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Continuum s of Care and Homeless Service Providers have been advised to "get Medicaid funding" for the vital services they provide to vulnerable individuals. This presentation outlines some basics and tips to prepare those professionals for collaboration with the world of Medicaid Funding.
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Managed Care and Medicaid for Beginners
• Spanish– Bano
– Gracias
– Dormitorio
• Italian– Bano
– Grazie
– Camera Da Letto
It’s a Whole New Language
Basic facts of Medicaid
Born in 1965, but not adopted by all states till 1982. A federal and state partnership. Government spent approximately $411
BILLION in 2011. Covers approximately 6% of US population or 58 million people before
the Affordable Care ACT. This includes 9 million persons who are “dual eligible”, for Medicaid AND Medicare.
Ability to innovate through 1115 Demonstration Waivers. The purpose of the demonstration must be to
Improve Care Increase Efficiency Reduce Costs
Whose making the Rules?
Center for Medicaid and Medicare Services (CMS) http://www.cms.gov/
Your State Medicaid Agency In CA its Medi-Cal, In Wisconsin its Badger Care, in MA its Mass Health. http://medicaiddirectors.org/about/state-directors
Whose managing the dollars in your community? A Government office, a managed Care Organization.
A Provider Organization, who decides what they can afford to do with the funding available.
5 Essential Questions
For Whom is my state using a Fee For Service (FFS) Model and for whom is my state using a Managed Care Model?
What is included in my State’s Medicaid Plan? What could be to fund Supportive Services?
Where are resources primarily managed? State, County, Local level?
Are Physical Health and Behavioral Health Carved in or Carved Out?
If there is a profit, Who Profits?
For Whom is my state using a Fee For Service (FFS) Model and for whom is my state using a Managed Care Model?
What is included in my State’s Medicaid Plan? What could be to fund Supportive Services?
Where are resources primarily managed? State, County, Local level?
Are Physical Health and Behavioral Health Carved in or Carved Out?
If there is a profit, Who Profits?
Some of that Language
Provider Network
Is a Service “Medically Necessary”? Who decides? Where do they live?
Utilization Management
Member
Last Covered Day
RATES
Contact Information:
www.pathwaystohousingpa.org
www.dbhids.org
Twitter: @Cella65 @PhillyRecovery
@Csimiriglia @PTHPA
