Post on 10-Oct-2014
2009 MEDICAID MANAGED CARE ENROLLMENT REPORT SUMMARY STATISTICS AS OF JUNE 30, 2009
This report is composed annually by the Finance, Systems, and Budget Group (FSBG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a plan-specific basis as of June 30, 2009. County level data is not collected. The information was collected from State Medicaid agencies and CMS Regional Offices. Data is presented for all States, the District of Columbia, Puerto Rico, and the Virgin Islands. Data is not presented for the following territories: Guam, Northern Mariana Islands, and American Somoa. Special Thanks to Loan Swisher and Carolyn Lawson of DSG for developing this publication and Joseph Del Pilar of DSG for designing this publication. Please Contact Carolyn Lawson at 410-786-0704; E-mail: carolyn.lawson@cms.hhs.gov or Loan Swisher at 410-786-4650; E-mail: loan.swisher@cms.hhs.gov, if you have any questions concerning this report.
Medicaid Managed Care Enrollment Report as of June 30, 2009
Table of Contents
Managed Care Trends (2000-2009) and National Breakout of Managed Care Entities and Enrollment charts ....................................... Page 1 Total Medicaid Population (in percentages) Distribution by Year: Managed Care versus “Other” from 2004-2009 .................... Page 2 Total Medicaid Population (in millions) Distribution by Year: Managed Care versus “Other” from 2004-2009 ..................... Page 3 Medicaid Managed Care Penetration Rates by State.............................. Page 4 Managed Care Entity Type Enrollment by State .................................... Page 5 Number of Managed Care Entities by State ........................................... Page 6 Top 20 Medicaid Managed Care States ................................................. Page 7 Regional Breakout of Medicaid Managed Care Enrollment & States with Comprehensive Health Care Reform Demonstrations ...... Page 8 Prepaid Ambulatory Health Plans (PAHPs) and Enrollment by State ... Page 9 Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State .......... Page 10 Medicaid Dual Eligible Enrollment by State .......................................... Page 11 Dual Eligible Enrollment by Managed Care Entity Type ...................... Page 12 Dual Eligible Enrollment by Plan ........................................................... Page 13 Medicaid Managed Care Enrollment Plan level data by State .............. Page 22 Facts Sheet (Major changes from 6/30/2008-6/30/2009)………………Page 75 New Medicaid Managed Care Plans……………………………………Page 77 Terminated Medicaid Managed Care Plans…………………………….Page 79 Glossary…………………………………………………………………Page 80
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT AS OF JUNE 30, 2009
1
TOTAL MEDICAID MANAGED CARE OTHER % MANAGED CAREYEAR POPULATION POPULATION POPULATION ENROLLMENT
2009 50,471,859 36,202,281 14,269,578 71.73%
2008 47,142,791 33,427,582 13,715,209 70.91%
2007 45,962,271 29,463,098 16,499,173 64.10%
2006 45,652,642 29,830,406 15,822,236 65.34%
2005 45,392,325 28,575,585 16,816,740 62.95%
2004 44,355,955 26,913,570 17,442,385 60.68%
2003 42,740,719 25,262,873 17,477,846 59.11%
2002 40,147,539 23,117,668 17,029,871 57.58%
2001 36,562,567 20,773,813 15,788,754 56.82%
2000 33,690,364 18,786,137 14,904,227 55.76%
These figures represent point-in-time enrollment as of June 30th for each reporting year.
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits. This table also provides unduplicated national figures for the Total Medicaid population and
Other population. The statistics also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
NATIONAL BREAKOUT OF MANAGED CARE ENTITIES
AND ENROLLMENT AS OF JUNE 30, 2009
MANAGED CARE ENTITY TYPE # OF PLANS # OF ENROLLEES
Health Insuring Organization 4 601,662
Commercial Managed Care Organization
159 10,284,082
Medicaid-only Managed Care Organization
159 13,176,581
Primary Care Case Management 36 7,275,241
Prepaid Inpatient Health Plan 152 8,593,773
Prepaid Ambulatory Health Plan 60 7,866,947
Program of ALL-inclusive Care for the Elderly
67 17,091
Other 9 2,113,534
TOTAL 646 49,928,911
This table provides duplicated figures by plan type. The total number of enrollees include 13,726,630 individuals who were individuals who were enrolled in more than one managed care plan. It also includes individuals enrolled in State healthcare reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
MANAGED CARE TRENDS
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT
2
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
2004 2005 2006 2007 2008 2009
60.68% 62.95% 65.34% 64.10%70.91% 71.73%
39.32% 37.05% 34.66% 35.90%29.09% 28.27%
Perc
ent o
f Tot
al Me
dica
id P
opul
atio
n
Year
Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009
Other
Managed Care
NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT
* Note: Numbers may not add up to totals due to rounding.
