Managed Care is a health care delivery system set up to manage cost, quality, and utilization. Medicaid Managed care allows for the delivery of Medicaid health benefits and additional services through contracted arrangements between Medicaid agencies and Managed Care Organizations (MCOs), that accept a set number per member per month (capitation) payment for services. By contracting with various types of MCOs to deliver Medicaid program services to beneficiaries, states can reduce Medicaid program costs and manage utilization of healthcare services. Keep in mind the goal is to improve health plan performance, quality, and outcomes.
The state of California provides Managed Care Medicaid programs to over 8.8 million Medi-Cal beneficiaries …show more content…
In these counties, there is a Local Initiative (county organized) and a Commercial Plan. The DHCS contracts with both plans. The Regional plan providers service to 230, 000 beneficiaries in 18 counties. In the Regional Model counties, there are two Commercial Plans that contract with the DHCS. Imperial serves about 60,000 beneficiaries in Imperial County. In the Imperial Model county, there are two Commercial Plans that contract with the DHCS. San Benito serves about 7, 000 beneficiaries in San Benito County. In the San Benito Model county, there is one Commercial Plan that contracts with the DHCS. In a San Benito County, beneficiaries can choose the managed care plan or regular (Fee-for-Service) Medi-Cal. California Managed Care Med-Cal enrollment makes up approximately 13% of all Medicaid enrollees in the Unites States. The 2013 report of State Managed Care Enrollment (Medicaid-only and Medicare-Medicaid) showed over 8 million Medicaid enrollees in California and approximately 62 million enrollees in the United States. In California, the majority of enrollees were in MCO plans which were close to 6 million, close to 700,000 were part of dental plans, and 4,000 were enrolled in PACE (Program for all-Inclusive Care of Elderly). Based on the Managed Care Medi-Cal report from January 2016, enrollment is up to over 10 million. In the January 2016 report of California Medi-Cal Managed Care plans, …show more content…
Rates are set through actual calculations, with adjustments for beneficiaries’ age, eligibility, category, health status, and county of residence. Plans negotiate payment with most contracted network providers.
There are also quality and performance incentives. The state required Medicaid Manage care plans to submit audited data. The state annually publishes adapted HEDIS and quality performance measures for the health plan relative to the state average and national Medicaid and commercial plan averages for each measure. The state creates a signed composite score for 15 HEDIS indicators, which may be used for other quality-withhold purposes in the future.
In conclusion, there are several Medi-Cal Managed care plans within California. The trend for Medi-Cal managed care is to move in this direction, giving these beneficiaries a more coordinated approach to healthcare. These individuals need the assistance the most, are more vulnerable, and there are opportunities to improved their well being and reduce cost with education, and support. Although there are some drawbacks Medi-Cal to managed care plans, the positive out way the negative, and our neediest patients are getting patient-centered, coordinated care they
The state of California provides Managed Care Medicaid programs to over 8.8 million Medi-Cal beneficiaries …show more content…
In these counties, there is a Local Initiative (county organized) and a Commercial Plan. The DHCS contracts with both plans. The Regional plan providers service to 230, 000 beneficiaries in 18 counties. In the Regional Model counties, there are two Commercial Plans that contract with the DHCS. Imperial serves about 60,000 beneficiaries in Imperial County. In the Imperial Model county, there are two Commercial Plans that contract with the DHCS. San Benito serves about 7, 000 beneficiaries in San Benito County. In the San Benito Model county, there is one Commercial Plan that contracts with the DHCS. In a San Benito County, beneficiaries can choose the managed care plan or regular (Fee-for-Service) Medi-Cal. California Managed Care Med-Cal enrollment makes up approximately 13% of all Medicaid enrollees in the Unites States. The 2013 report of State Managed Care Enrollment (Medicaid-only and Medicare-Medicaid) showed over 8 million Medicaid enrollees in California and approximately 62 million enrollees in the United States. In California, the majority of enrollees were in MCO plans which were close to 6 million, close to 700,000 were part of dental plans, and 4,000 were enrolled in PACE (Program for all-Inclusive Care of Elderly). Based on the Managed Care Medi-Cal report from January 2016, enrollment is up to over 10 million. In the January 2016 report of California Medi-Cal Managed Care plans, …show more content…
Rates are set through actual calculations, with adjustments for beneficiaries’ age, eligibility, category, health status, and county of residence. Plans negotiate payment with most contracted network providers.
There are also quality and performance incentives. The state required Medicaid Manage care plans to submit audited data. The state annually publishes adapted HEDIS and quality performance measures for the health plan relative to the state average and national Medicaid and commercial plan averages for each measure. The state creates a signed composite score for 15 HEDIS indicators, which may be used for other quality-withhold purposes in the future.
In conclusion, there are several Medi-Cal Managed care plans within California. The trend for Medi-Cal managed care is to move in this direction, giving these beneficiaries a more coordinated approach to healthcare. These individuals need the assistance the most, are more vulnerable, and there are opportunities to improved their well being and reduce cost with education, and support. Although there are some drawbacks Medi-Cal to managed care plans, the positive out way the negative, and our neediest patients are getting patient-centered, coordinated care they