicaid-only MCO 3,559AZ Pinal County Long Term Care (PC) Medicaid-only MCO 1,241AZ SCAN Medicaid-only MCO 2,396AZ University Family Care (HP) Medicaid-only MCO 3,983AZ Yavapai County Long Term Care (PC) Medicaid-only MCO 911CA Access Dental Plan-LA Dental PAHP 1,886CA Access Dental Plan-Sacramento Dental PAHP 2,039CA Alameda Alliance for Health Commercial MCO 3,972CA AltaMed Health Services Corporation PACE 492CA American Health Guard-Dental Plan-LA Dental PAHP 411CA Anthem Blue Cross Partnership Plan - Sacramento Commercial MCO 2,207CA Anthem Blue Cross Partnership Plan-TPMP Commercial MCO 7,880CA Caloptima-Orange HIO 67,165CA Care 1st Health Plan/San Diego Commercial MCO 154CA Care 1st Health Plan-Dental-LA Dental PAHP 733CA Central Coast Alliance For Health HIO 15,153
CACoalition of Elders Independence dba Center for Elders Independence PACE 358
CA Community Dental Services/Sacramento Dental PAHP 361CA Community Dental Services-LA Dental PAHP 196CA Community Eldercare of San Diego dba St. Paul's PACE PACE 64CA Community Health Group Partnership Plan-San Diego Commercial MCO 2,206CA Contra Costa Health Plan Commercial MCO 2,129CA Health Net Community Solutions, Inc. - Sacramento Commercial MCO 724CA Health Net Community Solutions, Inc.-San Diego Commercial MCO 491CA Health Net Community Solutions, Inc.-TPMP Commercial MCO 7,188CA Health Net of CA-Dental-LA Dental PAHP 1,097CA Health Net of CA-Dental-Sacramento Dental PAHP 211CA Health Plan of San Joaquin Commercial MCO 1,461CA Health Plan of San Mateo *MCO/COHS 14,945
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
14
CA Inland Empire Health Plan Commercial MCO 5,699CA Kern Family Health Care Commercial MCO 1,771CA KP Cal, LLC Commercial MCO 362CA KP Cal, LLC - Sacramento Commercial MCO 1,840CA KP Cal, LLC-San Diego Commercial MCO 1,139CA LA Care Health Plan Commercial MCO 10,856CA Liberty Dental Plan of CA/Sacramento Dental PAHP 949CA Liberty Dental Plan of CA-LA Dental PAHP 328CA Molina Healthcare of California Partner Plan, Inc. - Sacramento Commercial MCO 595CA Molina Healthcare of California Partner Plan, Inc. - San Diego Commercial MCO 903CA Molina Healthcare of California Partner Plan, Inc.-TPMP Commercial MCO 665CA On Lok Senior Health Services dba On Lok Lifeways PACE 958CA Partnership Health Plan HIO 16,835CA Positive Healthcare/AHF Healthcare Centers Medicaid-only MCO 250CA Safeguard Dental-LA Dental PAHP 1,654CA San Francisco Health Plan Commercial MCO 1,457CA Santa Barbara San luis Obispo Regional Health Authority HIO 14,807CA Santa Clara Family Health Plan Commercial MCO 5,491CA Senior Care Action Network (SCAN) Medicaid-only MCO 6,920CA Sutter Health sacramento Sierra dba Sutter Senior Care PACE 196CA Western Dental Services-LA Dental PAHP 2,315CA Western Dental Services-Sacramento Dental PAHP 2,706
CA Western Health Advantage Community Health Plan-Sacramento Commercial MCO 910CO Access Behavioral Care Mental Health (MH) PIHP 9,155CO Behavioral Healthcare, Inc. Mental Health (MH) PIHP 9,421CO Colorado Health Partnerships Mental Health (MH) PIHP 19,627CO Denver Health and Hospital Authority Medicaid-only MCO 2,788CO Foothills Behavioral Health Partners Mental Health (MH) PIHP 6,906CO Northeast Behavioral Health Partnership Mental Health (MH) PIHP 6,285CO Primary Care Physician Program PCCM Provider 4,786CO Rocky Mountain Health Plan Authority Medical-only PIHP 1,884CO Rocky Mountain PACE PACE 23CO Total Long Term Care PACE 1,215CO VOANS PACE, Inc PACE 118DC DC Chartered Health Plan, Incorporated Medicaid-only MCO 173DC Health Right Incorporated Medicaid-only MCO 42DC Health Services For Children with Special Needs Medical-only PIHP 17DC Medical Transportation Management Transportation PAHP 11,048DC Unison Health Plan of the Capital Area Medicaid-only MCO 36FL Access Health Solutions (Reform) Medical-only PIHP 467FL Alzheimer's Waiver Service Provider *Community Care for the Elderly 294FL American Eldercare Long Term Care PIHP 3,821FL Amerigroup Commercial MCO 4,765FL Amerigroup (NHD) Long Term Care PIHP 2,301FL Amerigroup (Reform) Commercial MCO 121FL Atlantic Dental, Inc. Dental PAHP 94
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
15
FL Better Health (Reform) Medical-only PIHP 25FL Buena Vista Commercial MCO 469FL Children's Medical Services (Reform) Medical-only PIHP 12FL Citrus (NHD) Long Term Care PIHP 1,226FL Citrus Health Care Commercial MCO 488FL First Coast Advantage (Reform) Medical-only PIHP 570FL Florida PACE Centers PACE 221FL Freedom Health Plan Commercial MCO 24FL Freedom Health Plan (Reform) Commercial MCO 9FL HealthEase Medicaid-only MCO 3,724FL HealthEase (Reform) Commercial MCO 78FL Healthy Palm Beaches Medicaid-only MCO 2FL Hope Life Care Long Term Care PIHP 203FL Hope Select Care PACE 98FL Humana Family Commercial MCO 1,584FL Humana Family (Reform) Commercial MCO 172FL Humana Medical Plan Long Term Care PIHP 605FL Humana Senior's Choice Long Term Care PIHP 303FL JMH Health Plan Commercial MCO 571FL Little Havana Activities and Nutrition Centers Long Term Care PIHP 847FL Managed Care of North America Dental PAHP 1FL Molina Health Care of Florida Medicaid-only MCO 234FL Molina Health Care of Florida (Reform) Commercial MCO 32FL Neighborly Care Network Long Term Care PIHP 522FL NetPass (Reform) Medical-only PIHP 251FL Preferred Medical Plan Commercial MCO 416FL Preferred Medical Plan (Reform) Commercial MCO 31FL Project Independence at Home Long Term Care PIHP 105FL South Florida Community Care Network (Reform) Medical-only PIHP 329FL StayWell Commercial MCO 3,725FL Sunshine State Health Plan Medicaid-only MCO 150FL Total Health Choice Commercial MCO 70FL Total Health Choice (Reform) Commercial MCO 199FL United Evercare Commercial MCO 1,940FL United Health Care Commercial MCO 2,092FL United Health Care (NHD) Long Term Care PIHP 2,198FL United Health Care (Reform) Commercial MCO 29FL United Home Care Services Long Term Care PIHP 918FL Universal Health Care Commercial MCO 285FL Universal Health Care (NHD) Long Term Care PIHP 682FL Universal Health Care (Reform) Commercial MCO 86FL Urban Jacksonville Long Term Care PIHP 96FL Vista Health Plan of South Florida Commercial MCO 372FL Vista Independence Plan Long Term Care PIHP 1,233FL YourCare Brevard Long Term Care PIHP 62GA Non-Emergency Transportation Brokerage Program Transportation PAHP 129,559Hi Evercare Commercial MCO 12,450
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
16
HI Maui PACE PACE 13HI Ohana Commercial MCO 12,863IA Iowa Plan For Behavioral Health MH/SUD PIHP 32,222IA Siouxland PACE PACE 3ID Healthy Connections PCCM Provider 15,822ID Medicare-Medicaid Coordinated Plan Medical-only PAHP 1,030KS Kansas Health Solutions Mental Health (MH) PAHP 33,252KS Midland Care Services PACE 53
KS ValueOptions-KansasSubstance Use Disorders (SUD) PIHP 33,252
KS Via Christi Healthcare Outreach Programs for Elders PACE 172KY Human Service Transportation Transportation PAHP 88,914KY Passport Health Plan Medicaid-only MCO 12,557LA Greater New Orleans PACE 97MA Elder Service Plan of Cambridge Health Alliance PACE 178MA Elder Service Plan of East Boston PACE 277MA Elder Service Plan of Harbor Health Services, Inc. PACE 284MA Elder Service Plan of the North Shore, Inc. PACE 595MA Neighborhood Health Plan Commercial MCO 153MA Summit Elder Care PACE 578MA Uphams Elder Service Plan PACE 135MD Hopkins Elder Plus PACE 129MI Care Resources PACE 146MI Comprehensive Senior Care Corporation PACE 14MI Henry Ford Health System-Center for Senior Independence PACE 189MI Life Circles PACE 21MN Blue Plus Commercial MCO 12,801MN First Plan Blue Commercial MCO 1,450MN Health Partners Commercial MCO 3,845MN Itasca Medical Care Medicaid-only MCO 614MN Medica Commercial MCO 12,266MN Metropolitan Health Plan Commercial MCO 1,371MN PrimeWest Health System Medicaid-only MCO 3,319MN South Country Health Alliance Medicaid-only MCO 3,544MN UCARE Commercial MCO 10,343MO Alexian Brothers Community Services PACE 152MS LogistiCare Soultions, LLC Transportation PAHP 69,166NC Carolina Access PCCM Provider 6,623NC Community Care of North Carolina (Access II/III) PCCM Provider 40,334NC Piedmont Cardinal Health Plan MH/SUD PIHP 13,241NC Piedmont Senior Care PACE 4NC Elderhaus PACE 24ND Northland PACE PACE 20NE Magellan Behavioral Health *Specialty Physician Case 19,557NJ AmeriChoice of New Jersey, Inc. Commercial MCO 5,853NJ AMERIGROUP New Jersey, Inc. Medicaid-only MCO 2,184NJ Health Net of New Jersey, Inc. Medicaid-only MCO 1,490
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
17
NJ Horizon NJ Health Medicaid-only MCO 9,394NJ LIFE St. Francis PACE 14NJ LIFE at Lourdes PACE 14NJ University Health Plans, Inc. Commercial MCO 1,350NM AMERIGROUP Community Care of New Mexico, Inc. Commercial MCO 16,250NM Evercare of New Mexico Commercial MCO 15,095NM Total Community Care (PACE) PACE 355NV Logisticare Transportation PAHP 38,060NY Affinity/Medicaid Advantage Commercial MCO 81NY Amerigroup Community Connections Long Term Care PIHP 355NY Broome County MC PCCM Provider 11NY CCM Select Long Term Care PIHP 1,017NY Comprehensive Care Management (CCM) PACE 1,986NY Eddy Senior Care PACE 97NY GHI/Medicaid Advantage Commercial MCO 904NY Guildnet Long Term Care PIHP 5,402NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP 160NY Health Advantage/Elant Choice Long Term Care PIHP 129NY Health Now/Medicaid Advantage Commercial MCO 165NY HHH Choices Long Term Care PIHP 617NY HIP Health Plan/Medicaid Advantage Commercial MCO 1,949NY HomeFirst Long Term Care PIHP 2,975NY Independent Care Systems Long Term Care PIHP 722NY Independent Living For Seniors PACE 219NY Liberty Health Advantage/Medicaid Advantage Commercial MCO 610NY Managed Health Inc/Medicaid Advantage Commercial MCO 51NY MetroPlus/Medicaid Advantage Commercial MCO 8NY Neighborhood Health Provider/Medicaid Advantage Commercial MCO 193NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Commercial MCO 229NY PACE CNY PACE 309NY Partners In Community Care Long Term Care PIHP 245NY Physician Case Management Program PCCM Provider 1,000NY Senior Health Partners Long Term Care PIHP 1,371NY Senior Network Health Long Term Care PIHP 355NY Senior Whole Health Medicaid Advantage Plus Long Term Care PIHP 135NY Senior Whole Health/ Medicaid Advantage Commercial MCO 593NY Southern Tier Priority PCCM Provider 8NY Total Aging in Place Long Term Care PIHP 135NY Total Senior Care PACE 15NY Touchstone/Prestige/Medicaid Advantage Commercial MCO 508NY VNS Choice Long Term Care PIHP 6,904NY VNS Choice Plus/Medicaid Advantage Plus Long Term Care PIHP 21NY WellCare Advantage Plus/Medicaid Advantage Plus Long Term Care PIHP 123NY WellCare Advocate Long Term Care PIHP 251OH Concordia Care PACE 204OH TriHealth Senior Link PACE 375OK Cherokee Elder Care PACE 46