3
0.00
10.00
20.00
30.00
40.00
50.00
60.00
2004 2005 2006 2007 2008 2009
26.91 28.58 29.83 29.4633.43 36.20
17.44 16.82 15.82 16.5013.72
14.27
Tota
l Med
icaid
Pop
ulat
ion
(in m
illion
s)
Year
Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009
Other
Managed Care
4
ROW STATE MEDICAID MANAGED CARE PERCENT IN NUMBER ENROLLMENT ENROLLMENT MANAGED CARE
1 ALABAMA 812,220 540,093 66.50%2 ALASKA 101,702 0 0.00%3 ARIZONA 1,223,271 1,096,365 89.63%4 ARKANSAS 645,389 511,014 79.18%5 CALIFORNIA 6,955,761 3,632,547 52.22%6 COLORADO 467,556 444,819 95.14%7 CONNECTICUT 455,878 342,784 75.19%8 DELAWARE 170,562 126,089 73.93%9 DISTRICT OF COLUMBIA 153,779 150,406 97.81%
10 FLORIDA 2,426,010 1,600,550 65.97%11 GEORGIA 1,385,721 1,274,823 92.00%12 HAWAII 235,203 228,174 97.01%13 IDAHO 198,000 166,524 84.10%14 ILLINOIS 2,320,700 1,278,200 55.08%15 INDIANA 961,986 711,636 73.98%16 IOWA 397,823 329,897 82.93%17 KANSAS 297,290 257,464 86.60%18 KENTUCKY 768,777 638,083 83.00%19 LOUISIANA 1,006,842 692,048 68.73%20 MAINE 280,148 178,353 63.66%21 MARYLAND 787,366 620,024 78.75%22 MASSACHUSETTS 1,227,109 731,123 59.58%23 MICHIGAN 1,629,959 1,447,373 88.80%24 MINNESOTA 675,149 426,009 63.10%25 MISSISSIPPI 673,630 512,796 76.12%26 MISSOURI 895,077 883,423 98.70%27 MONTANA 84,785 56,434 66.56%28 NEBRASKA 214,699 179,512 83.61%29 NEVADA 213,440 178,711 83.73%30 NEW HAMPSHIRE 124,498 96,553 77.55%31 NEW JERSEY 968,598 725,614 74.91%32 NEW MEXICO 464,852 344,977 74.21%33 NEW YORK 4,422,121 2,926,950 66.19%34 NORTH CAROLINA 1,442,396 1,012,474 70.19%35 NORTH DAKOTA 60,111 40,605 67.55%36 OHIO 1,951,511 1,374,520 70.43%37 OKLAHOMA 625,546 553,385 88.46%38 OREGON 474,835 418,096 88.05%39 PENNSYLVANIA 1,920,134 1,576,523 82.10%40 PUERTO RICO 1,013,486 977,648 96.46%41 RHODE ISLAND 177,981 110,584 62.13%42 SOUTH CAROLINA 763,225 763,225 100.00%43 SOUTH DAKOTA 107,196 85,476 79.74%44 TENNESSEE 1,230,750 1,230,750 100.00%45 TEXAS 3,343,241 2,161,210 64.64%46 UTAH 238,358 204,793 85.92%47 VERMONT 156,503 137,385 87.78%48 VIRGIN ISLANDS 7,728 0 0.00%49 VIRGINIA 814,820 520,773 63.91%50 WASHINGTON 1,103,291 949,263 86.04%51 WEST VIRGINIA 325,653 149,694 45.97%52 WISCONSIN 1,004,704 606,509 60.37%53 WYOMING 64,489 0 0.00%
TOTALS 50,471,859 36,202,281 71.73%The unduplicated Medicaid enrollment figures include individuals in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards. The unduplicated managed care enrollment figures includes enrollees receiving comprehensive and limited benefits.
MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009
Page 5
Commercial Medicaid-only
STATE HIO MCO MCO PCCM PIHP PAHP PACE OTHERAlabama 0 0 0 443,327 540,093 0 0 0Alaska 0 0 0 0 0 0 0 0Arizona 0 0 1,096,365 0 104,101 0 0 0Arkansas 0 0 0 411,351 0 451,863 21 0California 601,662 2,996,873 7,507 0 157 447,661 2,311 0Colorado 0 0 44,247 22,426 463,464 0 1,421 0Connecticut 0 83,069 259,547 168 0 0 0 0Delaware 0 0 117,602 0 0 0 0 8,487Dist of Columbia 0 0 96,639 0 3,593 50,174 0 0Florida 0 684,903 249,331 455,877 700,431 341,100 329 9,392Georgia 0 0 838,344 108,619 0 1,274,823 0 0Hawaii 0 160,120 68,037 0 0 0 17 0Idaho 0 0 0 166,524 0 130,338 0 0Illinois 0 133,200 44,700 1,100,300 0 0 0 0Indiana 0 455,565 191,413 64,189 0 0 0 469Iowa 0 0 0 170,659 329,897 0 55 0Kansas 0 0 141,000 24,050 243,352 243,352 227 0Kentucky 0 0 159,005 304,973 0 638,083 0 0Louisiana 0 0 0 729,219 0 0 119 0Maine 0 0 0 178,353 0 0 0 0Maryland 0 0 589,540 0 0 30,346 138 0Massachusetts 0 147,546 288,628 284,404 304,821 0 2,178 0Michigan 0 0 1,088,815 0 1,447,373 0 387 0Minnesota 0 375,046 50,963 0 0 0 0 0Mississippi 0 0 0 0 0 512,796 0 0Missouri 0 0 401,314 0 0 481,926 183 0Montana 0 0 0 371 0 368 24 0Nebraska 0 36,119 0 38,623 0 0 0 179,512Nevada 0 59,381 46,921 0 0 178,711 0 0New Hampshire 0 0 0 0 0 96,553 0 0New Jersey 0 268,734 456,880 0 0 0 31 0New Mexico 0 275,942 69,035 0 312,498 0 376 0New York 0 862,624 2,013,976 16,639 24,353 0 3,210 6,148North Carolina 0 0 0 998,909 72,734 0 50 0North Dakota 0 0 0 29,339 0 2,427 25 0Ohio 0 0 1,373,828 0 0 0 692 0Oklahoma 0 0 0 412,473 0 553,385 49 0Oregon 0 35,501 303,046 12,207 399,545 410,448 555 0Pennsylvania 0 965,188 0 262,583 1,442,729 457,520 1,637 0Puerto Rico 0 959,059 0 0 505,302 0 0 0Rhode Island 0 46,216 74,027 0 0 41,717 164 0South Carolina 0 0 341,782 90,136 0 763,367 407 0South Dakota 0 0 0 85,476 0 0 0 0Tennessee 0 0 1,159,089 0 143,322 0 309 1,909,526Texas 0 210,066 1,218,036 732,219 306,513 54,794 889 0Utah 0 0 0 58,484 273,016 176,036 0 0Vermont 0 0 137,385 0 0 0 76 0Virgin Islands 0 0 0 0 0 0 0 0Virginia 0 312,878 153,794 54,101 0 520,773 315 0Washington 0 581,587 0 4,495 949,263 8,386 319 0West Virginia 0 149,694 0 14,747 0 0 0 0Wisconsin 0 484,771 95,785 0 27,216 0 577 0Wyoming 0 0 0 0 0 0 0 0TOTALS 601,662 10,284,082 13,176,581 7,275,241 8,593,773 7,866,947 17,091 2,113,534This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
