Question

List the three reasons Medicaid enrolled members in managed care plans. (3-7 sentences)

Answer 1

Ans) - Medicaid provides benefits to more people than even Medicare

- State Children's Health Insurance Program (SCHIP) expanded eligibility for children
- Recession led to rapid growth in Medicaid
- Medicaid has been expanded numerous times

Medicaid federally mandated services:

1. Hospital (IP and OP)
2. Physician
3. Labs and radiology
4. Diagnostic screenings
5. Federally-qualified health centers and rural health clinics
6. Tobacco cessation
7. Non-emergency transport
8. Home health
9. Nursing facilities
10. Freestanding birth center and midwife
11. Family planning

Optional services:

1. Rx
2. Physical and occupational therapy
3. Dental
4. Vision
5. Speech and hearing treatments
6. Prosthetics
7. Care for mental retardation
8. Hospice

Reason for which Medicaid enrolled members in managed care plans:

1. Comprehensive network
2. Effective UM, DM, CM (case management) programs
3. Effective customer support - call centers, multi-language options, education
4. Ability to support ACOs, PCMHs, Home Health
5. Coordination of care for carved out services
6. Quick and accurate claims payments to providers
7. Efficient use of electronic medical records.

Elements to ensure success of managed LTC programs:

1. Population - cover as broad a population as possible
2. Benefits - include all Medicaid and waiver benefits
3. Ensure no participation limitations
4. Personalized care management - reduce waste and improve quality
5. Reimbursements - structure reimbursements to encourage appropriate utilization (e.g. home care over SNF)
6. Network development - robust network including nontraditional providers (adult day care, home-delivered meals, etc.)