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
18
OK SoonerRide Transportation PAHP 98,219OR Accountable Behavioral Health Mental Health (MH) PIHP 3,427OR Capitol Dental Care Inc. Dental PAHP 13,921OR Care Oregon Medicaid-only MCO 10,229OR Cascade Comprehensive Care Medicaid-only MCO 690OR Central Oregon Independent Health Solutions Medicaid-only MCO 911OR Clackamas County Mental Health Mental Health (MH) PIHP 3,959
OR Deschutes County CDOSubstance Use Disorder (SUD) PAHP 2,300
OR Doctors of the Oregon Coast South Medicaid-only MCO 1,113OR Douglas County IPA Commercial MCO 1,333OR FamilyCare (Mental Health) Mental Health (MH) PIHP 995OR FamilyCare Health Plans Commercial MCO 1,861OR Greater Oregon Behavioral Health, Inc. Mental Health (MH) PIHP 6,206OR Hayden Family Dentistry Dental PAHP 5,305OR Inter-Community Health Network Medicaid-only MCO 1,893OR Jefferson Behavioral Health Mental Health (MH) PIHP 7,494OR Kaiser Permanente Oregon Plus Medicaid-only MCO 706OR Lane Care MHO Mental Health (MH) PIHP 5,464OR Lane Individual Practice Association Medicaid-only MCO 2,945OR Managed Dental Care of Oregon Dental PAHP 968OR Marion Polk Community Health Plan Medicaid-only MCO 3,958OR Mid Valley Behavioral Care Network Mental Health (MH) PIHP 8,979OR Mid-Rogue Independent Practice Assoc. Medicaid-only MCO 1,346OR Multicare Dental Dental PAHP 2,438OR Multnomah County Verity Mental Health (MH) PIHP 11,313OR Northwest Dental Services Dental PAHP 6,498OR ODS Community Health Inc. Medicaid-only MCO 300OR Oregon Dental Service Dental PAHP 10,064OR Oregon Health Management Service Medicaid-only MCO 433OR PCCM PCCM Provider 905OR Providence Elder Place PACE 555OR Providence Health Assurance Medicaid-only MCO 2,040OR Tuality Health Care Medicaid-only MCO 811OR Washington County Health (Mental Health) Mental Health (MH) PIHP 4,507OR Willamette Dental Dental PAHP 7,462PA Access Plus Program PCCM Provider 626PA Albright LIFE Medical-only PIHP 44PA AmeriChoice of Pennsylvania Commercial MCO 271PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan Commercial MCO 255PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL Commercial MCO 5PA Community Care Behavioral Health - North Central MH/SUD PIHP 18,939PA Community Care Behavioral Health - Northeast MH/SUD PIHP 11,562PA Community LIFE PACE 283
PA Counties of Armstrong/Indiana - Value Behavioral Health of PA MH/SUD PIHP 2,863
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
19
PACounties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,275
PACounties of Carbon/Monroe/Pike - Community Care Behavioral Health MH/SUD PIHP 3,401
PA Counties of Crawford/Mercer/Venango - Value Behavioral Health MH/SUD PIHP 5,378
PACounties of Franklin/Fulton - Community Behavorial Healthcare Network of Pennsylvania MH/SUD PIHP 1,838
PACounties of Lycoming/Clinton - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,752
PA County of Adams - Community Care Behavioral Health MH/SUD PIHP 849PA County of Allegheny - Community Care Behavioral Health MH/SUD PIHP 19,370PA County of Beaver - Value Behavioral Health of PA MH/SUD PIHP 2,841PA County of Berks - Community Care Behavioral Health MH/SUD PIHP 5,020
PACounty of Blair County - Community Behavioral Healthcare Network of PA MH/SUD PIHP 2,654
PA County of Bucks - Magellan Behavioral Health MH/SUD PIHP 5,074PA County of Butler - Value Behavioral Health of PA MH/SUD PIHP 1,991PA County of Cambria - Value Behavioral Health MH/SUD PIHP 2,756PA County of Chester - Community Care Behavioral Health MH/SUD PIHP 2,999
PACounty of Cumberland - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,711
PACounty of Dauphin - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 3,470
PA County of Delaware - Magellan Behavioral Health MH/SUD PIHP 6,516PA County of Erie - Value Behavioral Health MH/SUD PIHP 4,506PA County of Fayette - Value Behavioral Health of PA MH/SUD PIHP 3,776
PACounty of Lancaster - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 5,288
PA County of Lawrence - Value Behavioral Health of PA MH/SUD PIHP 1,819
PACounty of Lebanon - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,485
PA County of Lehigh - Magellan Behavioral Health MH/SUD PIHP 4,965PA County of Montgomery - Magellan Behavioral Health MH/SUD PIHP 5,900PA County of Northampton - Magellan Behavioral Health MH/SUD PIHP 3,333
PACounty of Perry - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 456
PA County of Philadelphia - Community Behavioral Health MH/SUD PIHP 38,630PA County of Washington - Value Behavioral Health of PA MH/SUD PIHP 3,081PA County of Westmoreland - Value Behavioral Health of PA MH/SUD PIHP 5,387PA County of York - Community Care Behavioral Health MH/SUD PIHP 4,265PA Everyday LIFE PACE 4PA Gateway Health Plan, Inc. Commercial MCO 504PA Gateway Health Plan, Inc. -VOL Commercial MCO 42PA Health Partners of Philadelphia Commercial MCO 351PA Keystone Mercy Health Plan Commercial MCO 526PA LIFE - Beaver County PACE 114
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
20