NUMBER OF MANAGED CARE ENTITY ENROLLEES BY STATE AS OF JUNE 30, 2009
Page 6
Commercial Medicaid-onlySTATE HIO MCO MCO PCCM PIHP PAHP PACE OTHERAlabama 0 0 0 1 2 0 0 0Alaska 0 0 0 0 0 0 0 0Arizona 0 0 29 0 1 0 0 0Arkansas 0 0 0 1 0 1 1 0California 4 23 2 0 1 13 5 0Colorado 0 0 2 1 6 0 3 0Connecticut 0 1 2 1 0 0 0 0Delaware 0 0 2 0 0 0 0 1Dist of Columbia 0 0 3 0 1 1 0 0Florida 0 22 5 1 26 10 2 3Georgia 0 0 3 1 0 1 0 0Hawaii 0 4 1 0 0 0 1 0Idaho 0 0 0 1 0 2 0 0Illinois 0 1 2 1 0 0 0 0Indiana 0 4 1 2 0 0 0 1Iowa 0 0 0 1 1 0 1 0Kansas 0 0 2 1 1 1 2 0Kentucky 0 0 1 1 0 1 0 0Louisiana 0 0 0 1 0 0 1 0Maine 0 0 0 1 0 0 0 0Maryland 0 0 7 0 0 5 1 0Massachusetts 0 2 2 1 1 0 6 0Michigan 0 0 14 0 18 0 4 0Minnesota 0 6 3 0 0 0 0 0Mississippi 0 0 0 0 0 1 0 0Missouri 0 0 6 0 0 1 1 0Montana 0 0 0 1 0 1 1 0Nebraska 0 1 0 1 0 0 0 1Nevada 0 1 1 0 0 1 0 0New Hampshire 0 0 0 0 0 1 0 0New Jersey 0 2 3 0 0 0 2 0New Mexico 0 5 1 0 1 0 1 0New York 0 21 13 4 17 0 5 1North Carolina 0 0 0 2 1 0 2 0North Dakota 0 0 0 1 0 1 1 0Ohio 0 0 7 0 0 0 2 0Oklahoma 0 0 0 2 0 1 1 0Oregon 0 2 13 1 9 8 1 0Pennsylvania 0 11 0 1 38 2 10 0Puerto Rico 0 10 0 0 2 0 0 0Rhode Island 0 2 1 0 0 1 1 0South Carolina 0 0 6 1 0 3 2 0South Dakota 0 0 0 1 0 0 0 0Tennessee 0 0 6 0 2 0 1 2Texas 0 6 13 1 1 1 2 0Utah 0 0 0 1 11 1 0 0Vermont 0 0 1 0 0 0 1 0Virgin Islands 0 0 0 0 0 0 0 0Virginia 0 3 2 1 0 1 4 0Washington 0 8 0 1 1 1 1 0West Virginia 0 3 0 1 0 0 0 0Wisconsin 0 21 5 0 11 0 1 0Wyoming 0 0 0 0 0 0 0 0
TOTALS 4 159 159 36 152 60 67 9
NUMBER OF MANAGED CARE ENTITIES BY STATE AS OF JUNE 30, 2009
7
MEDICAID MANAGED CARE ENROLLMENT AS OF 6/30/09STATES 1-10
Rank States Waiver Type Managed Care Enrollment1 California 1915(b), 1932(a), 1915(a), PACE 3,632,5472 New York 1115(a), 1915(a), PACE 2,926,9503 Texas 1915(b), 1932(a), 1915(a), 1915(b)/(c), PACE 2,161,2104 Florida 1915(b), 1115(a), 1915(b)/(c), 1915(a)/(c), PACE 1,600,5505 Pennsylvania 1915(b), 1915(a), 1902(a)(70), PACE 1,576,5236 Michigan 1915(b), PACE 1,447,3737 Ohio 1932(a), PACE 1,374,5208 Illinois 1932(a), 1915(a) 1,278,2009 Georgia 1932(a), 1902(a)(70) 1,274,823
10 Tennessee 1115(a), PACE 1,230,750Subtotal 18,503,446National Managed Care Grand Total 36,202,143Percentage 51.11%
STATES 11-2011 Arizona 1115(a) 1,096,36512 North Carolina 1915(b)/(c), 1932(a), PACE 1,012,47413 Puerto Rico 1915(a) 977,64814 Washington 1915(b), 1932(a), PACE 949,26315 Missouri 1915(b), 1902(a)(70), PACE 883,42316 South Carolina 1915(b), 1932(a), 1902(a)(70), PACE 763,22517 Massachusetts 1115(a), PACE 731,12318 New Jersey 1915(b), 1932(a), PACE 725,61419 Indiana 1915(b), 1115(a) 711,63620 Louisiana 1932(a), PACE 692,048
Subtotal 8,542,819National Managed Care Grand Total 36,202,143Percentage 23.60%
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.
REGIONAL BREAK-OUT OF MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009
REGION MEDICAID MANAGED CARE % REGION BENEFICIARIES % NATIONAL MANAGED ENROLLMENT ENROLLMENT ENROLLED IN MANAGED CARE CARE ENROLLMENT
I - Boston 2,422,117 1,596,782 65.93% 4.41%
II - New York 6,411,933 4,630,212 72.21% 12.79%
III - Philadelphia 4,172,314 3,143,509 75.34% 8.68%
IV - Atlanta 9,502,729 7,572,794 79.69% 20.92%
V - Chicago 8,544,009 5,844,247 68.40% 16.14%
VI - Dallas 6,085,870 4,262,634 70.04% 11.77%
VII - Kansas City 1,804,889 1,650,296 91.43% 4.56%
VIII - Denver 1,022,495 832,127 81.38% 2.30%
IX - San Francisco 8,627,675 5,135,797 59.53% 14.19%
X - Seattle 1,877,828 1,533,883 81.68% 4.24%
TOTALS 50,471,859 36,202,281 71.73% 100.00%
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.
This table also provides unduplicated Medicaid enrollment figures by region. The enrollment figures include individuals
enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
STATES WITH COMPREHENSIVE HEALTH CARE REFORM DEMONSTRATIONS AS OF JUNE 30, 2009
STATE MEDICAID EXPANSION MANAGED CARE % ENROLLEDENROLLMENT ENROLLMENT ENROLLMENT IN MANAGED CARE
Arizona 1,223,271 183,789 1,096,365 89.63%Arkansas 645,389 3,376 511,014 79.18%Delaware 170,562 24,550 126,089 73.93%Florida 2,426,010 225,749 1,600,550 65.97%Hawaii 235,203 26,277 228,174 97.01%Indiana 961,986 44,828 711,636 73.98%Kentucky 768,777 0 638,083 83.00%Maryland 787,366 30,346 620,024 78.75%Massachusetts 1,227,109 115,929 731,123 59.58%Minnesota 675,149 68,557 426,009 63.10%New York 4,422,121 383,247 2,926,950 66.19%Oklahoma 625,546 0 553,385 88.46%Oregon 474,835 25,374 418,096 88.05%Rhode Island 177,981 20,428 110,584 62.13%Tennessee 1,230,750 30,667 1,230,750 100.00%Utah 238,358 24,022 204,793 85.92%Vermont 156,503 41,967 137,385 87.78%
TOTALS 16,446,916 1,249,106 12,271,010 74.61%
The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.This table also provides unduplicated Medicaid and Expansion enrollment figures. The enrollment figures includeindividuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibilitystandards.
