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SUMMARY STATISTICS AS OF JULY 1, 2012
MEDICAID MANAGED CARE ENROLLMENT REPORT
2012 MEDICAID MANAGED CARE ENROLLMENT REPORT SUMMARY STATISTICS AS OF JULY 1, 2012
This report is composed annually by the Data and Systems Group (DSG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a plan-specific basis as of July 1, 2012. County level data are not collected. The information was collected from State Medicaid Agencies and CMS Regional Offices. Data are presented for all States, the District of Columbia, Puerto Rico, and the Virgin Islands. Data are not presented for the following territories: Guam, Northern Mariana Islands, and American Somoa. Please contact Loan Swisher at 410-786-4650; E-mail: [email protected], or Arun Natarajan at 410-786-7455; Email: [email protected] if you have any questions concerning this report.
Medicaid Managed Care Enrollment Report as of July 1, 2012
Table of Contents
Medicaid Managed Care Enrollment Plan level data by State .............. Page 1 Glossary…………………………………………………………………Page 74
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AL Maternity Care Program Medical-only PAHP
Non-risk Capitation 1915(b) Statewide 21,040
AL Mercy Life of Alabama (MLOA) PACE Risk-based Capitation
PACE 36502, 36505, 36507, 36509, 36511, 36521, 36522, 36523, 36525, 36526, 36527, 36528, 36530, 36532, 36535, 36541, 36542, 36544, 36549, 36550, 36551, 36559, 36560, 36561, 36562, 36564, 36567, 36571, 36572, 36574, 36575, 36576, 36577, 36578, 36579, 36580, 36582, 36587, 36602, 36603, 36604, 36605, 36606, 36607, 36608, 36609, 36610, 36611, 36612, 36613, 36617, 36618, 36619, 36693, 36695
55
AL Patient 1st Traditional PCCM Provider
Primary Care Case
Management Fee
1915(b) Statewide 536,100
AR Connect Care Traditional PCCM
Provider
Fee-For-Service 1115 Statewide 374,241
AR Non-Emergency Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 474,350
AR Total Life Healthcare PACE Risk-based Capitation
PACE 72315, 72319, 72324, 72354, 72365, 72373, 72387, 72396, 72401, 72404, 72411, 72414, 72416, 72417, 72419, 72421, 72427, 72432, 72433, 72437, 72438, 72442, 72447, 72450, 72455, 72465, 72467, 72472, 72476
114
AZ AZ Physicians IPA (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 La Paz, Maricopa, Pima, Yuma 838
AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based Capitation
1115 LaPaz, Maricopa, Pima, Yuma 233,870
AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-based Capitation
1115 Yavapai 79
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 1
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-based Capitation
1115 Yavapai 16,234
AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Maricopa, Pinal 6,050
AZ Care 1st Health Plan Medicaid MCO Risk-based Capitation
1115 Maricopa 45,892
AZ Care 1st Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 262
AZ Department of Economic Security/Childrens Medical and Dental Program (HP)
Medicaid MCO Risk-based Capitation
1115 Statewide 11,991
AZ Department of Economic Security/Division of Developmental Disabilities (PC)
Medicaid MCO Risk-based Capitation
1115 Statewide 24,566
AZ Department of Health Services (Behavioral Health)
MH/SUD PIHP Risk-based Capitation
1115 Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz, Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz, Yavapai, Yuma
119,507
AZ Evercare Select (PC) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yavapai, Yuma
8,089
AZ Health Choice Arizona (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
754
AZ Health Choice Arizona (HP) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
170,381
AZ Maricopa County Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 185
AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-based Capitation
1115 Maricopa 49,538
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 2
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AZ Mercy Care Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 1,048
AZ Mercy Care Plan (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 279,045
AZ Mercy Care Plan (PC) Medicaid MCO Risk-based Capitation
1115 Maricopa, Pima 11,342
AZ Phoenix Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
829
AZ Phoenix Health Plan (HP) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
179,070
AZ University Family Care (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 224
AZ University Family Care (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 66,661
CA Access Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 131,482
CA Access Dental Plan-Sacramento Dental PAHP Risk-based Capitation
1115 Sacramento 52,509
CA Access, Coverage, Enrollment Program (ACE Program for Adults)
Medical-only PIHP
Risk-based Capitation
1115 Ventura 10,945
CA Alameda Alliance for Health Commercial MCO
Risk-based Capitation
1115 Alameda 127,230
CA AltaMed Health Services Corporation PACE Risk-based Capitation
PACE LA 1,130
CA American Health Guard-Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 8,201
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 3
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Anthem Blue Cross Partnership Plan - Sacramento
Commercial MCO
Risk-based Capitation
1115 Sacramento 98,089
CA Anthem Blue Cross Partnership Plan-TPMP
Commercial MCO
Risk-based Capitation
1115 Alameda, Contra Costa, Fresno, San Francisco, San Joaquin, Santa Calra, Stanislaus, Tulare
350,403
CA ArrowCare Medical-only PIHP
Risk-based Capitation
1115 San Bernardino 22,468
CA Caloptima-Orange HIO Risk-based Capitation
1115 Orange 376,053
CA CalViva Health Commercial MCO
Risk-based Capitation
1115 Fresno, Kings, Madera 190,610
CA Care 1st Health Plan/San Diego Commercial MCO
Risk-based Capitation
1115 San Diego 28,625
CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 17,019
CA CenCal Health Plan HIO Risk-based Capitation
1115 Santa Barbara, San Luis Obispo 90,612
CA Central California Alliance For Health HIO Risk-based Capitation
1115 Merced, Monterey, Santa Cruz 179,971
CA Coalition of Elders Independence dba Center for Elders Independence
PACE Risk-based Capitation
PACE Alameda 543
CA Community Eldercare of San Diego dba St. Paul's PACE
PACE Risk-based Capitation
PACE San Diego 196
CA Community Health Group Partnership Plan-San Diego
Commercial MCO
Risk-based Capitation
1115 San Diego 122,225
CA Contra Costa Health Plan Commercial MCO
Risk-based Capitation
1115 Contra Costa 77,349
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 4
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Contra Costa Health Plan - LIHP Medical-only PIHP
Risk-based Capitation
1115 Contra Costa 12,273
CA Gold Coast Health Plan HIO Risk-based Capitation
1115 Ventura 98,970
CA Health Net Community Solutions, Inc. - Sacramento
Commercial MCO
Risk-based Capitation
1115 Sacramento 69,166
CA Health Net Community Solutions, Inc.-San Diego
Commercial MCO
Risk-based Capitation
1115 San Diego 36,781
CA Health Net Community Solutions, Inc.-TPMP
Commercial MCO
Risk-based Capitation
1115 Fresno, Kern, LA, Stanislaus, Tulare 613,960
CA Health Net of CA-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 59,358
CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-based Capitation
1115 Sacramento 34,008
CA Health Plan of San Joaquin Commercial MCO
Risk-based Capitation
1115 San Joaquin 100,709
CA Health Plan of San Mateo Medicaid MCO Risk-based Capitation
1115 San Mateo 59,983
CA Healthy Way LA Medical-only PIHP
Risk-based Capitation
1115 Los Angeles 198,373
CA HealthyPAC Medical-only PIHP
Risk-based Capitation
1115 Alameda 43,002
CA Inland Empire Health Plan Commercial MCO
Risk-based Capitation
1115 Riverside, San Bernardino 501,503
CA Kern Family Health Care Commercial MCO
Risk-based Capitation
1115 Kern 116,285
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 5
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Kern Medical Center Health Plan Medical-only PIHP
Risk-based Capitation
1115 Kern 6,426
CA KP Cal, LLC - Sacramento Commercial MCO
Risk-based Capitation
1115 Sacramento 28,515
CA KP Cal, LLC-San Diego Commercial MCO
Risk-based Capitation
1115 San Diego 13,677
CA LA Care Health Plan Commercial MCO
Risk-based Capitation
1115 Los Angeles 997,719
CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-based Capitation
1115 Sacramento 39,296
CA Liberty Dental Plan of CA-LA Dental PAHP Risk-based Capitation
1915(a) LA 12,656
CA Medical Services Initiative Medical-only PIHP
Risk-based Capitation
1115 Orange 42,427
CA MediCruz Advantage Program Medical-only PIHP
Risk-based Capitation
1115 Santa Cruz 1,953
CA Molina Healthcare of California Partner Plan, Inc. - Sacramento
Commercial MCO
Risk-based Capitation
1115 Sacramento 35,170
CA Molina Healthcare of California Partner Plan, Inc. - San Diego
Commercial MCO
Risk-based Capitation
1115 San Diego 72,695
CA Molina Healthcare of California Partner Plan, Inc.-TPMP
Commercial MCO
Risk-based Capitation
1115 Riverside, San Bernardino 93,575
CA On Lok Senior Health Services dba On Lok Lifeways
PACE Risk-based Capitation
PACE San Francisco 1,148
CA Partnership Health Plan HIO Risk-based Capitation
1115 Napa, Solano, Sonoma, Yolo 189,521
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 6
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Path2Health Medical-only PIHP
Risk-based Capitation
1115 Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humbolt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Modoc, Mono, Napa, Nevada, Plumas, San Benito, Shasta, Sierra, Siskiyou, Solano, Sonoma, Sutter, Tehama, Toulumne, Trinity, Yolo, Yuba
55,307
CA Positive Healthcare/AHF Healthcare Centers
Medicaid MCO Risk-based Capitation
1915(a) Los Angeles 886
CA Riverside County Healthcare Medical-only PIHP
Risk-based Capitation
1115 Riverside 21,854
CA Safeguard Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, San Bernardino 18,866
CA San Diego LIHP Medical-only PIHP
Risk-based Capitation
1115 San Diego 30,507
CA San Francisco City & CO/Family Mosaic * Emotional and Mental Health Support PIHP
Risk-based Capitation
1915(a) San Francisco 134
CA San Francisco Health Plan Commercial MCO
Risk-based Capitation
1115 San Francisco 56,688
CA San Joaquin LIHP Medical-only PIHP
Risk-based Capitation
1115 San Joaquin 537
CA San Mateo Access and Care for Everyone (ACE)
Medical-only PIHP
Risk-based Capitation
1115 San Mateo 8,314
CA Santa Clara Family Health Plan Commercial MCO
Risk-based Capitation
1115 Santa Clara 116,644
CA Senior Care Action Network (SCAN) Medicaid MCO Risk-based Capitation
1915(a) LA, Riverside, San Barnardino 7,187
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 7
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA SF Path Medical-only PIHP
Risk-based Capitation
1115 San Francisco 10,943
CA Sutter Health sacramento Sierra dba Sutter Senior Care
PACE Risk-based Capitation
PACE Sacramento, Yolo 218
CA Valley Care Medical-only PIHP
Risk-based Capitation
1115 Santa Clara 11,673
CA Western Dental Services-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 46,591
CA Western Dental Services-Sacramento Dental PAHP Risk-based Capitation
1115 Sacramento 91,372
CO Access Behavioral Care Mental Health PIHP
Risk-based Capitation
1915(b) Denver 101,541
CO Accountable Care Collaborative Program Enhanced PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 128,114
CO Behavioral Healthcare, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) East Metro Denver 147,112
CO Colorado Health Partnerships Mental Health PIHP
Risk-based Capitation
1915(b) Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, La Plata, Lake, Las Animas, Mesa, Mineral, Moffat, Montezuma, Montrose, Otero, Ouray, Park, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit, Teller
205,800
CO Denver Health and Hospital Authority Medicaid MCO Risk-based Capitation
1915(a) Adams, Arapahoe, Denver, Jefferson 49,195
CO Foothills Behavioral Health Partners Mental Health PIHP
Risk-based Capitation
1915(b) Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 69,428
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 8
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CO Northeast Behavioral Health Partnership Mental Health PIHP
Risk-based Capitation
1915(b) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma
75,921
CO Primary Care Physician Program Enhanced PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 23,400
CO Rocky Mountain Health Plan Authority Medical-only PIHP
Non-risk Capitation 1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 21,878
CO Rocky Mountain PACE PACE Risk-based Capitation
PACE El Paso 141
CO Total Long Term Care PACE Risk-based Capitation
PACE Adams, Arapahoe, Denver, Jefferson, Pueblo 1,651
CO VOANS PACE, Inc PACE Risk-based Capitation
PACE Delta, Montrose 219
DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation
1115, 1932(a) Statewide 92,264
DC Health Services For Children with Special Needs
Medical-only PIHP
Risk-based Capitation
1915(a) Statewide 5,199
DC Medical Transportation Management Transp PAHP Non-risk Capitation 1902(a)(70) Statewide 49,562
DC United Healthcare Community Plan Medicaid MCO Risk-based Capitation
1115, 1932(a) Statewide 45,915
DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation
1115 Statewide 109,850
DE Diamond State Partners Traditional PCCM
Provider
Fee-For-Service 1115 Statewide 3,782
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 9
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
DE UnitedHealthcare Community Plan Medicaid MCO Risk-based Capitation
1115 Statewide 60,507
FL AHF MCO of Florida, Inc.(Reform) d/b/a Positive Healthcare Florida (Reform)
Commercial MCO
Risk-based Capitation
1115 Broward 183
FL AIDS Healthcare Foundation, Inc. Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 6,005
FL American Eldercare, Inc. Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Dade, Duval, Escambia, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Nassau, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Volusia, Walton
4,497
FL AMERIGROUP Florida, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval, Hernando, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, Volusia
2,802
FL Amerigroup of Florida, Inc. Commercial MCO
Risk-based Capitation
1915(b) Brevard, Dade, Hernando, Hillsborough, Lake, Manatee, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia
183,868
FL Better Health, LLC Medical-only PIHP
FFS/Administrative Fee
1915(b) Dade 1,535
FL Better Health, LLC (Reform) Medical-only PIHP
FFS w/Administrative
Fee
1115 Broward 35,896
FL Brevard Alzheimer's Foundation, Inc. Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard 208
FL Caremark Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 309
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 10
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Chapters Health Senior Independence (PACE)
PACE Risk-based Capitation
PACE 33637 53
FL Children's Medical Services (Reform) Medical-only PIHP
FFS/Administrative Fee
1115 Broward, Duval 8,437
FL Community Based Care Partnership, Ltd. Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 22,861
FL Coventry Health Care of Florida, Inc. (NHD)
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 1,141
FL Coventry Health Care of Florida, Inc. d/b/a Buena Vista
Commercial MCO
Risk-based Capitation
1915(b) Broward, Dade, Gadsden, Hendry, Hillsborough, Jefferson, Leon, Liberty, Madison, Palm Beach, Wakulla
23,074
FL Coventry Health Care of Florida, Inc. d/b/a Vista
Commercial MCO
Risk-based Capitation
1915(b) Dade 22,074
FL DentaQuest of Florida, Inc d/b/a DentaQuest
Dental PAHP Risk-based Capitation
1915(b) Dade, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
264,906
FL First Coast Advantage (Reform) Medical-only PIHP
FFS/Administrative Fee
1115 Baker, Clay, Duval, Nassau 66,907
FL First Coast Advantage Cental, LLC Medical-only PIHP
FFS/Administrative Fee
1915(b) Alachua, Bradford, Columbia, Marion, Union 1,098
FL Florida Health Partners, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington
187,642
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 11
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Florida PACE Centers PACE Risk-based Capitation
PACE 33010, 33012, 33013, 33014, 33054, 33122, 33125, 33126, 33127, 33128, 33129, 33130, 33131, 33132, 33133, 33134, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33143, 33144, 33145, 33146, 33147, 33150, 33154, 33155, 33161, 33165, 33166, 33167, 33168, 33172, 33173, 33174, 33175, 33181, 33182, 33183, 33184, Dade
327
FL Florida PACE Centers, Inc. d/b/a Project Independence at Home (NHD)
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade 764
FL Freedom Health Plan, Inc. Commercial MCO
Risk-based Capitation
1915(b) Dade, Hernando, Hillsborough, Manatee, Marion, Palm Beach, Pasco, Polk
24,147
FL Freedom Health Plan, Inc. (Reform) Commercial MCO
Risk-based Capitation
1115 Broward 4,100
FL HealthEase of Florida, Inc. Medicaid MCO Risk-based Capitation
1915(b) Bay, Brevard, Broward, Calhoun, Citrus, Dade, Duval, Escambia, Gadsden, Highlands, Hillsborough, Jefferson, Lake, Leon, Liberty, Madison, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, Volusia, Wakulla
175,187
FL Hemophilia of the Sunshine State (Lynnfield Drug, Inc.)
Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 128
FL HOPE Hospice and Community Services, Inc. (NHD)
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Charlotte, Collier, Hendry, Lee 189
FL Hope PACE PACE Risk-based Capitation
PACE 33901 191
FL Humana Medical Plan, Inc. Commercial MCO
Risk-based Capitation
1915(b) Broward, Dade, Palm Beach 39,193
FL Humana Medical Plan, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Duval, Flagler, Hillsborough, Manatee, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia
1,586
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 12
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Humana Medical Plan, Inc. (Reform) Commercial MCO
Risk-based Capitation
1115 Broward 5,960
FL Integral Health Plan Medicaid MCO Risk-based Capitation
1915(b) Collier, Highlands, Manatee, Marion, Polk, Sumter 21,234
FL Lakeview Center, Inc. d/b/a Access Behavioral Health
Mental Health PIHP
Risk-based Capitation
1915(b) Escambia, Okaloosa, Santa Rosa, Walton 46,089
FL Little Havana Activities and Nutrition Centers of Dade County, Inc. (NHD)
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 1,189
FL Magellan Behavioral Health of Florida Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington
230,105
FL Managed Care of North America d/b/a MCNA Dental Plans
Dental PAHP Risk-based Capitation
1915(b) Dade, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
154,602
FL Medica Health Plans of Florida, Inc. Commercial MCO
Risk-based Capitation
1915(b) Dade 3,225
FL Medica Health Plans of Florida, Inc. (Reform)
Commercial MCO
Risk-based Capitation
1115 Broward 3,663
FL MediPass Traditional PCCM Provider
Primary Care Case
Management Fee
1915(b) Statewide 592,602
FL Molina Healthcare of Florida, Inc. Commercial MCO
Risk-based Capitation
1915(b) Dade, Hillsborough, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole
41,231
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 13
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Molina Healthcare of Florida, Inc. (Reform)
Commercial MCO
Risk-based Capitation
1115 Broward 27,343
FL Neighborly Care Network, Inc. (NHD) 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
866
FL North Florida Behavioral Health Partnership
Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
91,074
FL Personal Health Plan d/b/a Healthy Palm Beaches, Inc
Medicaid MCO Risk-based Capitation
1915(b) Palm Beach 11,893
FL Preferred Care Partners Inc. d/b/a Care Florida
Commercial MCO
Risk-based Capitation
1915(b) Dade 1,955
FL Preferred Care Partners, Inc. d/b/a Care Florida (Reform)
Commercial MCO
Risk-based Capitation
1115 Broward 3,203
FL Preferred Medical Plan, Inc. Commercial MCO
Risk-based Capitation
1915(b) Broward, Dade 15,950
FL Prestige Health Choice Medicaid MCO Risk-based Capitation
1915(b) Alachua, Bradford, Columbia, Dade, Dixie, Gadsden, Gilchrist, Hamilton, Hendry, Hillsborough, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Marion, Orange, Osceola, Pasco, Pinellas, Putnam, Seminole, Sumter, Suwannee, Union, Wakulla
70,690
FL Public Health Trust of Dade County Mental Health PIHP
Risk-based Capitation
1915(b) Dade 74,118
FL Simply Healthcare Plans, Inc. Commercial MCO
Risk-based Capitation
1915(b) Dade, Hernando, Hillsborough, Osceola, Pasco, Pinellas, Polk, Seminole
264,445
FL Simply Healthcare Plans, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Statewide 158
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 14
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL South Florida Community Care Network * Shared Savings Model
FFS/Administrative Fee
1915(b) Dade 8,101
FL South Florida Community Care Network (Reform)
Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 35,749
FL Suncoast Care PACE Risk-based Capitation
PACE 33762 118
FL Sunshine State Health Plan Medicaid MCO Risk-based Capitation
1915(b) Dade, Flagler, Hillsborough, Lake, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, St. Lucie, Volusia
114,595
FL Sunshine State Health Plan, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Citrus, Dade, Duval, Hernando, Hillsborough, Lake Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia
2,283
FL Sunshine State Health Plan, Inc. (Reform) Medicaid MCO Risk-based Capitation
1115 Broward, Clay, Duval 84,573
FL The Commission for the Transportation of the Disadvantaged
Transp PAHP Flat Rate per Ride 1915(b) Statewide 295
FL United Healthcare of Florida, Inc. Commercial MCO
Risk-based Capitation
1915(b) Brevard, Broward, Citrus, Dade, Duval, Flagler, Hernando, Highlands, Hillsborough, Lake, Leon, Manatee, Marion, Okeechobee, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Seminole, Volusia
101,242
FL United Healthcare of Florida, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia
3
FL United Healthcare of Florida, Inc. (Reform)
Commercial MCO
Risk-based Capitation
1115 Baker, Clay, Duval, Nassau 8,521
FL United Home Care Services, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 1,166
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 15
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Universal Health Care, Inc. Commercial MCO
Risk-based Capitation
1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon, Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Wakulla
43,231
FL Universal Health Care, Inc. (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Clay, Collier, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole
1,289
FL Universal Health Care, Inc. (Reform) Commercial MCO
Risk-based Capitation
1115 Broward, Duval 19,491
FL Urban Jacksonville, Inc. d/b/a Aging True (NHD)
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Clay, Duval, St. Johns 192
FL WeCareHealth Plans, Inc. Medical-only PIHP
FFS/Administrative Fee
1915(b) Palm Beach 1,178
FL WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Commercial MCO
Risk-based Capitation
1915(b) Brevard, Broward, Charlotte, Dade, Desoto, Hernando, Hillsborough, Indian River, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter
193,229
FL WorldNet Services Corp (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Escambia, Okaloosa, Santa Rosa, Walton 83
GA Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, East Region, North Region, Southeast Region
271,166
GA Non-Emergency Transportation Brokerage
Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 1,136,515
GA Peach State Health Plan Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, Southwest Region 305,017
GA WellCare Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, East Region, North Region, Southeast Region, Southwest Region
560,335
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 16
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
HI Aloha Care Medicaid MCO Risk-based Capitation
1115 Statewide 75,908
HI HMSA-Medical Commercial MCO
Risk-based Capitation
1115 Statewide 129,209
HI Kaiser Permanente Commercial MCO
Risk-based Capitation
1115 Maui, Oahu 26,569
HI Ohana QExA Commercial MCO
Risk-based Capitation
1115 Statewide 24,073
HI Ohana QUEST Commercial MCO
Risk-based Capitation
1115 Statewide 2,014
HI United QExA Commercial MCO
Risk-based Capitation
1115 Statewide 20,988
HI United QUEST Commercial MCO
Risk-based Capitation
1115 Statewide 1,780
IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Statewide 413,300
IA Medipass Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas, Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet, Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Henry, Howard, Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Kossuth, Lee, Linn, Lucas, Lyon, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott, Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren, Warren, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright
202,710
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 17
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
IA Meridian Health Plan of Iowa Medicaid MCO Risk-based Capitation
1932(a) Benton County, Clinton County, Muscatine County 1,274
IA PACE Iowa PACE Risk-based Capitation
PACE Harrison, Mills, Pottawattamie 210
IA Siouxland PACE PACE Risk-based Capitation
PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 166
IA TMS Management Group, Inc. Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 398,902
ID Healthy Connections Traditional PCCM Provider
Primary Care Case
Management Fee
1937 Statewide 205,383
ID Idaho Smiles - Blue Cross Dental PAHP Risk-based Capitation
1937 Statewide 0
ID Medicare-Medicaid Coordinated Plan Medical-only PAHP
Risk-based Capitation
1937 Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Clark, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley, Washington
574
ID Non-Emergency Medical Transportation - AMR
Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 0
IL Aetna Better Health Commercial MCO
Risk-based Capitation
1932(a) Du Page, Kane, Kankakee, Lake, Suburban Cook (zip codes not beginning with 606), Williamson
18,000
IL Family Health Network Medicaid MCO Risk-based Capitation
1915(a) Cook 74,300
IL Harmony Health Plan Commercial MCO
Risk-based Capitation