PA LIFE - Geisinger PACE 96PA LIFE - Pittsburgh PACE 303PA LIFE - University of Pennsylvania PACE 314PA LIFE at Home PACE 51PA LIFE Butler County Medical-only PIHP 15PA LIFE Lutheran Services PACE 14PA LIFE NWPA Medical-only PIHP 27PA Logisticare Solutions, LLC Transportation PAHP 50,942PA McKesson Health Solutions Disease Management PAHP 13PA Mercy LIFE PACE 221PA New Courtland LIFE Medical-only PIHP 100PA Senior LIFE Johnstown PACE 140PA Unison Health Plan / MedPLUS Commercial MCO 280PA Unison Health Plan/MedPlus - VOL Commercial MCO 63PA UPMC Health Plan, Inc./UPMC for You Commercial MCO 277PA UPMC Health Plan, Inc./UPMC for You - VOL Commercial MCO 7PA Value Behavioral Health of PA (Greene County) MH/SUD PIHP 856PR American Health Medicare Commercial MCO 14,134PR APS Healthcare MH/SUD PIHP 22,054PR FHC Healthcare MH/SUD PIHP 11,444PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO 14,065PR Humana Puerto Rico Commercial MCO 8,338PR MCS Advantage Commercial MCO 40,124PR MCS Health Management Options, Inc. Commercial MCO 16,382PR MMM Healthcare Inc. Commercial MCO 48,755PR PMC Medicare Choice Commercial MCO 32,093PR Salud Dorada con Medicare Commercial MCO 3,292PR Triple S Commercial MCO 18,405PR Triple-S, Inc. Commercial MCO 20,829RI PACE Organization of Rhode Island PACE 153SC Logisticare Transportation PAHP 128,711SC Palmetto SeniorCare (PACE) PACE 367SC South Carolina Solutions PCCM Provider 8,337SC The Oaks PACE PACE 28TN Alexian Brothers Community Services PACE 309TN AmeriChoice - East TN Medicaid-only MCO 34,401TN AmeriChoice - Middle TN Medicaid-only MCO 27,960TN AmeriChoice - West TN Medicaid-only MCO 24,883TN AmeriGroup Community Care Medicaid-only MCO 28,086TN Doral Dental of Tennessee, LLC Dental Benefit Manager 347TN Premier Behavioral Systems of TN MH/SUD PIHP 5,528TN SXC Health Solution Corperation Pharmacy Benefit Manager 192,774TN Volunteer State Health Plan (Bluecare) - East Medicaid-only MCO 45,569TN Volunteer State Health Plan (Bluecare) - West Medicaid-only MCO 26,347TN Volunteer State Health Plan (TennCare Select) *PIHP 5,528TX Amerigroup (STAR+PLUS) Medicaid-only MCO 27,021TX Bienvivir Senior Health Service PACE 700
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
21
TX Evercare Medicaid-only MCO 32,312TX Jan Werner Adult Day Care Center PACE 126TX Molina (STAR+Plus) Medicaid-only MCO 10,087TX Superior HealthPlan (STAR+Plus) Medicaid-only MCO 16,934TX ValueOptions MH/SUD PIHP 1,017UT Bear River Mental Health Mental Health (MH) PIHP 715UT Central Utah Counseling Center Mental Health (MH) PIHP 631UT Davis Behavioral Health Mental Health (MH) PIHP 1,106UT Four Corners Community Behavioral Health Mental Health (MH) PIHP 488UT Healthy U Medical-only PIHP 2,855UT Molina Healthcare of Utah (Molina) Medical-only PIHP 2,797UT Non-Emergency Medical Transportation Transportation PAHP 14,534UT Northeastern Counseling Center Mental Health (MH) PIHP 366UT Select Access PCCM Provider 4,621UT Southwest Behavioral Health Services Mental Health (MH) PIHP 1,205UT Valley Mental Health Mental Health (MH) PIHP 6,825UT Wasatch Mental Health Mental Health (MH) PIHP 1,938UT Weber Human Services Mental Health (MH) PIHP 1,863VA AllCare for Seniors PACE 26VA LogistiCare Solutions Transportation PAHP 106,372VA Mountain Empire PACE 45VA Riverside Peninsula PACE 104VA Sentara Senior Community Care PACE 121VT Global Committment to Health Medicaid-only MCO 14,832VT Vermont PACE PACE 72WA Molina Healthcare (WMIP) Commercial MCO 519WA Providence ElderPlace - Seattle PACE 304WA Regional Support Network Mental Health (MH) PIHP 97,637WI Abri Health Plan -- Medicaid HMO Commercial MCO 8WI Abri Health Plan -- SSI Commercial MCO 373WI Care Wisconsin First, Inc. Long Term Care PIHP 2,243WI Care Wisconsin Health Plan, Inc. (Partnership) Medicaid-only MCO 977WI Children's Community Health Plan - Medicaid HMO Commercial MCO 1WI CHP-LTS, Inc. Long Term Care PIHP 704WI Community Care Health Plan, Inc. Commercial MCO 1,006WI Community Care, Inc. Long Term Care PIHP 2,916WI Community Care of Central Wisconsin Long Term Care PIHP 2,434WI Community Care Organization (PACE) PACE 499WI Community Health Partnership -- Partnership Commercial MCO 247WI Compcare (formerly Atrium Health Plan) -- Medicaid HMO Commercial MCO 18WI Dean Health Plan -- Medicaid HMO Commercial MCO 6WI Family Care Long Term Care PIHP 16,912WI Group Health Cooperative Of Eau Claire -- Medicaid HMO Commercial MCO 13WI Group Health Cooperative of Eau Claire County SSI Commercial MCO 101
WI Group Health Cooperative Of South Central WI -- Medicaid HMO Commercial MCO 1WI Gundersen Lutheran Health Plan - Medicaid HMO Commercial MCO 5
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
22
WI Health Tradition Health Plan -- Medicaid HMO Commercial MCO 5WI Independent Care (iCare) - Medicaid HMO Medicaid-only MCO 9WI Independent Care Health Plan -- SSI Medicaid-only MCO 3,077WI Lakeland Care District Long Term Care PIHP 863WI Managed Health Services -- Medicaid HMO Medicaid-only MCO 31WI Managed Health Services -- SSI Medicaid-only MCO 928WI MercyCare Insurance Company -- Medicaid HMO Commercial MCO 8WI Milwaukee County Dept. on Aging Long Term Care PIHP 6,295WI Network Health Plan -- Medicaid HMO Commercial MCO 40WI Network Health Plan - SSI Commercial MCO 403WI Northern Bridges Long Term Care PIHP 739WI Partnership Health Plan Inc. Commercial MCO 1,667WI Security Health Plan -- Medicaid HMO Commercial MCO 27WI Southern Family Care Alliance Long Term Care PIHP 771WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO 111WI UnitedHealthcare of WI -- SSI Commercial MCO 880WI Unity Health Insurance -- Medicaid HMO Commercial MCO 16WI Western Wisconsin Cares Long Term Care PIHP 2,439Total 2,809,037