Page 8
Page 9
StateMedical-
only
Medical-only
EnrolleesMental Health
Mental Health
EnrolleesSubstance
Use Disorders
Substance Use Disorders Enrollees Dental
Dental Enrollees Transportation
Transportation Enrollees
Disease Management
Disease Management
Enrollees
Arkansas 1 451,863
California 13 447,661
District of Columbia 1 50,174
Florida 2 71,107 2 182,199 1 70,965 5 16,829
Georgia 1 1,274,823
Idaho 1 1,030 1 129,308
Kansas 1 243,352
Kentucky 1 638,083
Maryland 5 30,346
Montana 1 368
Mississippi 1 512,796
Missouri 1 481,926
Nevada 1 178,711
New Hampshire 1 96,553
North Dakota 1 2,427
Oklahoma 1 553,385
Oregon 1 15,615 7 394,833
Pennsylvania 1 406,732 1 50,788
Rhode Island 1 41,717
South Carolina 1 142 2 763,225
Texas 1 54,794
Utah 1 176,036
Virginia 1 520,773
Washington 1 8,386
Totals 9 102,625 1 243,352 1 15,615 24 1,195,718 14 6,079,492 11 230,145
Number of Prepaid Ambulatory Health Plans (PAHPs) and Enrollment by State as of June 30, 2009
Page 10
State# of Medical-
only PIHPs Medical-only
Enrollees# of Mental Health
(MH) PIHPsMH PIHP Enrollees
# of MH & SUD PIHPs
MH & SUD Enrollees
# of SUD PIHPs
SUD Enrollees
# of Long Term Care PIHPs
Long Term Care Enrollees
Alabama 2 540,093
Arizona 1 104,101
California 1 157
Colorado 1 15,157 5 448,307
District of Columbia 1 3,593
Florida 6 115,980 5 569,329 15 15122
Iowa 1 329,897
Kansas 1 243,352
Massachusetts 1 304,821
Michigan 18 1,447,373
New Mexico 1 312,498
New York 17 24,353
North Carolina 1 72,734
Oregon 9 399,545
Pennsylvania 4 203 34 1,442,526
Puerto Rico 2 505,302
Tennessee 1 71,661 1 71,661
Texas 1 306,513
Utah 2 71,454 9 201,562
Washington 1 949,263
Wisconsin 2 905 9 26,311
Totals 17 818,141 49 4,328,034 44 3,138,460 1 243,352 41 65,786
Number of Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State as of June 30, 2009
Page 11
State Medicaid Dual EligiblesAlabama 185,738Alaska 12,501Arizona 137,195Arkansas 107,520California 981,725Colorado 68,718Connecticut 83,246Delaware 25,437District of Columbia 19,462Florida 544,958Georgia 234,817Hawaii 28,476Idaho 25,000Illinois 516,032Indiana 128,779Iowa 72,528Kansas 64,358Kentucky 152,054Louisiana 162,278Maine 84,539Maryland 94,159Massachusetts 233,181Michigan 228,609Minnesota 116,451Mississippi 147,884Missouri 160,535Montana 18,904Nebraska 32,875Nevada 32,322New Hampshire 24,891New Jersey 184,158New Mexico 60,067New York 643,204North Carolina 279,230North Dakota 13,385Ohio 267,085Oklahoma 98,219Oregon 82,148Pennsylvania 367,192Puerto Rico 217,652Rhode Island 34,461South Carolina 128,711South Dakota 17,914Tennessee 257,156Texas 559,954Utah 23,136Vermont 32,384Virginia 154,209Washington 136,149West Virginia 69,065Wisconsin 160,867Wyoming 9,050National Total 8,520,568
DUAL ELIGIBLE ENROLLMENT AS OF JUNE 30, 2009
This table provides an unduplicated number of Medicaid dual eligibles receiving full or partial Medicaid benefits.
DUAL ELIGIBLE ENROLLMENT BY MANAGED CARE ENTITY TYPE AS OF JUNE 30, 2009
Page 12
STATE HIO MCO PCCM PIHP PAHP PACE OTHERArizona 93,768Arkansas 45,645 19California 113,960 82,215 14,886 2,068Colorado 2,788 4,786 53,278 1,356Dist. of Columbia 251 17 11,048Florida 21,668 16,776 95 319 294Georgia 129,559Hawaii 25,313 13Idaho 15,822 1,030Iowa 32,222 3Kansas 33,252 33,252 225Kentucky 12,557 88,914Louisiana 97Maryland 129Massachusetts 153 2,047Michigan 370Minnesota 49,553Missouri 152Mississippi 69,166Nebraska 19,557Nevada 38,060New Jersey 20,271 28New Mexico 31,345 355New York 5,291 1,019 20,917 2,626North Carolina 46,957 13,241 28North Dakota 20Ohio 579Oklahoma 98,219 46Oregon 30,569 905 52,344 48,956 555Pennsylvania 2,581 626 188,192 50,955 1,540Puerto Rico 216,417 33,498Rhode Island 153South Carolina 8,337 128,711 395Tennessee 187,246 11,056 309 193,121Texas 86,354 1,017 826Utah 4,621 20,789 14,534Vermont 14,832 72Virginia 106,372 296Washington 519 97,637 304Wisconsin 9,958 36,316 499TOTALS 113,960 893,649 83,073 610,552 879,402 15,429 212,972
MANAGED CARE ENTITY TYPES
This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include invididuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
13
State Plan Managed Care Entity EnrollmentAR Total Life Healthcare PACE 19AR Non-Emergency Transportation Transportation PAHP 45,645AZ AZ Physicians IPA (HP) Medicaid-only MCO 15,360AZ Bridgeway Health Solution (HP) Medicaid-only MCO 1,665AZ Bridgeway Health Solution (PC) Medicaid-only MCO 2,173AZ Care 1st Health Plan Medicaid-only MCO 2,834AZ Cochise Co. Dept. of Health Services (PC) Medicaid-only MCO 844
AZDepartment of Economic Security/Division of Developmental Disabilities (PC) Medicaid-only MCO 4,773
AZ Evercare Select (PC) Medicaid-only MCO 3,117AZ Health Choice Arizona (HP) Medicaid-only MCO 12,019AZ Maricopa County Health Plan (HP) Medicaid-only MCO 3,250AZ Mercy Care Plan (HP) Medicaid-only MCO 19,107AZ Mercy Care Plan (PC) Medicaid-only MCO 6,658AZ Phoenix Health Plan/Community Connection (HP) Medicaid-only MCO 9,741AZ Pima Health System (HP) Medicaid-only MCO 137AZ Pima Health System (PC) Medicaid-only MCO 3,559AZ Pinal County Long Term Care (PC) Medicaid-only MCO 1,241AZ SCAN Medicaid-only MCO 2,396AZ University Family Care (HP) Medicaid-only MCO 3,983AZ Yavapai County Long Term Care (PC) Medicaid-only MCO 911CA Access Dental Plan-LA Dental PAHP 1,886CA Access Dental Plan-Sacramento Dental PAHP 2,039CA Alameda Alliance for Health Commercial MCO 3,972CA AltaMed Health Services Corporation PACE 492CA American Health Guard-Dental Plan-LA Dental PAHP 411CA Anthem Blue Cross Partnership Plan - Sacramento Commercial MCO 2,207CA Anthem Blue Cross Partnership Plan-TPMP Commercial MCO 7,880CA Caloptima-Orange HIO 67,165CA Care 1st Health Plan/San Diego Commercial MCO 154CA Care 1st Health Plan-Dental-LA Dental PAHP 733CA Central Coast Alliance For Health HIO 15,153