1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, Williamson
133,600
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 18
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
IL IlliniCare Health Plan, Inc. Medicaid MCO Risk-based Capitation
1932(a) Dupage, Kane, Kankakee, Lake, Suburban Cook (non 606 Zip Codes), Williamson
17,800
IL Illinois Health Connect Traditional PCCM
Provider
Primary Care Case
Management Fee
1932(a) Statewide 1,763,700
IL Meridian Health Plan Medicaid MCO Risk-based Capitation
1915(a) Adams, Brown, Cook, Henry, Mercer, Pike, Rock Island, Scott
7,300
IN Advantage Health Solutions-Care Select Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 15,425
IN Anthem-Healthy Indiana Plan Commercial MCO
Risk-based Capitation
1115 Statewide 26,789
IN Anthem-Hoosier Healthwise Commercial MCO
Risk-based Capitation
1115, 1932(a) Statewide 209,071
IN Enhanced Services Plan (ESP)-Healthy Indiana Plan
* High Risk Plan Fee-For-Service 1115 Statewide 1,443
IN Managed Health Services (MHS)-Hoosier Healthwise
Commercial MCO
Risk-based Capitation
1115, 1932(a) Statewide 194,243
IN Managed Health Services-Healthy Indiana Plan
Commercial MCO
Risk-based Capitation
1115 Statewide 3,486
IN MDwise-Care Select Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 19,473
IN MDwise-Healthy Indiana Plan Commercial MCO
Risk-based Capitation
1115 Statewide 10,735
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 19
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
IN MDwise-Hoosier Healthwise Commercial MCO
Risk-based Capitation
1115, 1932(a) Statewide 269,874
KS Coventry Health Care of Kansas Medicaid MCO Risk-based Capitation
1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 127,941
KS HealthConnect Kansas Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 25,319
KS Kansas Health Solutions Mental Health PAHP
Risk-based Capitation
1915(b)/(c) Statewide 305,246
KS Medical Transportation Management Inc. (MTM)
Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 123,306
KS Midland Care Services PACE Risk-based Capitation
PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie, Shawnee, Wabaunsee
103
KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-based Capitation
1932(a) Statewide 64,652
KS ValueOptions-Kansas Substance Use Disorders PIHP
Risk-based Capitation
1915(b)/(c) Statewide 305,246
KS Via Christi Healthcare Outreach Programs for Elders
PACE Risk-based Capitation
PACE Sedgwick 197
KY Coventry Cares of Kentucky Commercial MCO
Risk-based Capitation
1915(b) Statewide 243,297
KY Human Service Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 713,579
KY Kentucky Spirit Commercial MCO
Risk-based Capitation
1915(b) Statewide 148,865
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 20
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
KY Passport Health Plan Commercial MCO
Risk-based Capitation
1115 Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, LaRue, Marion, Nelson, Oldham, Shelby, Spencer, Trimble, Washington
172,799
KY Passport Health Plan Commercial MCO
Risk-based Capitation
1115 Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, LaRue, Marion, Nelson, Oldham, Shelby, Spencer, Trimble, Washington
172,799
KY WellCare of Kentucky, Inc Commercial MCO
Risk-based Capitation
1915(b) Statewide 158,614
LA Americagroup Medicaid MCO Risk-based Capitation
1932(a) Statewide 142,123
LA Community Health Solutions of Louisiana Enhanced PCCM
Provider
Primary Care Case
Management Fee
1932(a) Statewide 188,790
LA Francican PACE Baton Rouge PACE Risk-based Capitation
PACE East Baton Rouge, West Baton Rouge 131
LA Greater New Orleans Community Health Connection (GNOCHC)
* All Inclusive Encounter-Based Plan
All-Inclusive Encounter-Based
Rates
1115 Jefferson Parish, Orleans Parish, Plaquemines Parish, St. Bernard Parish
53,758
LA LaCare/AmeriHealth Caritas Health Plan Medicaid MCO Risk-based Capitation
1932(a) Statewide 155,232
LA Louisiana Healthcare Connection Medicaid MCO Risk-based Capitation
1932(a) Statewide 167,338
LA PACE Greater New Orleans PACE Risk-based Capitation
PACE Ascension, Jefferson, Orleans, St. Bernard, Tangipahoa 175
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 21
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
LA United Healthcare Community Plan of Louisiana
Enhanced PCCM
Provider
Primary Care Case
Management Fee
1932(a) Statewide 226,589
MA Boston Medical Center HealthNet Plan Commercial MCO
Risk-based Capitation
1115 Boston/Greater Boston Region, Central Region, Northern Region, Southern Region, Western Region
190,244
MA Commonwealth Care Alliance Medicaid MCO Risk-based Capitation
1915(a)/(c) Essex County, Hampden County, Middlesex County, Norfolk County, Plymouth County, Suffolk County
4,236
MA Elder Service Plan of Cambridge Health Alliance
PACE Risk-based Capitation
PACE Allston, Cambridge, Somerville 255
MA Elder Service Plan of East Boston Neighborhood Health Center
PACE Risk-based Capitation
PACE East Boston 356
MA Elder Service Plan of Harbor Health Services
PACE Risk-based Capitation
PACE Greater Boston 410
MA Elder Service Plan of the North Shore PACE Risk-based Capitation
PACE Northeastern MA 848
MA Fallon Community Health Plan Commercial MCO
Risk-based Capitation
1115 Central Region 12,822
MA Health New England Commercial MCO
Risk-based Capitation
1115 Western Region 6,369
MA MA Behavioral Health Partnership MH/SUD PIHP Risked-Based Capitation with
Incentive Arrangement
1115 Statewide 437,830
MA NaviCare Medicaid MCO Risk-based Capitation
1915(a)/(c) Franklin County (partial), Hampden County, Hampshire County (partial), Middlesex County (partial), Norfolk County (partial), Worcester County
1,390
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 22
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MA Neighborhood Health Plan Commercial MCO
Risk-based Capitation
1115 Boston/Greater Region, Central Region, Northern Region, Southern Region, Western Region
155,789
MA Network Health Medicaid MCO Risk-based Capitation
1115 Boston/Greater Boston Region, Central Region, Northern Region, Southern Region, Western Region (where approved)
124,174
MA Primary Care Clinician Plan Traditional PCCM Provider
Primary Care Case
Management Fee
1115, 1932(a)/1915(c)
Statewide 369,051
MA Senior Whole Health Medicaid MCO Risk-based Capitation
1915(a)/(c) Bristol County, Essex County, Middlesex County, Norfolk County, Plymouth County, Suffolk County, Worcester County
8,884
MA Summit Elder Care PACE Risk-based Capitation
PACE Central Region 897
MA United Health Care Medicaid MCO Risk-based Capitation
1915(a)/(c) Bristol County, Essex County, Hampden County, Middlesex County, Norfolk County, Plymouth County, Suffolk County, Worcester County
8,381
MA Uphams Elder Service Plan PACE Risk-based Capitation
PACE Boston 209
MD AMERIGROUP - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide except Allegany, Cecil, Garrett, St. Mar 7,602
MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-based Capitation
1115 Anne Arundel, Baltimore City, Baltimore County, Calvert, Carroll, Charles
206,346
MD Hopkins Elder Plus PACE Risk-based Capitation
PACE 21052, 21202, 21205, 21206, 21213, 21214, 21217, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237
104
MD JAI Medical System Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County 14,087
MD JAI Medical Systems - PAC Medical-only PAHP
Risk-based Capitation
1115 Baltimore City, Baltimore County 7,319
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 23
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MD Maryland Physicians Care Medicaid MCO Risk-based Capitation
1115 Statewide 157,917
MD Maryland Physicians Care - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 12,471
MD Medstar Family Choice Medicaid MCO Risk-based Capitation
1115 Anne Arundel North, Baltimore City, Baltimore County, Western Harford County
28,880
MD Priority Partners - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 11,638
MD Priority Partners MCO Medicaid MCO Risk-based Capitation
1115 Statewide 213,470
MD The Coordinating Center * Selective Contract
Fee-For-Service 1915(b)/(c) Statewide 848
MD The Diamond Plan Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County, Harford 13,356
MD United Health Care Medicaid MCO Risk-based Capitation
1115 Statewide 142,769
MD United HealthCare - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 20,929
ME MaineCare Primary Care Case Management
Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 171,316
MI Access Alliance of Michigan Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 57,561
MI Blue Cross Complete of Michigan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Washtenaw, Wayne 21,647
MI Care Resources PACE Capitation PACE Kent 206
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 24
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MI CareSource of Michigan Medicaid MCO Risk-based Capitation
1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Benzie, Berrien, Calhoun, Cass, Charlevoix, Cheboygan, Crawford, Genesee, Gladwin, Grand Traverse, Ionia, Iosco, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montmorency, Newaygo, Oceana, Ogemaw, Osceola, Oscoda, Ottawa, Presque Isle, Roscommon, Saginaw, St. Joseph, Van Buren
32,590
MI Center for Senior Independence PACE Risk-based Capitation
PACE 48101, 48120, 48122, 48124, 48125, 48126, 48127, 48128, 48146, 48201, 48202, 48203, 48204, 48205, 48206, 48207, 48208, 48209, 48210, 48211, 48212, 48213, 48214, 48215, 48216, 48217, 48218, 48219, 48221, 48223, 48224, 48225, 48226, 48227, 48228, 48229, 48230, 48234, 48235, 48236, 48238, 48239, 48240
226
MI CMH Affiliation of Mid-Michigan Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee, Newago
94,392
MI CMH for Central Michigan Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 41,884
MI CMH Partnership of Southeast Michigan Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Lenawee, Livingston, Monroe, Washtenaw 79,372
MI Comprehensive Senior Care Corporation PACE Risk-based Capitation
PACE Calhoun 117
MI CoventryCares of Michigan, Inc. Commercial MCO
Risk-based Capitation
1915(b) Cass, Kalamazoo, Oakland, St. Joseph, Wayne 43,957
MI Detroit-Wayne County CMH Agency Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Wayne 430,236
MI Genesee County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Genesee 90,083
MI HealthPlus Partners, Inc. Medicaid MCO Risk-based Capitation
1915(b) Bay, Genesee, Lapeer, Saginaw, Shiawassee, Tuscola 66,211
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 25
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MI Healthy Kids Dental Dental PAHP Risk-based Capitation
1915(b) Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Benzie, Branch, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ionia, Iosco, Iron, Isabella, Kalkaska, Keweenaw, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Manistee, Marquette, Menominee, Midland, Missaukee, Monroe, Montmorency, Ogemaw, Ontonagon, Oscoda, Otsego, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren
347
MI Lakeshore Behavioral Health Alliance Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Muskegon, Ottawa 63,714
MI Life Circles PACE Risk-based Capitation
PACE Muskegon, Ottawa 187
MI LifeWays Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Hillsdale, Jackson 35,292
MI Macomb County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Macomb 112,723
MI McLaren Health Plan Medicaid MCO Risk-based Capitation
1915(b) Arenac, Bay, Clinton, Crawford, Eaton, Genesee, Gratiot, Ingham, Ionia, Isabella, Lapeer, Macomb, Montcalm, Oakland, Ogemaw, Oscoda, Roscommon, Saginaw, Shiawassee, Tuscola
83,889
MI Meridian Health Plan of Michigan Medicaid MCO Risk-based Capitation
1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Clare, Clinton, Crawford, Eaton, Emmet, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenaw, Wayne, Wexford
292,661
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 26
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MI Midwest Health Plan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne 78,081
MI Molina Healthcare of Michigan Medicaid MCO Risk-based Capitation
1915(b) Alcona, Allegan, Arenac, Bay, Benzie, Clare, Crawford, Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Isabella, Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, St. Clair, Tuscola, Wayne, Wexford
208,678
MI Network 180 Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Kent 98,273
MI North Care Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft
44,229
MI Northern Affiliation Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle
46,152
MI Northwest CMH Affiliation Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Crawford, Grand Traverse, Lake, Leelanau, Mason, Missaukee, Oceana, Roscommon, Wexford
43,805
MI Oakland County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Oakland 119,670
MI PACE of Southwest Michigan PACE Risk-based Capitation
PACE Berrien, Cass, VanBuren 31
MI Physicians Health Plan - FamilyCare Medicaid MCO Risk-based Capitation
1915(b) Clinton, Eaton, Ingham, Ionia, Isabella, Shiawassee 17,893
MI Priority Health Government Programs, Inc.