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AL Maternity Care Program Medical-only PIHP
Risk-based Capitation
1915(b) Statewide 21,324
AL Partnership Hospital Program Medical-only PIHP
Risk-based Capitation
1915(a) - 1902(a)(4)
Statewide 518,769
AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 443,327
AR Connect Care PCCM Fee-For-Service 1115 Statewide 411,351
AR Non-Emergency Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 451,863
AR Total Life Healthcare PACE Risk-based Capitation
DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation
1932(a) Statewide 63,915
DC Health Right Incorporated Medicaid MCO Risk-based Capitation
1932(a) Statewide 20,356
DC Health Services For Children with Special Needs
Medical-only PIHP
Risk-based Capitation
1915(a) Statewide 3,593
DC Medical Transportation Management Transp PAHP Non-risk Capitation
1902(a)(70) Statewide 50,174
DC Unison Health Plan of the Capital Area Medicaid MCO Risk-based Capitation
1932(a) Statewide 12,368
DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation
1115 Statewide 78,603
DE Diamond State Partners *Fee for Service Model
Fee-For-Service 1115 Statewide 8,487
DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-based Capitation
1115 Statewide 38,999
FL Access Health Solutions Medical-only PAHP
Non-risk Capitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucie, Volusia
57,539
Page 29Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Access Health Solutions (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Baker, Broward, Clay, Duval, Nassau 51,260
FL Adult Day Health Care *Adult Day Health Care
Facility
Fee-For-Service 1915(b)/(c) Lee, Palm Beach 37
FL AIDS Healthcare Foundation, Inc. Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 6,015
FL Alternative Medicine Integration Disease Management
PAHP
Non-risk Capitation
1915(b) Hillsborough, Pasco, Pinellas 428
FL Alzheimer's Waiver Service Provider *Community Care for the
Elderly Agencies
Fee-For-Service 1915(b)/(c) Broward, Dade, Palm Beach, Pinellas 310
FL American Eldercare Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Clay, Dade, Duval, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, Volusia
FL Molina Health Care of Florida Medicaid MCO Risk-based Capitation
1915(b) Broward (Reform), Dade, Hillsborough, Palm Beach, Pasco, Pinellas, Polk
23,731
FL Molina Health Care of Florida (Reform) Commercial MCO Risk-based Capitation
1115 Broward County 5,023
FL Neighborly Care Network Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Citrus, Dade, Hernando, Hillsborough, Indian River, Manatee, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie
522
Page 32Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL NetPass Medical-only PAHP
Risk-based Capitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucia, Volusia
13,568
FL NetPass (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 8,002
FL North Florida Behavioral Health Partnership
Mental Health PIHP
Risk-based Capitation
1915(b) Alachua 88,856
FL Preferred Medical Plan Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 14,512
FL Preferred Medical Plan (Reform) Commercial MCO Risk-based Capitation
1115 Broward 2,735
FL Prestige Health Choice Medicaid MCO Risk-based Capitation
1915(b) Dade, Hillsborough, Lee, Pinellas 16,327
FL Project Independence at Home Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 105
FL Provider Service Network *Shared Savings Model
FFS/Some Risk Capitation
1915(b) Dade 9,045
FL Public Health Trust of Dade County Mental Health PIHP
Risk-based Capitation
1915(b) Dade 47,332
FL South Florida Community Care Network (Reform)
Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 17,792
FL StayWell Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter
178,605
FL Sunshine State Health Plan Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,587
TX ValueOptions MH/SUD PIHP FFS/Some Risk Based Capitation
1915(b) Collin County, Dallas County, Ellis County, Hunt County, Kaufman County, Navarro County, Rockwall County
306,513
UT Bear River Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Box Elder, Cache, Rich 12,284
UT Central Utah Counseling Center Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,115
UT Davis Behavioral Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Davis 16,430
UT Four Corners Community Behavioral Health
Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Carbon, Emery, Grand 4,544
UT Healthy U Medical-only PIHP
Non-risk Capitation
1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 29,338
UT Molina Healthcare of Utah (Molina) Medical-only PIHP
Non-risk Capitation
1115, 1915(b) Davis, Salt Lake, Utah, Weber 42,116
UT Non-Emergency Medical Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 176,036
UT Northeastern Counseling Center Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Daggett, Duchesne, Uintah 4,207
