MEDICAID FFS TO MCO TRANSITIONS AND DUAL ELIGIBLE DEMONSTRATIONS REPORT 2015 Updated 12/18/15 Copyright Artia Solutions 2015

Transcription

1 MEDICAID FFS TO MCO TRANSITIONS AND DUAL ELIGIBLE DEMONSTRATIONS REPORT 2015 Updated 12/18/15 Copyright Artia Solutions 2015 State Activity Recent Developments Red=New Information Florida 2/19/15 has released an RFP that moves nearly all of the current recipients (570,000) into managed effective 1/1/16. The MCO s will be required to follow a statewide PDL. 8/17/15: Dept of Human Services awarded to 4 plans: Amerigrou, AmeriHealth Plan of River Valley, Inc, UnitedHealthCare Plan of the River Valley, Inc, and WellCare of 12/18/15 CMS announced that was not ready to transition FFS lives to MCO. Implementation has been delayed 60 days 5/6/2011 HB7107&7109 passed on 5/6/2011. Bill places overwhelming majority of recipients into Care. agency must submit invitations to negotiate with managed care plans by January Includes long term care, which will implement July See 7107 summary document for detailed information on the plan. Update 8/12/11: Waiver submitted to CMS on 8/1/11. Enrollment expected to begin 4Q2013. Update 1/28/13: ITN was released on 12/28/12. Proposals are due 3/15/13 and contract awards expected September ITN requirement is that the MCO s follow the state s PDL for the first year. Then up to state s discretion to continue or request formularies from MCO s. Manufacturers will be expected to pay supplemental rebates on MCO utilization once program is implemented in 1/1/2014 2/20/13: Florida received approval for the statewide managed waiver adding million lives. The state and CMS reached agreement in principle and final details of the waiver are being developed. 9/23/13: State announced the selection of 10 general, nonspecialty plans: Amerigroup, Better Health, First Coast Advantage, Humana, IntegralHealth, Preferred Medical Plan, Prestige Health Choice, Sunshine State Health Plan (Centene), UnitedHealthCare, Wellcare. Update 7/25/14: Florida released MCO enrollment in which 8 of the 11 regions have completed their transition to. 1.9 million lives have been transitioned to date.

2 Illinois Illinois Gov. Quinn (D) signed a measure that reforms the state s program by increasing the use of managed care, and requiring more rigorous proof of eligibility. The state estimates that the measure will save up to $774 million over the next five years in part by enrolling over 50% of beneficiaries in managed care plans and ending the state s presumptive eligibility policy. Approximately 8% of all current beneficiaries in Illinois are enrolled in fully capitated managed care plans. 5/24/12: The state is seeking Federal approval for early expansion in Cook County. There are approximately 100,000 beneficiaries right now in Cook County whose costs would be picked up under Expansion guidelines. Remember, the Feds pay 100% of Expansion for the first 3 years. 7/2/14: 1.7 million recipients, ½ of current enrollment, will begin receiving managed enrollment packets in the Fall Those who do no select a plan by 1/1/15 will be automatically assigned one. Recipients can change plans in the first 90 days. Target date for transition is 1/1/15 North Carolina April 2013: Governor announced the intent to develop a plan to move FFS lives to. The program is called: Partnership for a Healthy North Carolina. 12/5/13: NC Reform Committee met and began discussions. 3 more meetings to take place in 2014 (Jan-Mar). Reform proposal expected to be presented to the legislature in Spring 2014 March 2014: Reform Advisory Group proposes to begin moving to ACO model in July By 2018, 80% of lives would be managed by ACO s. ACO s would be at full risk. September 2015: privatization is passed and signed into law. 3 plans will be contracted with. Not expected to take place until 2019 Alabama Delaware Nebraska 3/27/13: The Alabama Advisory Commission is recommending that they move all lives into MCO s by The plan is being presented to the House and Senate. 6/17/13: State released a proposal of the 5 regions in the state. MCO plans to be selected and ready to go by Oct /30/14 Alabama submitted a 1115 waiver allowing them to move a RCO (capitated) model. On 1/31/14 a RFP was released for the re-procurement of the MCO s. Proposals are due April 4, Currently Delaware carves out the pharmacy benefit from the MCO s and manages it in the FFS benefit. The RFP indicates the state will be removing the carve out and instead implementing a statewide PDL. Delaware has come to agreement with United HealthCare and soon with Highmark. Effective 1/1/15 State intends to release a RFP in July 2014 for it s statewide managed care program. Transition expected in No progress to date 10/21/15: State issued an RFP for statewide. The contracts would be effective 1/1/17. Pharmacy will be carved back into the MCO s