CACoalition of Elders Independence dba Center for Elders Independence PACE 358
CA Community Dental Services/Sacramento Dental PAHP 361CA Community Dental Services-LA Dental PAHP 196CA Community Eldercare of San Diego dba St. Paul's PACE PACE 64CA Community Health Group Partnership Plan-San Diego Commercial MCO 2,206CA Contra Costa Health Plan Commercial MCO 2,129CA Health Net Community Solutions, Inc. - Sacramento Commercial MCO 724CA Health Net Community Solutions, Inc.-San Diego Commercial MCO 491CA Health Net Community Solutions, Inc.-TPMP Commercial MCO 7,188CA Health Net of CA-Dental-LA Dental PAHP 1,097CA Health Net of CA-Dental-Sacramento Dental PAHP 211CA Health Plan of San Joaquin Commercial MCO 1,461CA Health Plan of San Mateo *MCO/COHS 14,945
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
14
CA Inland Empire Health Plan Commercial MCO 5,699CA Kern Family Health Care Commercial MCO 1,771CA KP Cal, LLC Commercial MCO 362CA KP Cal, LLC - Sacramento Commercial MCO 1,840CA KP Cal, LLC-San Diego Commercial MCO 1,139CA LA Care Health Plan Commercial MCO 10,856CA Liberty Dental Plan of CA/Sacramento Dental PAHP 949CA Liberty Dental Plan of CA-LA Dental PAHP 328CA Molina Healthcare of California Partner Plan, Inc. - Sacramento Commercial MCO 595CA Molina Healthcare of California Partner Plan, Inc. - San Diego Commercial MCO 903CA Molina Healthcare of California Partner Plan, Inc.-TPMP Commercial MCO 665CA On Lok Senior Health Services dba On Lok Lifeways PACE 958CA Partnership Health Plan HIO 16,835CA Positive Healthcare/AHF Healthcare Centers Medicaid-only MCO 250CA Safeguard Dental-LA Dental PAHP 1,654CA San Francisco Health Plan Commercial MCO 1,457CA Santa Barbara San luis Obispo Regional Health Authority HIO 14,807CA Santa Clara Family Health Plan Commercial MCO 5,491CA Senior Care Action Network (SCAN) Medicaid-only MCO 6,920CA Sutter Health sacramento Sierra dba Sutter Senior Care PACE 196CA Western Dental Services-LA Dental PAHP 2,315CA Western Dental Services-Sacramento Dental PAHP 2,706
CA Western Health Advantage Community Health Plan-Sacramento Commercial MCO 910CO Access Behavioral Care Mental Health (MH) PIHP 9,155CO Behavioral Healthcare, Inc. Mental Health (MH) PIHP 9,421CO Colorado Health Partnerships Mental Health (MH) PIHP 19,627CO Denver Health and Hospital Authority Medicaid-only MCO 2,788CO Foothills Behavioral Health Partners Mental Health (MH) PIHP 6,906CO Northeast Behavioral Health Partnership Mental Health (MH) PIHP 6,285CO Primary Care Physician Program PCCM Provider 4,786CO Rocky Mountain Health Plan Authority Medical-only PIHP 1,884CO Rocky Mountain PACE PACE 23CO Total Long Term Care PACE 1,215CO VOANS PACE, Inc PACE 118DC DC Chartered Health Plan, Incorporated Medicaid-only MCO 173DC Health Right Incorporated Medicaid-only MCO 42DC Health Services For Children with Special Needs Medical-only PIHP 17DC Medical Transportation Management Transportation PAHP 11,048DC Unison Health Plan of the Capital Area Medicaid-only MCO 36FL Access Health Solutions (Reform) Medical-only PIHP 467FL Alzheimer's Waiver Service Provider *Community Care for the Elderly 294FL American Eldercare Long Term Care PIHP 3,821FL Amerigroup Commercial MCO 4,765FL Amerigroup (NHD) Long Term Care PIHP 2,301FL Amerigroup (Reform) Commercial MCO 121FL Atlantic Dental, Inc. Dental PAHP 94
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
15
FL Better Health (Reform) Medical-only PIHP 25FL Buena Vista Commercial MCO 469FL Children's Medical Services (Reform) Medical-only PIHP 12FL Citrus (NHD) Long Term Care PIHP 1,226FL Citrus Health Care Commercial MCO 488FL First Coast Advantage (Reform) Medical-only PIHP 570FL Florida PACE Centers PACE 221FL Freedom Health Plan Commercial MCO 24FL Freedom Health Plan (Reform) Commercial MCO 9FL HealthEase Medicaid-only MCO 3,724FL HealthEase (Reform) Commercial MCO 78FL Healthy Palm Beaches Medicaid-only MCO 2FL Hope Life Care Long Term Care PIHP 203FL Hope Select Care PACE 98FL Humana Family Commercial MCO 1,584FL Humana Family (Reform) Commercial MCO 172FL Humana Medical Plan Long Term Care PIHP 605FL Humana Senior's Choice Long Term Care PIHP 303FL JMH Health Plan Commercial MCO 571FL Little Havana Activities and Nutrition Centers Long Term Care PIHP 847FL Managed Care of North America Dental PAHP 1FL Molina Health Care of Florida Medicaid-only MCO 234FL Molina Health Care of Florida (Reform) Commercial MCO 32FL Neighborly Care Network Long Term Care PIHP 522FL NetPass (Reform) Medical-only PIHP 251FL Preferred Medical Plan Commercial MCO 416FL Preferred Medical Plan (Reform) Commercial MCO 31FL Project Independence at Home Long Term Care PIHP 105FL South Florida Community Care Network (Reform) Medical-only