Page 66Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
UT Select Access PCCM Fee-For-Service 1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 58,484
UT Southwest Behavioral Health Services Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Beaver, Garfield, Iron, Kane, Washington 18,006
UT Valley Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Salt Lake, Summit, Tooele 83,812
UT Wasatch Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Utah County 34,822
UT Weber Human Services Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Morgan, Weber 20,342
VA AllCare for Seniors PACE Risk-based Capitation
PACE Buchanan, Dickerson, Russell, Tazewell 27
VA AmeriGroup Community Care Medicaid MCO Risk-based Capitation
1915(b) Alexandria City, Arlington County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Loudoun County, Manassas City, Manassas Park City, Prince William County
24,889
VA Anthem Healthkeepers Plus Commercial MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alexandria City, Amelia County, Arlington County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Franklin City, Frederick County, Fredericksburg City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas City, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Richmond City, Richmond County, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Westmoreland County, Williamsburg City, Winchester City, York County
163,028
Page 67Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA LogistiCare Solutions Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 520,773
VA MEDALLION PCCM Fee-For-Service 1915(b) Alleghany County, Bath County, Bland County, Bristol City, Buchanan County, Carroll County, Covington City, Craig County, Dickenson County, Galax, Grayson County, Highland County, Lee County, Norton, Russell, Scott County, Smyth County, Tazewell County, Washington County, Wise County
54,101
VA Mountain Empire PACE Risk-based Capitation
PACE Lee, Norton, Scott, Wise 48
VA Optima Family Care Commercial MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Brunswick County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Danville City, Dinwiddie County, Emporia City, Essex County, Fluvanna County, Franklin City, Frederick County, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Rappahannock County, Richmond City, Richmond County, Rockingham County, Shenandoah County, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Williamsburg City, Winchester City, York County
130,954
VA Riverside Peninsula PACE Risk-based Capitation
PACE Hampton, Newport News, Poquoson, Southeastern portion of York County
114
VA Sentara Senior Community Care PACE Risk-based Capitation
PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 126
Page 68Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Southern Health CareNet Commercial MCO Risk-based Capitation
1915(b) Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlottesville, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Fluvanna County, Goochland County, Greene County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Lynchburg, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Northumberland County, Nottoway County, Orange County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Staunton, Surry County, Sussex County, Waynesboro, Westmoreland County
18,896
VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Amelia County, Appomattox County, Augusta County, Bedford City, Bedford County, Botetourt County, Brunswick County, Buckingham County, Buena Vista City, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Culpeper County, Cumberland County, Danville, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Nottoway County, Orange County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Rappahannock County, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Shenandoah County, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Winchester City, Wythe County
128,905
VT Global Committment to Health Medicaid MCO Risk-based Capitation
1115 Statewide 137,385
Page 69Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VT Vermont PACE PACE Risk-based Capitation
PACE Chittereden, Dorset, Grand Isle, Manchester, Rupert, South Hero
76
WA Asuris Northwest Health Commercial MCO Risk-based Capitation
1932(a) Spokane County 2,003
WA City of Seattle Human Services Disease Management
PAHP
Risk-based Capitation
1932(a) King 8,386
WA Columbia United Providers Commercial MCO Risk-based Capitation
1932(a) Clark 37,848
WA Community Health Plan Commercial MCO Risk-based Capitation
Page 74Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)
75
Arizona – The State Medicaid Enrollment increase was due to the economy. Bridgeway2 is now providing family planning services for the SOBRA family planning population.
Georgia – The State Medicaid Enrollment increase was due to the economy.
Hawaii – APS BHS, Child &Adolescent Mental Health Division, Department, and Early Intervention Programs, Department of Health are no longer valid mental PHIP plans under the Hawaii Quest Expanded (QEx) due to the removal of their mental health carve-out portion of their Hawaii Quest Expanded (QEx). The mental health portion is now under the fee-for-service model.