Medicaid MCO Risk-based Capitation
1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm, Muskegon, Oceana, Osceola, Ottawa
65,926
MI ProCare Health Plan Medicaid MCO Risk-based Capitation
1915(b) Wayne 2,165
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 27
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MI Saginaw County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Saginaw 40,537
MI Southwest Affiliation Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Allegan, Cass, Kalamazoo, St. Joseph 74,236
MI Thumb Alliance PIHP Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Lapeer, Sanilac, St. Clair 45,888
MI Total Health Care Medicaid MCO Risk-based Capitation
1915(b) Genesee, Macomb, Oakland, Wayne 54,874
MI UnitedHealthcare Community Plan Medicaid MCO Risk-based Capitation
1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Monroe, Muskegon, Oakland, Oceana, Ottawa, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne
239,680
MI Upper Peninsula Health Plan Medicaid MCO Risk-based Capitation
1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keewenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft
29,522
MI Venture Behavioral Health Mental Health PIHP
Risk-based Capitation
1915(b)/(c) Barry, Berrien, Branch, Calhoun, VanBuren 86,828
MN Blue Plus Commercial MCO
Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mcleod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Rouseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine
130,909
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 28
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MN Health Partners Commercial MCO
Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Anoka, Benton, Carver, Chisago, Dakota, Hennepin, McLeod, Meeker, Ramsey, Scott, Sherburne, Stearns, Washington, Wright
82,086
MN Itasca Medical Care Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Itasca 6,288
MN Medica Commercial MCO
Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Lake, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Polk, Ramsey, Rice, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright
137,911
MN Metropolitan Health Plan Commercial MCO
Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Anoka, Carver, Hennepin, Scott 4,399
MN PrimeWest Health System Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse
23,796
MN South Country Health Alliance Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Brown, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Rice, Sibley, Steele, Todd, Wabasha, Wadena, Waseca
23,334
MN UCARE Commercial MCO
Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Becker, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, LeSueur, Lincoln, Lyon, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Winona, Wright, Yellow Medicine
198,963
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 29
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MO Alexian Brothers Community Services PACE Risk-based Capitation
PACE St. Louis City, St. Louis County 192
MO HealthCare USA CENTRAL Medicaid MCO Risk-based Capitation
1915(b) Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole, Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline, Shelby
40,425
MO HealthCare USA EASTERN Medicaid MCO Risk-based Capitation
1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington
138,975
MO HealthCare USA WESTERN Medicaid MCO Risk-based Capitation
1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon
90,784
MO Home State Health Plan Central Medicaid MCO Risk-based Capitation
1915(b) Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole, Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline, Shelby
3,728
MO Home State Health Plan Eastern Medicaid MCO Risk-based Capitation
1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington
27,942
MO Home State Health Plan Western Medicaid MCO Risk-based Capitation
1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon
17,197
MO LogistiCare Solutions LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 441,781
MO Missouri Care CENTRAL Medicaid MCO Risk-based Capitation
1915(b) Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole, Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline, Shelby
36,970
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 30
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MO Missouri Care EASTERN Medicaid MCO Risk-based Capitation
1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington
39,412
MO Missouri Care WESTERN Medicaid MCO Risk-based Capitation
1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon
27,108
MS LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 596,108
MS Magnolia Health Plan Medicaid MCO Risk-based Capitation
1932(a) Statewide 29,710
MS United HealthCare Medicaid MCO Risk-based Capitation
1932(a) Statewide 18,678
MT Health Improvement Program Enhanced PCCM
Provider
Primary Care Case
Management Fee
1915(b) Statewide 81,953
MT Passport to Health Traditional PCCM
Provider
Primary Care Case
Management Fee
1915(b) Statewide 76,393
NC Cardinal Innovations MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Alamance, Cabarrus, Caswell, Chatham, Davidson, Franklin, Granville, Halifax, Orange, Person, Rowan, Stanly, Union, Vance, Warren
66,660
NC Carolina Access Traditional PCCM Provider
Fee-For-Service 1932(a) Statewide 62,341
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 31
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NC Community Care of North Carolina Enhanced PCCM
Provider
Primary Care Case
Management Fee
1932(a) Statewide 1,395,340
NC Eastern Carolina Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimmons, Pitt, Tyrell, Washington
91,792
NC Elderhaus PACE Risk-based Capitation
PACE Brunswick, New Hanover 96
NC LIFE of St. Joseph of the Pines PACE Risk-based Capitation
PACE Cumberland, Harnett, Hoke, Moore, Robinson 105
NC PACE of Guilford and Rockingham Counties, Inc. (PACE of the Triad)
PACE Risk-based Capitation
PACE Guilford, Rockingham 56
NC PACE@Home PACE Risk-based Capitation
PACE Alexander, Burke, Caldwell, Catawba, Lincoln 23
NC Piedmont Health SeniorCare PACE Risk-based Capitation
PACE Alamance, Caswell, Durham, Orange 120
NC Smokey Mountain Center MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Alexander, Alleghany, Ashe, Avery, Caldwell, Cherokee, Clay, Graham, Haywood, Jackson, Macon, McDowell, Swain, Watauga, Wilkes
77,383
NC Western Highlands Network MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Buncombe, Henderson, Madison, Mitchell, Polk, Rutherford, Transylvania, Yancey
71,869
ND Health Management Disease Management
PAHP
Risk-based Capitation
1932(a) Statewide 400
ND Northland PACE PACE Risk-based Capitation
PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602, 58630, 58652, 58655, 58656
58
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 32
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
ND Primary Care Case Management Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 42,942
NE Arbor Health Plan Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Statewide 21,569
NE Coventry Cares of Nebraska Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Statewide 90,521
NE Magellan Behavioral Health * Specialty Physician Case Management
(SPCM) Program
Fee-For-Service 1915(b) Statewide 202,340
NE Nebraska Medicaid Medical Home Pilot Enhanced PCCM Provider
Primary Care Case
Management Fee
1932(a) Buffalo, Dawson 6,383
NE United Healthcare of the Midlands/UnitedHealthcare Community Plan (formerly Share Advantage)
Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Statewide 55,260
NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren
131,606
NJ Amerivantage Specialty + RX Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren
1,874
NJ Healthfirst Health Plan of New Jersey, Inc.
Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex, Union, Warren
39,754
NJ Healthfirst NJ Maximum Plan Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex, Union, Warren
2,272
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 33
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NJ Horizon Medicare Blue Totalcare Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Statewide 5,188
NJ Horizon NJ Health Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Statewide 482,960
NJ Life at Lourdes PACE Risk-based Capitation
PACE 08002, 08003, 08004, 08007, 08009, 08012, 08026, 08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045, 08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095, 08099, 08101, 08102, 08103, 08105, 08106, 08107, 08108, 08109, 08110, 08821
182
NJ Life St. Francis PACE Risk-based Capitation
PACE 08501, 08505, 08512, 08518, 08520, 08525, 08530, 08534, 08540, 08541, 08542, 08543, 08544, 08550, 08554, 08560, 08561, 08601, 08602, 08603, 08604, 08605, 08606, 08607, 08608, 08609, 08610, 08611, 08618, 08619, 08620, 08625, 08628, 08629, 08638, 08645, 08646, 08647, 08648, 08650, 08666, 08690, 08691, 08695
216
NJ LogistiCare Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 1,185,165
NJ Lutheran Senior Life PACE Risk-based Capitation
PACE 07002, 07030, 07047, 07086, 07087, 07093, 07094, 07302, 07304, 07305, 07306, 07307, 07310, 07311
134
NJ South Jersey Healthcare LIFE PACE Risk-based Capitation
PACE 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
48
NJ United HealthCare Dual Complete Commercial MCO
Risk-based Capitation
1915(b), 1932(a) Statewide 6,732
NJ UnitedHealthCare Community Plan Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Statewide 362,753
NM AMERIGROUP Community Care of New Mexico, Inc.