PIHP 329FL StayWell Commercial MCO 3,725FL Sunshine State Health Plan Medicaid-only MCO 150FL Total Health Choice Commercial MCO 70FL Total Health Choice (Reform) Commercial MCO 199FL United Evercare Commercial MCO 1,940FL United Health Care Commercial MCO 2,092FL United Health Care (NHD) Long Term Care PIHP 2,198FL United Health Care (Reform) Commercial MCO 29FL United Home Care Services Long Term Care PIHP 918FL Universal Health Care Commercial MCO 285FL Universal Health Care (NHD) Long Term Care PIHP 682FL Universal Health Care (Reform) Commercial MCO 86FL Urban Jacksonville Long Term Care PIHP 96FL Vista Health Plan of South Florida Commercial MCO 372FL Vista Independence Plan Long Term Care PIHP 1,233FL YourCare Brevard Long Term Care PIHP 62GA Non-Emergency Transportation Brokerage Program Transportation PAHP 129,559Hi Evercare Commercial MCO 12,450
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
16
HI Maui PACE PACE 13HI Ohana Commercial MCO 12,863IA Iowa Plan For Behavioral Health MH/SUD PIHP 32,222IA Siouxland PACE PACE 3ID Healthy Connections PCCM Provider 15,822ID Medicare-Medicaid Coordinated Plan Medical-only PAHP 1,030KS Kansas Health Solutions Mental Health (MH) PAHP 33,252KS Midland Care Services PACE 53
KS ValueOptions-KansasSubstance Use Disorders (SUD) PIHP 33,252
KS Via Christi Healthcare Outreach Programs for Elders PACE 172KY Human Service Transportation Transportation PAHP 88,914KY Passport Health Plan Medicaid-only MCO 12,557LA Greater New Orleans PACE 97MA Elder Service Plan of Cambridge Health Alliance PACE 178MA Elder Service Plan of East Boston PACE 277MA Elder Service Plan of Harbor Health Services, Inc. PACE 284MA Elder Service Plan of the North Shore, Inc. PACE 595MA Neighborhood Health Plan Commercial MCO 153MA Summit Elder Care PACE 578MA Uphams Elder Service Plan PACE 135MD Hopkins Elder Plus PACE 129MI Care Resources PACE 146MI Comprehensive Senior Care Corporation PACE 14MI Henry Ford Health System-Center for Senior Independence PACE 189MI Life Circles PACE 21MN Blue Plus Commercial MCO 12,801MN First Plan Blue Commercial MCO 1,450MN Health Partners Commercial MCO 3,845MN Itasca Medical Care Medicaid-only MCO 614MN Medica Commercial MCO 12,266MN Metropolitan Health Plan Commercial MCO 1,371MN PrimeWest Health System Medicaid-only MCO 3,319MN South Country Health Alliance Medicaid-only MCO 3,544MN UCARE Commercial MCO 10,343MO Alexian Brothers Community Services PACE 152MS LogistiCare Soultions, LLC Transportation PAHP 69,166NC Carolina Access PCCM Provider 6,623NC Community Care of North Carolina (Access II/III) PCCM Provider 40,334NC Piedmont Cardinal Health Plan MH/SUD PIHP 13,241NC Piedmont Senior Care PACE 4NC Elderhaus PACE 24ND Northland PACE PACE 20NE Magellan Behavioral Health *Specialty Physician Case 19,557NJ AmeriChoice of New Jersey, Inc. Commercial MCO 5,853NJ AMERIGROUP New Jersey, Inc. Medicaid-only MCO 2,184NJ Health Net of New Jersey, Inc. Medicaid-only MCO 1,490
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
17
NJ Horizon NJ Health Medicaid-only MCO 9,394NJ LIFE St. Francis PACE 14NJ LIFE at Lourdes PACE 14NJ University Health Plans, Inc. Commercial MCO 1,350NM AMERIGROUP Community Care of New Mexico, Inc. Commercial MCO 16,250NM Evercare of New Mexico Commercial MCO 15,095NM Total Community Care (PACE) PACE 355NV Logisticare Transportation PAHP 38,060NY Affinity/Medicaid Advantage Commercial MCO 81NY Amerigroup Community Connections Long Term Care PIHP 355NY Broome County MC PCCM Provider 11NY CCM Select Long Term Care PIHP 1,017NY Comprehensive Care Management (CCM) PACE 1,986NY Eddy Senior Care PACE 97NY GHI/Medicaid Advantage Commercial MCO 904NY Guildnet Long Term Care PIHP 5,402NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP 160NY Health Advantage/Elant Choice Long Term Care PIHP 129NY Health Now/Medicaid Advantage Commercial MCO 165NY HHH Choices Long Term Care PIHP 617NY HIP Health Plan/Medicaid Advantage Commercial MCO 1,949NY HomeFirst Long Term Care PIHP 2,975NY Independent Care Systems Long Term Care PIHP 722NY Independent Living For Seniors PACE 219NY Liberty Health Advantage/Medicaid Advantage Commercial MCO 610NY Managed Health Inc/Medicaid Advantage Commercial MCO 51NY MetroPlus/Medicaid Advantage Commercial MCO 8NY Neighborhood Health Provider/Medicaid Advantage Commercial MCO 193NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Commercial MCO 229NY PACE CNY PACE 309NY Partners In Community Care Long Term Care PIHP 245NY Physician Case Management Program PCCM Provider 1,000NY Senior Health Partners Long Term Care PIHP 1,371NY Senior Network Health Long Term Care PIHP 355NY Senior Whole Health Medicaid Advantage Plus Long Term Care PIHP 135NY Senior Whole Health/ Medicaid Advantage Commercial MCO 593NY Southern Tier Priority PCCM Provider 8NY Total Aging in Place Long Term Care PIHP 135NY Total Senior Care PACE 15NY Touchstone/Prestige/Medicaid Advantage Commercial MCO 508NY VNS Choice Long Term Care PIHP 6,904NY VNS Choice Plus/Medicaid Advantage Plus Long Term Care PIHP 21NY WellCare Advantage Plus/Medicaid Advantage Plus Long Term Care PIHP 123NY WellCare Advocate Long Term Care PIHP 251OH Concordia Care PACE 204OH TriHealth Senior Link PACE 375OK Cherokee Elder Care PACE 46