Massachusetts - The State Medicaid Enrollment increase was due to the economy and the unemployment rate.
Michigan – North Country CMH6 is now Northern Affiliation6.
Mississippi – Due to the inclusion of the 1902(a)(70) NEMT program, the State has managed care
enrollment.
Missouri – Mercy Care Plus2 is now Molina Healthcare of Missouri2. The State Medicaid Managed Care Enrollment is higher than normal due to the inclusion of the 1902(a)(70) NEMT program.
Nebraska – Mercy Care Plus plan2 is now Molina Healthcare of Missouri2.
New Jersey – The State Medicaid Enrollment increase was due to the economy and unemployment rate.
New York – The 1115 Expansion Enrollment decrease was due to the State aligning the Medicaid Resource Level to the Family Health Plus (FHP) Level from $3,000 to $13,000. The State Medicaid Enrollment increase was due to the economy. Care Plus Health Plan2 is now AmeriGroup2. CarePlus Connections14 is now AmeriGroup Community Connections14. Suffolk Health Plan2 was bought out by Neighborhood Health Providers2.
North Carolina – The State Medicaid Enrollment and State Medicaid Managed Care Enrollment increases were due to statewide outreach efforts, the economy, and the inclusion of the CHIP Expansion enrollment.
Ohio – The State Medicaid Enrollment increase was due to economy and the unemployment rate. Buckeye Community Health Plan1, CareSource1, Molina Healthcare of Ohio1, Unison Health Plans of Ohio1, and WellCare of Ohio1 were defined as Medicaid MCO but changed their status to Commercial MCO.
Pennsylvania – The total transportation enrollment for Logisticare Solutions, LLC11 of 34,978 for 2008 reporting period was incorrectly.
Rhode Island – Neighborhood Health Plan of Rhode Island2 was operating under 1115(a) and 1915(a) authorities but it’s currently only operating under 1115(a).
South Carolina – Total Carolina Care Inc.2 is now Absolute Total Care2. Amerigroup Community Care2 merged with Absolute Total Care2. Logisticare and MTM are the two transportation brokers under the 1902(a)(70). The State was unable to accurately separate the number of enrollees in Logisticare and MTM ; therefore, the total number of enrollees of 683,966 were divided with 2/3 in LogistiCare and 1/3 in MTM.
2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)
76
South Dakota – The South Dakota Dental Program does not operate under any waiver authority or
managed care entity type. This program solely operates under the authority of the South Dakota State Plan. At the State’s request, it will no longer be reported in this report.
Tennessee – Volunteer State Health Plan (BlueCare)1 was divided into 2 separate regions – Volunteer State Health Plan (BlueCare)2 East and Volunteer State Health Plan (BlueCare)2 West. AmeriGroup Community Care2, Volunteer State Health Plan (Bluecare) East2, Volunteer State Health Plan (Bluecare) West2 were defined as Commercial-only MCO but changed their status to Medicaid-only MCO. TennCare Select4 is now Volunteer State Health Plan (TennCare Select)4. For reporting purposes, TennCare Select plan enrollment is incorporated under the Medical-only PIHP category.
Texas – The State Medicaid Enrollment increase was due partly to the Women’s Health Program and normal growth.
___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10 Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term-Care PIHP
NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
77
Arkansas – Total Life Healthcare9 is a new PACE organization.
California – Life Circles9 and Comprehensive Senior Care Corporation9 are new PACE organizations.
Colorado – Rocky Mountain PACE9 and VOANS PACE9 are new PACE organizations.
District of Columbia – Medical Transportation Management11 is a new transportation PAHP under the Non-Emergency Medical Transportation Program.
Florida – Prestige Health Choice2 and Molina Health Care of Florida2 are new MCO plans under the Managed Health Care program. Alternative Medicine Integration10, CareMark10, and Hemophilia of the Sunshine State10 are new Disease Management PAHP plans under the Managed Health Care program. Managed Care of North America8 is a new Dental PAHP under the Managed Health Care Program. Molina Health Care of Florida (Reform)1 is a new plan under Florida Medicaid Reform program.
Hawaii – Maui PACE9 is a new PACE organization. Evercare1 and Ohana1 are new MCO plans.
Illinois - Meridian Health Plan2 is a new MCO plan under the Voluntary Managed Care program.
Iowa – Sioux PACE9 is a new PACE organization.
Maryland – AMERIGROUP-PAC5 and Priority Partners –PAC5 are new medical-only PAHP plans under the HealthChoice program.
Michigan – Health Kids Dental8 is a new Dental PAHP plan under Healthy Kids Dental program.
Montana – Billings Clinic 9is a new PACE organization.
Nevada – Amerigroup Community Care2 is a new MCO plan under the Mandatory Health Maintenance Program.
New Jersey – LIFE St. Francis9 and LIFE at Lourdes9 are new PACE organizations.
New Mexico – AMERIGROUP Community Care of New Mexico, Inc.1 and Evercare of New Mexico1 are new MCO plans under the Coordinated Long-term Care Services program. Blue Cross Blue Shield of New Mexico1 is a new MCO plan under the NEW MEXICO SALUD! program.
New York – Senior Whole Health/Medicaid Advantage Plus14 is a new LTC PIHP under the F-SHRP Medicaid Advantage program. Total Senior Care9 is a new PACE Organization. Health Plus2 is a new MCO plan under the Federal-State Health Reform Partnership (F-SHRP) program. NYPS Catholic Health Plan 11991 is a new MCO plan under the Partnership Plan Medicaid Managed Care Program.
North Dakota – Northland PACE9 is a new PACE organization.
North Carolina – Piedmont Senior Care9 and Elderhaus9 are new PACE organizations.