3 Louisiana Indiana Michigan Bayou Health Program contracts with MCO s are expiring and the state intends to release an RFP for plans to change to a fully capitated model. New contracts will take place in Feb This impacts 900,000 lives Healthy Indiana Plan 2.0 This is Indiana s expansion that will assist about 350,000 These recipients will be managed by MCO s who will be fully capitated for all services. Pharmacy will NOT be carved out as standard FFS is. Coverage begins 2/1/15 Michigan has decided not to pursue a statewide PDL. Recent RFP s do not contain any language mandating that the MCO s follow the states PDL. 10/21/15: RFP awards have ben protested. New plan contracts due to be effective 1/1/16 Missouri California Colorado Connecticut 10/1/15: Moving XXX lives into effective 1/1/16. MCO plans will be required to follow the state s PDL 10/10/15: The state awarded contracts to Amerigroup, AmeriHealth Caritas, UntedHealthcare, and WellCare. DUAL ELIGIBLE DEMONSTRATION PROJECTS Timeframe: Not Pursuing Timeframe: January 2014 MOU executed with CMS Program will cover 350,000 Duals. Program will begin June 2013 using a capitated model. Opt enrollment bagan 4/1/14. Passive enrollment 5/1/14 HEALTH PLANS: CALOPTIMA, CARE 1 ST PARTNER PLAN, COMMUNITY HEALTH GROUP PARTNER, HEALTH NET, HEALTH PLAN OF SAN MATEO, INLAND EMPIRE HALTH PLAN, LA CARE, MOLINA, SANTA CLARA FAMILY HEALTH PLAN, ANTHEM 10/1/15: Passive enrollment in Orange Co for LTC delayed until 11/1/15 (3500 recipients) Timeframe: MOU executed 2/28/14 Duals program will cover 62,982 lives. Passive enrollment began 9/1/14 Timeframe: 2013 Delayed MOU Pending Program will cover 57,569 lives. Idaho CANCELLED

4 Illinois Timeframe: 1/1/14 (voluntary enrollment) MOU executed with CMS Contracts were awarded to Aetna Better Health, IliniCare Health Plan (Centene), Meridian Health Plan of Illinois, HealthSpring of Illinois, Humana Health Plan, BCBS of Illinois, Molina Healthcare of Illinois, and Health Alliance Medical Plans. The program began 1/1/13 and will cover 136,000 Duals. Voluntary enrollment begins 3/1/14 and passive enrollment will begin 6/1/14 10/1/15: Health Alliance will withdraw from being a participating plan effective 12/31/15. Massachusetts Timeframe: Oct 2013 MOU executed with CMS Contracts awarded to BCBS of Mass, Boston Medical Center HealthNet Plan, Commonwealth Care Alliance, Fallon Total Care, Neighborhood Health Plan, and Network Health. The state was first to enter a MOU with CMS. Program will cover 90,000 Duals between ages of Contracts begin 4/1/13 8/7/13: Neighborhood Health, BCBS, and Boston Medical Ctr have dropped out of participation citing low rates and losses. 10/1/15: Fallon Health has withdrawn from being a participating plan effective 10/1/15. 10/1/15: State is asking for a 2 year extension of the Demo in order to give it time to fully understand the impact of the project. Michigan Timeframe: MOU executed 4/3/14 100,000 duels will be impacted. Opt In enrollment begins 10/1/14. Program Opt-IN enrollment is effective 3/1/15. Passive enrollment begins 5/1/15 It will be a 3-way capitated model between Michigan-CMS-8 ICO s (Integrated Care Organizations. Behavior health is carved out to Michigan s Prepaid Inpatient Health Plans (PIHP). The Behavior Health carve out includes substance abuse disorder. Participating plans are: AmeriHealth Michigan, Coventry, Fidelis, SecureCare, Meridian Health Plan, Midwest Health Plan, Molina Healthcare, UnitedHealthcare, Upper Peninsula Health Plan 5/1/15: Passive enrollment began Minnesota Ohio Oklahoma Wisconsin Arizona Timeframe: MOU executed 12/11/12 Contracted with Aetna, Molina, CareSource/Humana, Centene, and UnitedHealth. Will cover 114,972 Duals. population will begin enrollment in May-June Medicare population from May-December. 1/1/15 will begin auto-enrollment for Medicare population Timeframe: 2013 MOU Pending Program will cover 79,891 Duals. Timeframe: 2013 MOU Pending Program to begin 4/1/13 and will cover 17,600 Duals Timeframe: 2014 Project Cancelled

5 Hawaii Idaho New York Rhode Island Timeframe: 2014 Program will begin 1/1/14 and will cover 24,189 Duals Project Cancelled Timeframe: 2014 Proposals from MCO s due May-June Capitated model will cover 17,735 Duals. Program to begin 1/1/14 Timeframe: 2014 MOU Executed with CMS Program to begin 1/1/14 and will cover 133,880 Duals using a capitated model. Voluntary enrollment begins 1/1/15. Passive enrollment begins 4/1/15. Update 1/15/15: Letters sent to 100,000 recipients on 1/1/15 telling they would be passively enrolled effective 4/1/15. Recipients have the ability to opt out of the demonstration program Phase two enrollment has been delayed Timeframe: Nov 2013 MOU Pending RFP issued 5/30/14. Impacts 31,668 Duals Program start date of 1/1/15 Opt In enrollment to begin South Carolina Timeframe: MOU executed 10/25/13 MCO contracts to Absolute Total Care (Centene), Advicare, Molina, Select Health, and Welcare Program will cover 53,000 Duals and will use a capitated model. Opt IN enrollment begins 2/1/15. Passive enrollment begins 4/1/16 Tennessee Texas Timeframe: 2015 MOU Approved Program will pilot in six of the states most populous counties (Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant) Expects to cover 168,000 lives. Participating plans include: Amerigroup, Molina, Superior, United, and Cigna-HealthSpring Enrollment has begun 3/1/15http:// Vermont Virginia Timeframe: Feb 1, 2014 MCO contract awards expected July Program covers 78,600 of the 110,634 Duals. Program begins 1/1/14 using capitated model. MOU executed 5/22/13 7/12/13: state has selected three plans: Anthem HealthKeepers, Humana, and Virginia Premier Enrollment completed 5/1/14 Virginia will NOT continue the demonstration project past 2017

6 Washington Timeframe: 2014 MOU executed with CMS MCO contract awards expected July Covers 115,000 Duals. Program begins 1/1/14. Capitated model.

7