Commercial MCO
Risk-based Capitation
1915(b)/(c) Statewide 20,894
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 34
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NM Blue Cross Blue Shield of New Mexico Commercial MCO
Risk-based Capitation
1915(b) Statewide 27,559
NM Lovelace Community Health Plan Commercial MCO
Risk-based Capitation
1115, 1915(b) Statewide 80,524
NM Molina Healthcare of New Mexico Commercial MCO
Risk-based Capitation
1115, 1915(b) Statewide 76,673
NM OptumHealth New Mexico Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 376,789
NM Presbyterian Health Plan Commercial MCO
Risk-based Capitation
1115, 1915(b) Statewide 164,799
NM Total Community Care (PACE) PACE Risk-based Capitation
PACE Bernalillo County, Sandoval County, Valencia County 394
NM United Healthcare Commercial MCO
Risk-based Capitation
1915(b)/(c) Statewide 19,335
NV Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Urban Clark County, Urban Washoe County 79,353
NV Health Plan of Nevada Commercial MCO
Risk-based Capitation
1932(a) Clark, Washoe 93,200
NV Logisticare Transp PAHP Risk-based Capitation
1932(a) Statewide 257,541
NY Affinity Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester
257,469
NY Affinity/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 309
NY Amerigroup Medicaid MCO Risk-based Capitation
1115 New York City, Putnam 433,743
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 35
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY AmeriGroup Advantage Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 10
NY Amerigroup Community Connections Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 1,544
NY AmidaCare Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 5,435
NY ArchCare Senior Life PACE Risk-based Capitation
PACE New York City 225
NY Capital District Physicians Health Plan Commercial MCO
Risk-based Capitation
1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Washington
88,188
NY Catholic Health - LIFE PACE Risk-based Capitation
PACE Erie 103
NY Centerlight (CCM) PACE Risk-based Capitation
PACE New York City, Westchester 3,244
NY Centerlight Select Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 4,696
NY Complete Senior Care PACE Risk-based Capitation
PACE Niagara 44
NY Eddy Senior Care PACE Risk-based Capitation
PACE Albany, Schenectady 132
NY Elder Plan/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 684
NY ElderPlan/Managed Long Term Care Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 5,802
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 36
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY ElderPlan/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 9
NY Elderserve Long Term Care PIHP
Risk-based Capitation
1915(a) Nassau, New York City, Suffolk, Westchester 5,991
NY Excellus Commercial MCO
Risk-based Capitation
1115 Broome, Chemung, Clinton, Essex, Franklin, Herkimer, Livingston, Madison, Monroe, Oneida, Onondaga, Ontario, Orleans, Oswego, Otsego, Seneca, St Lawrence, Wayne, Yates
207,251
NY Fidelis Care at Home Long Term Care PIHP
Risk-based Capitation
1115 Orange, Rockland 555
NY GHI/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 686
NY Guildnet Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 8,604
NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 389
NY Health Advantage/Elant Choice Long Term Care PIHP
Risk-based Capitation
1915(a) Orange 204
NY Health First Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, 538,177
NY Health Now Commercial MCO
Risk-based Capitation
1115 Albany, Allegany, Cattauragus, Chautauqua, Clinton, Columbia, Erie, Essex, Fulton, Genesee, Greene, Montgomery, Niagara, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming
56,990
NY HealthFirst/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 33
NY HHH Choices Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 1,420
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 37
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY HIP Combined Commercial MCO
Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester
238,556
NY HIP Health Plan/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 1,493
NY HIP Health Plan/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 383
NY HIP/Managed Long Term Care Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 49
NY Hudson Health Plan Medicaid MCO Risk-based Capitation
1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 117,587
NY Independent Care Systems Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 2,373
NY Independent Health/Hudson Valley&WNY Commercial MCO
Risk-based Capitation
1115 Erie, Niagara 48,314
NY Independent Living For Seniors PACE Risk-based Capitation
PACE Monroe 316
NY Liberty Health Advantage/Medicaid Advantage
Commercial MCO
Risk-based Capitation
1115 Statewide 693
NY Managed Health Inc/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 232
NY MetroPlus Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens 425,888
NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens 5,805
NY MetroPlus/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 254
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 38
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY MVP Health Plan Commercial MCO
Risk-based Capitation
1115 Dutchess, Ulster 35,626
NY Neighborhood Health Providers Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens, Richmond 216,967
NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-based Capitation
1115 Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton, Columbia, Cortland, Dutchess, Erie, Essex, Greene, Hamilton, Herkimer, Kings, Nassau, New York, Niagara, Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Warren, Washington, Westchester
779,417
NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage
Commercial MCO
Risk-based Capitation
1115 Statewide 1,848
NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 109
NY PACE CNY PACE Risk-based Capitation
PACE Onondaga 445
NY SCHC TotalCare Medicaid MCO Risk-based Capitation
1115 Onondaga, Oswego, Tompkins 34,905
NY Senior Health Partners Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 4,190
NY Senior Network Health Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 385
NY Senior Whole Health/ Medicaid Advantage
Commercial MCO
Risk-based Capitation
1115 Statewide 543
NY Senior Whole Health/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 330
NY Southern Tier Pediatrics Traditional PCCM Provider
Risk-based Capitation
1115 Chemung, Steuben 4,057
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 39
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY Southern Tier Priority Traditional PCCM Provider
Risk-based Capitation
1115 Chemung, Schuyler, Steuben 3,549
NY Total Aging in Place Long Term Care PIHP
Risk-based Capitation
1915(a) Erie 128
NY Total Senior Care PACE Risk-based Capitation
PACE Cattaraugus 84
NY Touchstone/Prestige/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 1,542
NY United Healthcare Commercial MCO
Risk-based Capitation
1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 321,265
NY United HealthCare/Medicaid Advantage Commercial MCO
Risk-based Capitation
1115 Statewide 384
NY Univera Community Health Medicaid MCO Risk-based Capitation
1115 Allegany, Cattaraugus, Chautauqua, Erie 49,815
NY Village Care Max Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 15
NY VNS Choice Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 11,727
NY VNS Choice Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 95
NY VNS Choice Special Needs Medicaid MCO Risk-based Capitation
1915(a) Bronx, Brooklyn, Manhattan, Queens, Staten Island 5,842
NY Wellcare Commercial MCO
Risk-based Capitation
1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, New York, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster
76,437
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 40
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY WellCare Advantage Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 50
NY WellCare Advocate Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 2,680
NY WellCare/Medicaid Advantage Commercial MCO
Risk-based Capitation
1915(a) Statewide 459
OH Amerigroup Ohio Medicaid MCO Risk-based Capitation
1932(a) Southwest, West Central 58,254
OH Buckeye Community Health Plan Medicaid MCO Risk-based Capitation
1932(a) East Central, Northeast, Northwest, Southwest 168,143
OH CareSource Medicaid MCO Risk-based Capitation
1932(a) Central, East Central, Northeast, Northeast Central, Northwest, Southeast, Southwest, West Central
920,940
OH McGregor PACE PACE Risk-based Capitation
PACE Cuyahoga 236
OH Molina Healthcare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Central, Southeast, Southwest, West Central 262,932
OH Paramount Advantage Medicaid MCO Risk-based Capitation
1932(a) Northwest 100,787
OH TriHealth Senior Link PACE Risk-based Capitation
PACE Butler, Clermont, Hamilton, Warren 602
OH United Healthcare Community Plan of Ohio
Medicaid MCO Risk-based Capitation
1932(a) East Central, North East Central, Northwest, Southeast 122,630
OH WellCare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Northeast 103,053
OK Cherokee Elder Care PACE Risk-based Capitation
PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434, 74441, 74451, 74452, 74464, 74471
103
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 41
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OK SoonerCare American Indian PCCM Traditional PCCM Provider
Primary Care Case
Management Fee
1115 Statewide 17,066
OK SoonerCare PCCM Traditional PCCM Provider
Primary Care Case
Management Fee
1115 Statewide 462,426
OK SoonerRide Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 628,918
OR Access Dental Plan Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 8,405
OR Accountable Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Benton, Lincoln 15,032
OR Advantage Dental Services Dental PAHP Risk-based Capitation
1115 Baker, Benton, Clackamas, Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Gilliam, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Lincoln, Linn, Malheur, Marion, Morrow, Multnomah, Polk, Sherman, Umatilla, Union, Wallowa, Wasco, Washington, Wheeler, Yamhill
186,981
OR Capitol Dental Care, Inc. Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Umatilla, Wasco, Washington, Yamhill
194,868
OR CareOregon Medicaid MCO Risk-based Capitation
1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson, Klamath, Lincoln, Marion, Morrow, Multnomah, Polk, Tillamook, Umatilla, Washington, Yamhill
159,291
OR Cascade Comprehensive Care Medicaid MCO Risk-based Capitation
1115 Klamath 9,753
OR Clackamas County Mental Health Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Hood River, Sherman, Wasco 27,861
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 42
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OR Doctors of the Oregon Coast South Medicaid MCO Risk-based Capitation
1115 Coos, Curry 11,774
OR Douglas County IPA Commercial MCO
Risk-based Capitation
1115 Douglas 16,834
OR Family Dental Care Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 8,294
OR FamilyCare (Mental Health) Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Multnomah, Washington 39,580
OR FamilyCare Health Plans Commercial MCO
Risk-based Capitation
1115 Clackamas, Clatsop, Jackson, Josephine, Marion, Morrow, Multnomah, Umatilla, Washington
42,409
OR FamilyCare, Inc. (PCO) Medicaid MCO Risk-based Capitation
1115 Morrow, Umatilla 11,972
OR Greater Oregon Behavioral Health, Inc. Mental Health PIHP
Risk-based Capitation
1115 Baker, Clatsop, Columbia, Douglas, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Umatilla, Union, Wallowa, Wheeler
72,722
OR InterCommunity Health Network Medicaid MCO Risk-based Capitation
1115 Benton, Lincoln, Linn, Tillamook 30,963
OR Jefferson Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Coos, Curry, Jackson, Josephine, Klamath 80,759
OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-based Capitation
1115 Clackamas, Marion, Multnomah, Polk 12,988
OR Lane Care MHO Mental Health PIHP
Risk-based Capitation
1115 Lane 54,322
OR Lane Individual Practice Association Medicaid MCO Risk-based Capitation
1115 Benton, Lane, Linn 48,899
OR Managed Dental Care of Oregon Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 17,332
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 43
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OR Marion Polk Community Health Plan Medicaid MCO Risk-based Capitation
1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 62,075
OR Mid Rogue Independent Physician Association
Medicaid MCO Risk-based Capitation
1115 Curry, Douglas, Jackson, Josephine 23,325
OR Mid Valley Behavioral Care Network Mental Health PIHP
Risk-based Capitation
1115 Linn, Marion, Polk, Tillamook, Yamhill 112,914
OR MultiCare Dental Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 34,470
OR ODS Community Health (Dental) Dental PAHP Risk-based Capitation
1115 Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Hood River, Jackson, Jefferson, Josephine, Lane, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Wallowa, Wasco, Washington, Yamhill
70,322
OR ODS Community Health Inc. Medicaid MCO Risk-based Capitation
1115 Baker, Clatsop, Columbia, Jackson, Malheur, Union, Wallowa, Yamhill
13,170
OR Oregon Health Management Services Medicaid MCO Risk-based Capitation
1115 Douglas, Jackson, Josephine 5,611
OR PacificSource Community Solutions Medicaid MCO Risk-based Capitation
1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler
39,942
OR PacificSource Community Solutions (Mental Health)
Mental Health PIHP
Risk-based Capitation
1115 Crook, Deschutes, Jefferson, Klamath 31,515
OR PCCM Traditional PCCM Provider
Primary Care Case
Management Fee
1115 Statewide 3,024
OR Providence Elder Place PACE Risk-based Capitation
PACE 97009, 97010, 97014, 97019, 97024, 97030, 97034, 97035, 97056, 97060, 97080, 97124, 97133, 97201, 97202, 97203, 97204, 97205, 97206, 97209, 97210, 97211, 97212, 97213, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97222, 97225, 97227, 97229, 97230, 97231, 97232, 97233, 97236, 97239, 97258, 97266