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
18
OK SoonerRide Transportation PAHP 98,219OR Accountable Behavioral Health Mental Health (MH) PIHP 3,427OR Capitol Dental Care Inc. Dental PAHP 13,921OR Care Oregon Medicaid-only MCO 10,229OR Cascade Comprehensive Care Medicaid-only MCO 690OR Central Oregon Independent Health Solutions Medicaid-only MCO 911OR Clackamas County Mental Health Mental Health (MH) PIHP 3,959
OR Deschutes County CDOSubstance Use Disorder (SUD) PAHP 2,300
OR Doctors of the Oregon Coast South Medicaid-only MCO 1,113OR Douglas County IPA Commercial MCO 1,333OR FamilyCare (Mental Health) Mental Health (MH) PIHP 995OR FamilyCare Health Plans Commercial MCO 1,861OR Greater Oregon Behavioral Health, Inc. Mental Health (MH) PIHP 6,206OR Hayden Family Dentistry Dental PAHP 5,305OR Inter-Community Health Network Medicaid-only MCO 1,893OR Jefferson Behavioral Health Mental Health (MH) PIHP 7,494OR Kaiser Permanente Oregon Plus Medicaid-only MCO 706OR Lane Care MHO Mental Health (MH) PIHP 5,464OR Lane Individual Practice Association Medicaid-only MCO 2,945OR Managed Dental Care of Oregon Dental PAHP 968OR Marion Polk Community Health Plan Medicaid-only MCO 3,958OR Mid Valley Behavioral Care Network Mental Health (MH) PIHP 8,979OR Mid-Rogue Independent Practice Assoc. Medicaid-only MCO 1,346OR Multicare Dental Dental PAHP 2,438OR Multnomah County Verity Mental Health (MH) PIHP 11,313OR Northwest Dental Services Dental PAHP 6,498OR ODS Community Health Inc. Medicaid-only MCO 300OR Oregon Dental Service Dental PAHP 10,064OR Oregon Health Management Service Medicaid-only MCO 433OR PCCM PCCM Provider 905OR Providence Elder Place PACE 555OR Providence Health Assurance Medicaid-only MCO 2,040OR Tuality Health Care Medicaid-only MCO 811OR Washington County Health (Mental Health) Mental Health (MH) PIHP 4,507OR Willamette Dental Dental PAHP 7,462PA Access Plus Program PCCM Provider 626PA Albright LIFE Medical-only PIHP 44PA AmeriChoice of Pennsylvania Commercial MCO 271PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan Commercial MCO 255PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL Commercial MCO 5PA Community Care Behavioral Health - North Central MH/SUD PIHP 18,939PA Community Care Behavioral Health - Northeast MH/SUD PIHP 11,562PA Community LIFE PACE 283
PA Counties of Armstrong/Indiana - Value Behavioral Health of PA MH/SUD PIHP 2,863
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
19
PACounties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,275
PACounties of Carbon/Monroe/Pike - Community Care Behavioral Health MH/SUD PIHP 3,401
PA Counties of Crawford/Mercer/Venango - Value Behavioral Health MH/SUD PIHP 5,378
PACounties of Franklin/Fulton - Community Behavorial Healthcare Network of Pennsylvania MH/SUD PIHP 1,838
PACounties of Lycoming/Clinton - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,752
PA County of Adams - Community Care Behavioral Health MH/SUD PIHP 849PA County of Allegheny - Community Care Behavioral Health MH/SUD PIHP 19,370PA County of Beaver - Value Behavioral Health of PA MH/SUD PIHP 2,841PA County of Berks - Community Care Behavioral Health MH/SUD PIHP 5,020
PACounty of Blair County - Community Behavioral Healthcare Network of PA MH/SUD PIHP 2,654
PA County of Bucks - Magellan Behavioral Health MH/SUD PIHP 5,074PA County of Butler - Value Behavioral Health of PA MH/SUD PIHP 1,991PA County of Cambria - Value Behavioral Health MH/SUD PIHP 2,756PA County of Chester - Community Care Behavioral Health MH/SUD PIHP 2,999
PACounty of Cumberland - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,711
PACounty of Dauphin - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 3,470
PA County of Delaware - Magellan Behavioral Health MH/SUD PIHP 6,516PA County of Erie - Value Behavioral Health MH/SUD PIHP 4,506PA County of Fayette - Value Behavioral Health of PA MH/SUD PIHP 3,776
PACounty of Lancaster - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 5,288
PA County of Lawrence - Value Behavioral Health of PA MH/SUD PIHP 1,819
PACounty of Lebanon - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,485
PA County of Lehigh - Magellan Behavioral Health MH/SUD PIHP 4,965PA County of Montgomery - Magellan Behavioral Health MH/SUD PIHP 5,900PA County of Northampton - Magellan Behavioral Health MH/SUD PIHP 3,333
PACounty of Perry - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 456
PA County of Philadelphia - Community Behavioral Health MH/SUD PIHP 38,630PA County of Washington - Value Behavioral Health of PA MH/SUD PIHP 3,081PA County of Westmoreland - Value Behavioral Health of PA MH/SUD PIHP 5,387PA County of York - Community Care Behavioral Health MH/SUD PIHP 4,265PA Everyday LIFE PACE 4PA Gateway Health Plan, Inc. Commercial MCO 504PA Gateway Health Plan, Inc. -VOL Commercial MCO 42PA Health Partners of Philadelphia Commercial MCO 351PA Keystone Mercy Health Plan Commercial MCO 526PA LIFE - Beaver County PACE 114
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
20