Oklahoma – Cherokee Elder Care9 is a new PACE organization.
NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
78
Tennessee – SXC Health Solutions12 is a new plan under TennCare program. Volunteer State Health
Plan (Bluecare) was broken into regions – AmeriChoice – West TN2 and Volunteer State Health Plan (Bluecare) – East2 are new plans under TennCare program.
Wisconsin – Gundersen Lutheran Health Plan1 and Physicians Plus Health Plan1 are new MCO plans under the BadgerCare Plus program. Care Wisconsin First, Inc.14, CHP-LTS, Inc., Community Care of Central Wisconsin14, Community Care, Inc.14, Lakeland Care District14, Milwaukee County Dept. on Aging14, Northern Bridges14, Southern Family Care Alliance14, and Western Wisconsin Cares14 are new Long Term Care PIHP plans under the Family Care program. Partnership Health Plan Inc.1 is a new MCO plan under the Wisconsin Partnership Program.
___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8Dental PAHP 9PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP
TERMINATED MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
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Florida – Pediatric Associates (Reform)4 terminated under the Florida Medicaid Reform program. Vista Health Plan of South Florida1, Community Based Care Partnership6, and Buena Vista1 were terminated under the Managed Health Care program. StayWell (Reform)1 was terminated under the Florida Medicaid Reform program.
Hawaii – Summerlin1 was terminated under the Hawaii Quest Expanded (QEx) program.
Iowa – Coventry HealthCare1 plan was terminated under the Iowa Medicaid Managed Care program.
Nevada – Anthem Blue Cross Blue Shield Partnership1 plan was terminated under the Mandatory Health Maintenance program.
New York - Manhattan PHSP/CenterCare2, NY Presbyterian Hospital Health Plan1, and Preferred Care1 were terminated under the Federal-State Health Reform Partnership (FSHRP), Partnership-Family Health Plus, and Partnership Plan Medicaid Managed Care Program.
Ohio – Anthem Blue Cross Blue Shield Partnership Plan2 was terminated under the State Plan Amendment for Ohio's Full-Risk Managed Care Program.
Puerto Rico – COSVIMed1 and MAPFRE1 were terminated under the Medicare Platino program.
Tennessee – First Health Services Corporation12, Preferred health Partnership/PHP2, TLC Family Healthplan2, Unison Health Plan-BHHP1, UAHC Health Plan of Tennessee2, Inc, Tennessee Behavioral Health13 plans were terminated under the TennCare program.
Texas - Evercare of Texas2 was terminated under ICM program.
Washington – United Healthcare Services Inc.10 was terminated under the Chronic Care
Management Program (CCMP). ___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP
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Medicaid Managed Care Enrollment Report Glossary as of June 30, 2009
Terms used in "Managed Care Entity" column
• Primary Care Case Management (PCCM) Provider is a provider (usually a physician, physician group practice, or an entity employing or having other arrangements with such physicians, but sometimes with such physicians, but sometimes also including nurse practitioners, nurse midwives, or physician assistants who contracts directly with the State to locate, coordinate, and monitor covered primary care (and sometimes additional services). This category also includes those PIHPs that contract with the State as “primary care case managers.”
• Commercial Managed Care Organization (MCO) – A Commercial MCO is a health
maintenance organization, an eligible organization with a contract under §1876 or a Medicare+Choice organization, a provider sponsored organization or any other private or public organization, which meets the requirements of §1902(w). A Commercial MCO provides comprehensive services to both Medicaid and commercial and/or Medicare.
• Medicaid-only Managed Care Organization (MCO) – A Medicaid-only MCO provides
comprehensive services to only Medicaid beneficiaries, not to commercial or Medicare enrollees.
• Health Insuring Organization (HIO) – A HIO is a managed care entity which, by law, is
exempt from certain rules governing MCO program operation such as the requirement for beneficiaries to have a choice of at least two managed care entities in mandatory programs.
• Prepaid Inpatient Health Plan (PIHP) – A PIHP is a prepaid inpatient health plan that
provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and provides, arranges for, or otherwise has responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are define in 42 CFR 438.2} There are several types of PIHPs that States use to deliver a range of services. For example, a Mental Health (MH) PIHP is a managed care entity that provides only mental health services.
• Prepaid Ambulatory Health Plan (PAHP) – A PAHP is a prepaid ambulatory health
plan that provides less than comprehensive services on an at-risk or other than state plan reimbursement basis, and does not provide, arrange for, or otherwise have responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are defined in 42 CFR 438.2} There are several types of PAHPs that States use to deliver a range of services. For example, a Dental PAHP is a managed care entity that provides only dental services.
• Program for All-inclusive Care for the Elderly (PACE) – program that provides pre-
paid, capitated comprehensive, health care services to the frail elderly.
• Other – The structure of the managed care plan is not considered a PCCM, PIHP, PAHP, Commercial MCO, Medicaid-only MCO, HIO, or PACE.
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Terms used in "Reimbursement Arrangement" Column
• Risk-based Capitation –The managed care entity is paid for providing services to enrollees primarily through capitation. (There may be other payments under the contract such as incentive arrangements or risk sharing.)
• Non-risk Capitation – The managed care entity is paid for providing services to
enrollees through capitation, but payments are settled at the end of the year at amounts that do not exceed the FFS cost for services actually provided, plus an amount for administration.
• Fee-For-Service (FFS) – The managed care entity is paid for providing services to
enrollees solely through fee-for service payments plus in most cases, a case management fee.
• Other – The managed care entity is providing services to enrollees through means other
than through capitation or fee-for-service reimbursements.