965
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 44
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OR Providence Health Assurance Medicaid MCO Risk-based Capitation
1115 Clackamas, Multnomah, Washington, Yamhill 24,034
OR Tuality Health Alliance Medicaid MCO Risk-based Capitation
1115 Washington 10,764
OR Verity MHO Mental Health PIHP
Risk-based Capitation
1115 Multnomah 95,030
OR Washington County Health (Mental Health)
Mental Health PIHP
Risk-based Capitation
1115 Washington 48,868
OR Willamette Dental Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Deschutes, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill
79,649
PA Access Plus Program Traditional PCCM Provider
Primary Care Case
Management Fee
1915(b) Bradford, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
268,641
PA Adult Community Autism Program/Keystone Autism Services
Long Term Care PIHP
Risk-based Capitation
1915(a) Chester County, Cumberland County, Dauphin County, Lancaster County
99
PA Aetna Better Health Commercial MCO
Risk-based Capitation
1915(b), 1932(a)/1915(c)
Adams, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, Franklin, Fulton, Huntington, Lancaster, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, York
53,753
PA Albright LIFE PACE Risk-based Capitation
PACE Clinton, Lancaster, Lycoming 160
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan
Commercial MCO
Risk-based Capitation
1915(b) Adams, Berks, Cumberland, Dauphin, Franklin, Fulton, Huntington, Lancaster, Lebanon, Lehigh, Northampton, Perry, York
101,394
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL
Commercial MCO
Risk-based Capitation
1915(a) Carbon, Lackawanna, Luzerne, Monroe, Pike 4,651
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 45
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA Community Care Behavioral Health - North Central
MH/SUD PIHP Risk-based Capitation
1915(b) Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniat
142,980
PA Community Care Behavioral Health - Northeast
MH/SUD PIHP Risk-based Capitation
1915(b) Lackawanna, Luzerne, Susquehanna, Wyoming 90,854
PA Community LIFE PACE Risk-based Capitation
PACE 14145, 15014, 15018, 15020, 15024, 15025, 15028, 15030, 15032, 15034, 15035, 15037, 15045, 15047, 15049, 15051, 15065, 15075, 15076, 15084, 15088, 15102, 15104, 15110, 15112, 15120, 15122, 15129, 15131, 15132, 15133, 15135, 15137, 15139, 15140, 15144, 15146, 15147, 15148, 15206, 15207, 15208, 15215, 15217, 15218, 15221, 15227, 15232, 15234, 15235, 15236, 15238, 15239, Allegheny, Washington & Westmoreland
406
PA Counties of Armstrong/Indiana - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Armstrong, Indiana 20,808
PA Counties of Bedford/Somerset - Community Behavioral Healthcare Network of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Bedford County, Somerset County 16,065
PA Counties of Carbon/Monroe/Pike - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Carbon, Monroe, Pike 36,255
PA Counties of Crawford/Mercer/Venango - Value Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b), 1932(a)/1915(c)
Crawford, Mercer, Venango 42,196
PA Counties of Franklin/Fulton - Community Behavorial Healthcare Network of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Franklin, Fulton 17,654
PA Counties of Lycoming/Clinton - Community Behavioral Healthcare Network of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Clinton, Lycoming 20,961
PA County of Adams - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Adams 8,286
PA County of Allegheny - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Allegheny 159,963
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 46
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA County of Beaver - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Beaver 23,758
PA County of Berks - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Berks 61,000
PA County of Blair County - Community Behavioral Healthcare Network of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Blair 21,012
PA County of Bucks - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Bucks 45,323
PA County of Butler - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Butler 16,481
PA County of Cambria - Value Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Cambria 21,018
PA County of Chester - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Chester 30,455
PA County of Cumberland - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Cumberland 17,259
PA County of Dauphin - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Dauphin 38,123
PA County of Delaware - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Delaware 68,921
PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Erie 51,839
PA County of Fayette - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Fayette 28,719
PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lancaster 58,690
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 47
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA County of Lawrence - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Lawrence 14,358
PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lebanon 16,539
PA County of Lehigh - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Lehigh 50,289
PA County of Montgomery - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Montgomery 55,787
PA County of Northampton - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Northampton 31,275
PA County of Perry - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Perry 4,513
PA County of Philadelphia - Community Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Philadelphia 444,474
PA County of Washington - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Washington 24,249
PA County of Westmoreland - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Westmoreland 42,463
PA County of York - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) York 49,719
PA Coventry Care Commercial MCO
Risk-based Capitation
1915(b) Allegheny, Armstrong, Beaver, Bedford, Blair, Bucks, Butler, Cambria, Chester, Delaware, Fayette, Greene, Indiana, Lawrence, Montgomery, Philadelphia, Somerset, Washington, Westmoreland
25,443
PA Everyday LIFE PACE Risk-based Capitation
PACE Berks, Lehigh, Northampton 67
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 48
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA Gateway Health Plan, Inc. Commercial MCO
Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Blair, Butler, Cambria, Cumberland, Dauphin, Fayette, Franklin, Fulton, Greene, Huntington, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Somerset, Washington, Westmoreland, York
239,415
PA Gateway Health Plan, Inc. -VOL Commercial MCO
Risk-based Capitation
1915(a) Blair, Erie 6,392
PA Health Partners of Philadelphia Commercial MCO
Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 152,862
PA Keystone Mercy Health Plan Commercial MCO
Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 307,056
PA LIFE Beaver/Lawrence PACE Risk-based Capitation
PACE Beaver, Lawrence 294
PA Life Butler PACE Risk-based Capitation
PACE Butler County 81
PA LIFE Geisinger PACE Risk-based Capitation
PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union, Wyoming
163
PA LIFE Lutheran Services PACE Risk-based Capitation
PACE Adams, Cumberland, Franklin 77
PA LIFE Northwestern PA Medical-only PIHP
Risk-based Capitation
1915(a) Erie 70
PA LIFE Pittsburgh PACE Risk-based Capitation
PACE 15006, 15007, 15015, 15017, 15031, 15044, 15046, 15056, 15064, 15071, 15082, 15086, 15090, 15091, 15101, 15106, 15108, 15116, 15126, 15127, 15136, 15142, 15143, 15201, 15202, 15203, 15204, 15205, 15209, 15210, 15211, 15212, 15213, 15214, 15216, 15219, 15220, 15222, 15223, 15224, 15225, 15226, 15228, 15229, 15233, 15237, 15241, 15243
394
PA LIFE St Mary PACE Risk-based Capitation
PACE Bucks 141
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 49
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA LIFE University of Pennsylvania PACE Risk-based Capitation
PACE 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153
436
PA Logisticare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Philadelphia 0
PA Mercy LIFE PACE Risk-based Capitation
PACE 19106, 19107, 19111, 19114, 19115, 19116, 19123, 19124, 19125, 19134, 19135, 19136, 19137, 19145, 19146, 19147, 19148, 19149, 19152, 19154, Philadelphia
431
PA New Courtland LIFE PACE Risk-based Capitation
PACE Philadelphia County zip codes 19118, 19119, 19120, 19126, 19127, 19128, 19129, 19132, 19138, 19141,
265
PA Senior LIFE York PACE Risk-based Capitation
PACE York 73
PA Senior LIFE Johnstown PACE Risk-based Capitation
PACE Blair, Cambria, Dauphin, Somerset County zip codes 15531, 15928, 15935, 15953 and 15963, Westmoreland County zip codes 15944 and 15954, York
168
PA Senior LIFE Washington PACE Risk-based Capitation
PACE Fayette, Greene and Washington 283
PA SeniorLIFE Ebensburg PACE Risk-based Capitation
PACE Blair, Cambria, Indiana 71
PA United Healthcare of PA Commercial MCO
Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Butler, Cambria, Cumberland, Dauphin, Fayette, Franklin, Fulton, Greene, Huntington, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Somerset, Washington, Westmoreland, York
169,038
PA United Healthcare of PA, Inc. - VOL Commercial MCO
Risk-based Capitation
1915(a) Blair, Bradford, Cambria, Carbon, Clarion, Columbia, Crawford, Erie, Forest, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Pike, Schuylkill, Somerset, Sullivan, Susquehanna, Warren, Wyoming
31,702
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 50
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA UPMC Health Plan, Inc./UPMC for You Commercial MCO
Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Bedford, Berks, Butler, Cambria, Cumberland, Dauphin, Fayette, Franklin, Fulton, Greene, Huntington, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Somerset, Washington, Westmoreland, York
156,160
PA UPMC Health Plan, Inc./UPMC for You - VOL
Commercial MCO
Risk-based Capitation
1915(a) Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango
8,414
PA Value Behavioral Health of PA (Greene County)
MH/SUD PIHP Risk-based Capitation
1915(b) Greene 6,819
PR American Health Medicare Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
31,090
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 51
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PR APS Healthcare - MBHO MH/SUD PIHP Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Anasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamon, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Catano, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabella, Jayuya, Juana Diaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Lioza, Luquillo, Manati, Maricao, Maunabo, Mayaguez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Penuelas, Ponce, Quebradillas, Rincon, Rio Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
1,143,127
PR First Medical/First Plus Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamon, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Diaz, Juncos, Lajas, Las Marias, Las Piedras, Loiza, Luquillo, Manati, Maricao, Maunabo, Mayaguez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Rio Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vieques, Villalba, Yabucoa, Yauco
700
PR Humana Health Plans of Puerto Rico, Inc.- MCO
Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, Cayey, Cidra, Coamo, Guanica, Guayama, Guayanilla, Gurabo, Humacao, Jayuya, Juana Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Penuelas, Ponce, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa, Yauco
402,717
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 52
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PR Humana Puerto Rico Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canóvanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerío, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Loíza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
14,663
PR MCS Advantage Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Loiza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
49,132
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 53
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PR MMM Healthcare Inc. Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
66,401
PR PMC Medicare Choice Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
21,725
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 54
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PR Triple S Commercial MCO
Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
6,808
PR Triple-S, Inc.- TPA Commercial MCO
Risk-based Capitation
1915(a) Aguada, Aguadilla, Anasco, Cabo Rojo, Canovanas, Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela, Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez, Moca, Rincon, Rio Grande, Sabana Grande, San German, San Juan, San Sebastian, Trujillo Alto, Vieques
730,287
RI Connect Care Choice PCCM Provider
Fee-For-Service 1115 Statewide 1,643
RI Neighborhood Health Plan of Rhode Island
Medicaid MCO Risk-based Capitation
1115 Statewide 88,949
RI PACE Organization of Rhode Island PACE Risk-based Capitation
PACE Statewide except for Zip Codes Block Island 02807 194
RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-based Capitation
1115 Statewide 44,466
RI United HealthCare of New England Commercial MCO
Risk-based Capitation
1115 Statewide 44,894
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 55
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
SC Absolute Total Care Medicaid MCO Risk-based Capitation
1932(a) Statewide 123,530
SC AMR Transp PAHP Risk-based Capitation
1902(a)(70) Region 1, Region 2 10,147
SC BlueChoice Health Plan Medicaid MCO Risk-based Capitation
1932(a) Statewide 94,207
SC Carolina Medical Homes Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 18,624
SC First Choice by Select Health of South Carolina, Inc.
Medicaid MCO Risk-based Capitation
1932(a) Statewide 307,385
SC Logisticare Transp PAHP Risk-based Capitation
1902(a)(70) Region 3, Region 4, Region 5, Region 6 61,477
SC Palmetto Physician Connections Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 22,795
SC Palmetto SeniorCare (PACE) PACE Risk-based Capitation
PACE Lexington, Richland 427
SC South Carolina Solutions Traditional PCCM Provider
Primary Care Case
Management Fee
1932(a) Statewide 186,624
SC The Oaks PACE PACE Risk-based Capitation
PACE Calhoun, Orangeburg County 129
SC United HealthCare of SC Medicaid MCO Risk-based Capitation
1932(a) Statewide 86,861
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 56
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
SD PRIME Traditional PCCM
Provider
Primary Care Case
Management Fee
1932(a) Statewide 0
TN Alexian Brothers Community Services PACE Risk-based Capitation
PACE Hamilton 321
TN AmeriGroup Community Care Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 196,716
TN Catamaran * Pharmacy PAHP
Risk-based Capitation
1115 Statewide 1,064,490
TN Delta Dental of Tennessee Dental PAHP Non-risk Capitation 1115 Statewide 735,670
TN United Healthcare - East TN Medicaid MCO Risk-based Capitation
1115 East Tennessee 191,335
TN United Healthcare - Middle TN Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 199,474
TN United Healthcare - West TN Medicaid MCO Risk-based Capitation
1115 West Tennessee 172,122
TN Volunteer State Health Plan (Bluecare) - East
Medicaid MCO Risk-based Capitation
1115 East Tennessee 217,202
TN Volunteer State Health Plan (Bluecare) - West
Medicaid MCO Risk-based Capitation
1115 West Tennessee 179,348
TN Volunteer State Health Plan (TennCare Select)
Medical-only PIHP
Partial Capitation 1115 Statewide 46,304
TX Aetna Commercial MCO
Risk-based Capitation
1115 Bexar SDA, Tarrrant SDA 61,054
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 57
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TX Amerigroup (STAR) Medicaid MCO Risk-based Capitation
1115 Bexar SDA, Dallas SDA, Harris SDA, Jefferson SDA, Lubbock SDA, MRSA Central, MRSA East, MRSA West, Tarrant SDA
556,700
TX Amerigroup (STAR+PLUS) Medicaid MCO Risk-based Capitation
1115 Bexar SDA, El Paso SDA, Harris SDA, Jefferson SDA, Lubbock SDA, Tarrant SDA, Travis SDA
116,293
TX Bienvivir Senior Health Service PACE Risk-based Capitation
PACE 79901, 79902, 79903, 79904, 79905, 79907, 79915, 79924, 79925, 79930, 79935, 79936
845
TX Blue Cross Blue Shield Commercial MCO
Risk-based Capitation
1115 Travis SDA 10,836
TX Christus Commercial MCO
Risk-based Capitation
1115 Nueces SDA 6,956
TX Community First Commercial MCO
Risk-based Capitation
1115 Bexar SDA 82,891
TX Community Health Choice Medicaid MCO Risk-based Capitation
1115 Harris SDA, Jefferson SDA 187,344
TX Cook Children's Medicaid MCO Risk-based Capitation
1115 Tarrant SDA 72,318
TX Driscoll Medicaid MCO Risk-based Capitation
1115 Hidalgo SDA, Nueces SDA 99,476
TX El Paso First Premier Commercial MCO
Risk-based Capitation
1115 El Paso SDA 49,645
TX First Care Commercial MCO
Risk-based Capitation
1115 Lubbock SDA, MRSA West 94,873
TX Health Spring Medicaid MCO Risk-based Capitation
1115 Hidalgo SDA, Tarrant SDA 19,798
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 58
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TX Jan Werner Adult Day Care Center PACE Risk-based Capitation
PACE 79015, 79101, 79102, 79103, 79104, 79106, 79107, 79108, 79109, 79110, 79111, 79118, 79119, 79121, 79124
144
TX Logisticare Transp PAHP Risk-based Capitation
1915(b) Collin, Dallas, Denton, Ellis, Hood, Hunt, Johnson, Kaufman, Navarro, Parker, Rockwall, Tarrant, Wise
669,039
TX McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 10,334
TX Medical Transportation Management Transp PAHP Risk-based Capitation
1915(b) Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Orange, Polk, San Jacinto, Tyler, Walker, Waller, Wharton
1,047,718
TX Molina (STAR) Medicaid MCO Risk-based Capitation
1115 Dallas SDA, El Paso SDA, Harris SDA, Hidalgo SDA, Jefferson SDA
105,906
TX Molina (STAR+Plus) Medicaid MCO Risk-based Capitation
1115 Bexar SDA, Dallas SDA, El Paso SDA, Harris SDA, Hidalgo SDA, Jefferson SDA
112,313
TX Parkland Community Health Plan Medicaid MCO Risk-based Capitation
1115 Dallas SDA 164,625
TX Scott and White Commercial MCO
Risk-based Capitation
1115 MRSA Central 29,114
TX Sendero Medicaid MCO Risk-based Capitation
1115 Travis SDA 6,963
TX Seton Commercial MCO
Risk-based Capitation
1115 Travis SDA 8,903
TX Silver Star PACE Risk-based Capitation
PACE 79403, 79404, 79407, 79408, 79414, 79415, 79416, 79423, 79424, 79452, 79453, 79464, 79490, 79493, 79499
35
TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-based Capitation
1915(a) Statewide 31,039
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 59
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TX Superior HealthPlan (STAR) Medicaid MCO Risk-based Capitation
1115 Bexar SDA, El Paso SDA, Hidalgo SDA, Lubbock SDA, MRSA Central, MRSA East, MRSA West, Nueces SDA, Travis SDA
669,120
TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-based Capitation
1115 Bexar SDA, Dallas SDA, Hidalgo SDA, Lubbock SDA, Nueces SDA
95,568
TX Texas Children Health Plan Medicaid MCO Risk-based Capitation
1115 Harris SDA, Jefferson SDA 267,307
TX United Commercial MCO
Risk-based Capitation
1115 Harris SDA, Hidalgo SDA, Jefferson SDA 99,439
TX United Health Care Medicaid MCO Risk-based Capitation
1115 Harris SDA, Jefferson SDA, Nueces SDA, Travis SDA 57,952
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
469,017
UT Bear River Mental Health Services, Inc MH/SUD PIHP Risk-based Capitation
1915(b) Box Elder, Cache, Rich 14,330
UT Central Utah Counseling Center MH/SUD PIHP Risk-based Capitation
1915(b) Juab, Millard, Piujte, Sanpete, Sevier, Wayne 8,030
UT Davis Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Davis 20,575
UT Four Corners Community Behavioral Health, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Carbon, Emery, Grand 4,910
UT Health Choice Utah Medicaid MCO Risk-based Capitation
1915(b) Davis, Salt Lake 194
UT Healthy Outcomes Medical Excellence (HOME)
Medicaid MCO Risk-based Capitation
1915(a) Statewide 817
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 60
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
UT Healthy U Medical-only PAHP
Other 1915(b) Box Elder County, Davis County, Salt Lake County, Summit County, Tooele County, Utah County, Weber County
41,044
UT Molina Healthcare of Utah (Molina) Medicaid MCO Risk-based Capitation
1915(b) Statewide 61,093
UT Northeastern Counseling Center MH/SUD PIHP Risk-based Capitation
1915(b) Daggett, Duchesne, Uintah 4,655
UT Pick Me Up Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 209,691
UT Salt Lake County Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Salt Lake County 99,497
UT Select Access Enhanced PCCM
Provider
Primary Care Case
Management Fee
1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 74,804
UT Southwest Center Behavioral Health Services
MH/SUD PIHP Risk-based Capitation
1915(b) Beaver, Garfield, Iron, Kane, Washington 23,437
UT Utah County Drug & Alcohol Substance Use Disorders PAHP
Risk-based Capitation
1915(b) Utah 42,691
UT Valley Mental Health MH/SUD PIHP Risk-based Capitation
1915(b) Summit, Tooele 6,711
UT Wasatch Mental Health MH/SUD PIHP Risk-based Capitation
1915(b) Utah County 42,691
UT Weber Human Services MH/SUD PIHP Risk-based Capitation
1915(b) Morgan, Weber 25,364
VA AllCare for Seniors PACE Risk-based Capitation
PACE Buchanan, Dickerson, Russell, Tazewell 51
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 61
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Amerigroup Medicaid MCO Risk-based Capitation
1915(b) Alexandria, Alleghany, Arlington, Bath, Bedford City, Bedford County, Bland, Botetourt, Bristol, Buchanan, Buena Vista, Carroll, City of Manassas, Clarke, Covington, Craig, Culpeper, Dickenson, Fairfax City, Fairfax County, Falls Church, Fauquier, Floyd, Franklin County, Frederick, Galax, Giles, Grayson, Henry, Highland, Lee, Lexington, Loudoun, Madison, Manassas Park, Martinsville, Montgomery, Norton, Orange, Page, Patrick, Prince William, Pulaski, Rappahannock, Roanoke City, Roanoke County, Rockbridge, Russell, Salem, Scott, Shenandoah, Smyth, Tazewell, Warren, Washington, Winchester, Wise, Wythe
49,219
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 62
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Anthem Healthkeepers Plus Commercial MCO
Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alexandria City, Alleghany, Amelia County, Arlington County, Bath, Bedford County, Bland, Botetourt, Bristol, Brunswick County, Buchanan, Buckingham County, Buena Vista, Caroline County, Carroll, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, City of Manassas, Clarke County, Colonial Heights City, Covington, Craig, Cumberland County, Dickenson, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Floyd, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Galax, Giles, Gloucester County, Goochland County, Grayson, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Henry, Highland, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Lee, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Montgomery, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Norton, Nottoway County, Orange County, Page, Patrick, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Pulaski, Rappahannock, Richmond City, Richmond County, Roanoke City, Roanoke County, Rockbridge, Russell, Salem, Scott, Shenandoah, Smyth, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Tazewell, Virginia Beach City, Warren County, Washington, Westmoreland County, Williamsburg City, Winchester City, Wise, Wythe, York, York County
220,835
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 63
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA CareNet Commercial MCO
Risk-based Capitation
1915(b) Alleghany, Amelia County, Amherst County, Appomattox County, Bath, Bedford City, Bedford County, Bland, Bristol City, Buchanan, Campbell County, Caroline County, Charles City County, Chesterfield County, Colonial Heights City, Covington City, Craig, Cumberland County, Dickenson, Dinwiddie County, Essex County, Floyd, Franklin County, Galax, Giles, Goochland County, Grayson, Hanover County, Henrico County, Henry, Highland, Hopewell City, King and Queen County, King William County, Lancaster County, Lee, Lunenburg County, Lynchburg, Martinsville City, Mecklenburg County, Middlesex County, Montgomery, New Kent County, Northumberland County, Norton, Nottoway County, Patrick, Petersburg City, Powhatan County, Prince George County, Pulaski, Radford, Richmond City, Richmond County, Roanoke City, Roanoke County, Rockbridge, Russell, Salem, Scott, Smyth, Surry County, Sussex County, Tazewell, Washington, Westmoreland, Wise, Wythe
34,376
VA Centra Health PACE Risk-based Capitation
PACE Amherst, Bedford, Campbell, Forest, Lynchburg 89
VA INOVA Cares for Seniors PACE Risk-based Capitation
PACE Fairfax City, Fairfax County, Falls Church 3
VA LogistiCare Solutions Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 292,908
VA MajestaCare Medicaid MCO Risk-based Capitation
1915(b) Alleghany, Bath, Bedford City, Bedford County, Bland, Botetourt, Bristol City, Buchanan, Buena Vista City, Carroll, Covington, Craig, Dickenson, Floyd, Franklin, Galax City, Giles, Grayson, Henry, Highland, Lee, Martinsville City, Montgomery, Norton City, Patrick, Pulaski, Radford City, Roanoke City, Roanoke County, Rockbridge, Russell, Salem City, Scott, Smyth, Tazewell, Washington, Wise, Wythe
10,750
VA MEDALLION II Medicaid MCO Risk-based Capitation
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
0
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 64
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Mountain Empire PACE Risk-based Capitation
PACE Lee, Norton, Scott, Wise 103
VA Optima Family Care Commercial MCO
Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alleghany, Amelia County, Amherst County, Appomattox County, Augusta County, Bath, Bedford City, Bedford County, Bland, Botetourt, Bristol, Brunswick County, Buchanan, Buckingham County, Buena Vista City, Campbell County, Caroline County, Carroll, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Colonial Heights City, Covington, Craig, Cumberland County, Danville City, Dickenson, Dinwiddie County, Emporia City, Essex County, Floyd, Fluvanna County, Franklin City, Franklin County, Galax City, Giles, Gloucester County, Goochland County, Grayson, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry, Highland, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Lee, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mathews County, Mecklenburg County, Middlesex County, Montgomery, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Norton City, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski, Richmond City, Richmond County, Roanoke City, Roanoke County, Rockbridge, Rockingham County, Russell, Salem City, Scott, Smyth, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Tazewell, Virginia Beach City, Washington, Waynesboro City, Westmoreland County, Williamsburg City, Wise, Wythe, York County
155,003
VA Riverside PACE PACE Risk-based Capitation
PACE Hampton, Hanover, Henrico, Newport News, Partial portion of Caroline, Partial portion of Charles City, Partial portion of Chesterfield, Partial portion of Colonial Heights, Partial portion of Goochland, Partial portion of Hopewell, Partial portion of King William, Partial portion of Louisa, Partial portion of New Kent, Partial portion of Powhatan, Partial portion of Prince George, Petersburg, Poquoson, Richmond City, Southeastern portion of York County
335
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 65
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Sentara Senior Community Care PACE Risk-based Capitation
PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 189
VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alleghany, Amelia County, Amherst, Appomattox County, Augusta County, Bath, Bedford City, Bedford County, Bland, Botetourt County, Bristol, Brunswick County, Buchanan, Buckingham County, Buena Vista City, Campbell County, Carroll, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Covington, Craig, Cumberland County, Danville, Dickenson, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Galax, Giles County, Goochland County, Grayson, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Highland, Hopewell City, Isle of Wight, King George County, King William County, Lee, Lexington, Louisa County, Lunenburg County, Lynchburg City, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Norton, Nottoway County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Russell, Salem City, Scott, Shenandoah County, Smyth, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Tazewell, Virginia Beach City, Washington, Waynesboro City, Westmoreland County, Winchester City, Wise, Wythe County
151,566
VT Global Commitment to Health Medicaid MCO Risk-based Capitation
1115 Statewide 105,314
VT PACE PACE Risk-based Capitation
PACE Chittenden County, Lower Grand Isle County, Rutland County 120
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 66
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WA Amerigroup Commercial MCO
Risk-based Capitation
1115, 1932(a) Columbia, Garfield, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima
16,512
WA Community Health Plan Commercial MCO
Risk-based Capitation
1115, 1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oriellle, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima
284,803
WA Coordinated Care Commercial MCO
Risk-based Capitation
1115, 1932(a) Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Whitman, Yakima
33,711
WA Cowlitz County Guidance Association Disease Management
PAHP
Risk-based Capitation
1932(a) Cowlitz County 219
WA Molina Healthcare Commercial MCO
Risk-based Capitation
1115, 1932(a) Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima
376,958
WA Molina Healthcare (WMIP) Commercial MCO
Risk-based Capitation
1932(a) Snohomish 4,313
WA OptumHealth MH/SUD PIHP Risk-based Capitation
1915(b) Pierce County 125,797
WA Providence ElderPlace - Seattle PACE Risk-based Capitation
PACE King 435
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 67
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WA Regional Support Network Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 1,014,479
WA United Health Care Commercial MCO
Risk-based Capitation
1115, 1932(a) Statewide 24,625
WI Care Wisconsin First, Inc. (FC) Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Columbia, Dodge, Green Lake, Jefferson, Marquette, Washington, Waukesha, Waushara
3,556
WI Care Wisconsin Health Plan, Inc. (Partnership)
Medicaid MCO Risk-based Capitation
1932(a)/1915(c) Dane County 1,321
WI Children's Community Health Plan - Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha
44,680
WI CHP-LTS, Inc. (FC) Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Chippewa, Dunn, Eau Claire, Pierce, St. Croix 1,200
WI Community Care Health Plan, Inc. (Partnership)
Commercial MCO
Risk-based Capitation
1932(a)/1915(c) Milwaukee 469
WI Community Care of Central Wisconsin (FC)
Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Marathon, Portage, Wood 3,281
WI Community Care Organization (PACE) PACE Risk-based Capitation
PACE Milwaukee 939
WI Community Care, Inc. (FC) Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha
7,829
WI CommunityConnect Health Plan - Medicaid HMO
Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Washington, Waukesha
13,377
WI Compcare -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Jackson, Juneau, La Crosse, Marquette, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn
21,968
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 68
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI Compcare - SSI Medicaid MCO Risk-based Capitation
1932(a) Chippewa, Douglas, Eau Claire, Grant, Green, Iowa, Juneau, Lafayette, Richland, Vernon, Washburn
156
WI Dane County Human Services Department -- CCF
MH/SUD PIHP Risk-based Capitation
1915(a) Dane 91
WI Dean Health Plan -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Grant, Green, Iowa, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Sauk, Walworth, Waukesha
42,103
WI Group Health Cooperative Of Eau Claire -- Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Adams, Barron, Bayfield, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, Lafayette, Lincoln, Marathon, Monroe, Ozaukee, Pepin, Pierce, Price, Rusk, Sauk, Sawyer, St. Croix, Taylor, Trempealeau, Vernon, Washburn
33,338
WI Group Health Cooperative of Eau Claire County SSI
Commercial MCO
Risk-based Capitation
1932(a) Buffalo, Chippewa, Columbia, Crawford, Douglas, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, La Crosse, Lafayette, Monroe, Pepin, Richland, Trempealeau, Vernon, Washburn
1,736
WI Group Health Cooperative Of South Central WI -- Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Dane 3,985
WI Gundersen Lutheran Health Plan - Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Richland, Sauk, Trempealeau, Vernon
17,114
WI Health Tradition Health Plan -- Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, La Crosse, Monroe, Trempealeau, Vernon
9,200
WI Independent Care (iCare) - Medicaid HMO
Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha
8,689
WI Independent Care Health Plan -- SSI Medicaid MCO Risk-based Capitation
1932(a) Brown, Kenosha, Manitowoc, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Winnebago
8,689
WI Independent Care Health Plan (SNP) Medicaid MCO Risk-based Capitation
1932(a)/1915(c) Milwaukee 535
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 69
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI Lakeland Care District Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Fond du Lac 2,736
WI Managed Health Services -- Medicaid HMO
Medicaid MCO Risk-based Capitation
1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Green Lake, Jefferson, Kenosha, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
33,598
WI Managed Health Services -- SSI Medicaid MCO Risk-based Capitation
1932(a) Kensosha, Milwaukee, Racine, Waukesha 5,694
WI MercyCare Insurance Company -- Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Dane, Green, Jefferson, Rock, Walworth 14,962
WI Milwaukee County Department of Family Care
Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Milwaukee 7,835
WI Milwaukee County Human Services Department -- Wraparound Milwaukee
MH/SUD PIHP Risk-based Capitation
1915(a) Milwaukee 868
WI Molina Health Plan -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Brown, Dodge, Green Lake, Jefferson, Kenosha, Kewaunee, Lincoln, Marathon, Marquette, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Shawano, Vilas, Washington, Waukesha, Waupaca, Waushara, Winnebago
40,037
WI Molina Health Plan -- SSI Commercial MCO
Risk-based Capitation
1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago
1,659
WI Network Health Plan -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Forest, Green Lake, Jefferson, Kenosha, Langlade, Lincoln, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
32,516
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 70
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI Network Health Plan - SSI Commercial MCO
Risk-based Capitation
1932(a) Brown, Calumet, Chippewa, Clark, Dodge, Door, Douglas, Eau Claire, Fond di Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Milwaukee, Monominee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
2,569
WI Northern Bridges Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Ashland, Barron, Bayfield, Burnett, Douglas, Iron, Polk, Price, Rusk, Sawyer, Washburn
2,092
WI Partnership Health Plan, Inc. Commercial MCO
Risk-based Capitation
1932(a)/1915(c) Chippewa, Dunn, Eau Claire 1,546
WI Physicians Plus Health Plan - Medicaid HMO
Commercial MCO
Risk-based Capitation
1932(a) Dane 8,444
WI Security Health Plan -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Polk, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Vilas, Washburn, Waupaca, Wood
54,650
WI Southwest Family Care Alliance Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Crawford, Green, Juneau, Lafayette, Richland, Sauk 2,043
WI UnitedHealthcare Community Plan of WI - Medicaid HMO
Medicaid MCO Risk-based Capitation
1932(a) Ashland, Barron, Bayfield, Brown, Burnett, Calumet, Dodge, Door, Douglas, Fond du Lac, Forest, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Pierce, Polk, Portage, Price, Racine, Rock, Sawyer, Shawano, Sheboygan, St. Croix, Taylor, Vilas, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
282,220
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 71
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI UnitedHealthcare Community Plan of WI -- SSI
Commercial MCO
Risk-based Capitation
1932(a) Ashland, Barron, Bayfield, Brown, Burnett, Calumet, Dodge, Door, Douglas, Fond du lac, Forest, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Lincoln, Manitowoc, Marathon, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Sawyer, Shawano, Sheboygan, St. Croix, Taylor, Vilas, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
13,407
WI Unity Health Insurance -- Medicaid HMO Commercial MCO
Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Green, Jefferson, Sauk 11,445
WI Western Wisconsin Cares Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, Vernon
3,872
WV Carelink Health Plan Commercial MCO
Risk-based Capitation
1915(b), 1937 Barbour, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Hancock, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Monroe, Nicholas, Ohio, Pleasants, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tyler, Wayne, Webster, Wetzel, Wirt, Wood, Wyoming
60,128
WV Health Plan of the Upper Ohio Valley Commercial MCO
Risk-based Capitation
1915(b), 1937 Barbour, Brooke, calhoun, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler, Upshur, webster, Wetzel, Wirt, Wood
25,947
WV Physician Assured Access System PCCM Provider
Fee-For-Service 1915(b) Statewide 3,986
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 72
State Plan
July 1, 2012
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WV Unicare Health Plan of WV Commercial MCO
Risk-based Capitation
1915(b), 1937 Barbour, Berkeley, Boone, Braxton, brooke, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pendleton, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming
80,413
TOTAL NUMBER OF ENROLLEES: 64,254,247
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2012
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE 73
74
Medicaid Managed Care Enrollment Report Glossary as of July 1, 2012
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.
75
• Other – The structure of the managed care plan is not considered a PCCM, PIHP, PAHP, Commercial MCO, Medicaid-only MCO, HIO, or PACE.
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.