PA LIFE - Geisinger PACE 96PA LIFE - Pittsburgh PACE 303PA LIFE - University of Pennsylvania PACE 314PA LIFE at Home PACE 51PA LIFE Butler County Medical-only PIHP 15PA LIFE Lutheran Services PACE 14PA LIFE NWPA Medical-only PIHP 27PA Logisticare Solutions, LLC Transportation PAHP 50,942PA McKesson Health Solutions Disease Management PAHP 13PA Mercy LIFE PACE 221PA New Courtland LIFE Medical-only PIHP 100PA Senior LIFE Johnstown PACE 140PA Unison Health Plan / MedPLUS Commercial MCO 280PA Unison Health Plan/MedPlus - VOL Commercial MCO 63PA UPMC Health Plan, Inc./UPMC for You Commercial MCO 277PA UPMC Health Plan, Inc./UPMC for You - VOL Commercial MCO 7PA Value Behavioral Health of PA (Greene County) MH/SUD PIHP 856PR American Health Medicare Commercial MCO 14,134PR APS Healthcare MH/SUD PIHP 22,054PR FHC Healthcare MH/SUD PIHP 11,444PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO 14,065PR Humana Puerto Rico Commercial MCO 8,338PR MCS Advantage Commercial MCO 40,124PR MCS Health Management Options, Inc. Commercial MCO 16,382PR MMM Healthcare Inc. Commercial MCO 48,755PR PMC Medicare Choice Commercial MCO 32,093PR Salud Dorada con Medicare Commercial MCO 3,292PR Triple S Commercial MCO 18,405PR Triple-S, Inc. Commercial MCO 20,829RI PACE Organization of Rhode Island PACE 153SC Logisticare Transportation PAHP 128,711SC Palmetto SeniorCare (PACE) PACE 367SC South Carolina Solutions PCCM Provider 8,337SC The Oaks PACE PACE 28TN Alexian Brothers Community Services PACE 309TN AmeriChoice - East TN Medicaid-only MCO 34,401TN AmeriChoice - Middle TN Medicaid-only MCO 27,960TN AmeriChoice - West TN Medicaid-only MCO 24,883TN AmeriGroup Community Care Medicaid-only MCO 28,086TN Doral Dental of Tennessee, LLC Dental Benefit Manager 347TN Premier Behavioral Systems of TN MH/SUD PIHP 5,528TN SXC Health Solution Corperation Pharmacy Benefit Manager 192,774TN Volunteer State Health Plan (Bluecare) - East Medicaid-only MCO 45,569TN Volunteer State Health Plan (Bluecare) - West Medicaid-only MCO 26,347TN Volunteer State Health Plan (TennCare Select) *PIHP 5,528TX Amerigroup (STAR+PLUS) Medicaid-only MCO 27,021TX Bienvivir Senior Health Service PACE 700
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
21
TX Evercare Medicaid-only MCO 32,312TX Jan Werner Adult Day Care Center PACE 126TX Molina (STAR+Plus) Medicaid-only MCO 10,087TX Superior HealthPlan (STAR+Plus) Medicaid-only MCO 16,934TX ValueOptions MH/SUD PIHP 1,017UT Bear River Mental Health Mental Health (MH) PIHP 715UT Central Utah Counseling Center Mental Health (MH) PIHP 631UT Davis Behavioral Health Mental Health (MH) PIHP 1,106UT Four Corners Community Behavioral Health Mental Health (MH) PIHP 488UT Healthy U Medical-only PIHP 2,855UT Molina Healthcare of Utah (Molina) Medical-only PIHP 2,797UT Non-Emergency Medical Transportation Transportation PAHP 14,534UT Northeastern Counseling Center Mental Health (MH) PIHP 366UT Select Access PCCM Provider 4,621UT Southwest Behavioral Health Services Mental Health (MH) PIHP 1,205UT Valley Mental Health Mental Health (MH) PIHP 6,825UT Wasatch Mental Health Mental Health (MH) PIHP 1,938UT Weber Human Services Mental Health (MH) PIHP 1,863VA AllCare for Seniors PACE 26VA LogistiCare Solutions Transportation PAHP 106,372VA Mountain Empire PACE 45VA Riverside Peninsula PACE 104VA Sentara Senior Community Care PACE 121VT Global Committment to Health Medicaid-only MCO 14,832VT Vermont PACE PACE 72WA Molina Healthcare (WMIP) Commercial MCO 519WA Providence ElderPlace - Seattle PACE 304WA Regional Support Network Mental Health (MH) PIHP 97,637WI Abri Health Plan -- Medicaid HMO Commercial MCO 8WI Abri Health Plan -- SSI Commercial MCO 373WI Care Wisconsin First, Inc. Long Term Care PIHP 2,243WI Care Wisconsin Health Plan, Inc. (Partnership) Medicaid-only MCO 977WI Children's Community Health Plan - Medicaid HMO Commercial MCO 1WI CHP-LTS, Inc. Long Term Care PIHP 704WI Community Care Health Plan, Inc. Commercial MCO 1,006WI Community Care, Inc. Long Term Care PIHP 2,916WI Community Care of Central Wisconsin Long Term Care PIHP 2,434WI Community Care Organization (PACE) PACE 499WI Community Health Partnership -- Partnership Commercial MCO 247WI Compcare (formerly Atrium Health Plan) -- Medicaid HMO Commercial MCO 18WI Dean Health Plan -- Medicaid HMO Commercial MCO 6WI Family Care Long Term Care PIHP 16,912WI Group Health Cooperative Of Eau Claire -- Medicaid HMO Commercial MCO 13WI Group Health Cooperative of Eau Claire County SSI Commercial MCO 101
WI Group Health Cooperative Of South Central WI -- Medicaid HMO Commercial MCO 1WI Gundersen Lutheran Health Plan - Medicaid HMO Commercial MCO 5
DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009
22
WI Health Tradition Health Plan -- Medicaid HMO Commercial MCO 5WI Independent Care (iCare) - Medicaid HMO Medicaid-only MCO 9WI Independent Care Health Plan -- SSI Medicaid-only MCO 3,077WI Lakeland Care District Long Term Care PIHP 863WI Managed Health Services -- Medicaid HMO Medicaid-only MCO 31WI Managed Health Services -- SSI Medicaid-only MCO 928WI MercyCare Insurance Company -- Medicaid HMO Commercial MCO 8WI Milwaukee County Dept. on Aging Long Term Care PIHP 6,295WI Network Health Plan -- Medicaid HMO Commercial MCO 40WI Network Health Plan - SSI Commercial MCO 403WI Northern Bridges Long Term Care PIHP 739WI Partnership Health Plan Inc. Commercial MCO 1,667WI Security Health Plan -- Medicaid HMO Commercial MCO 27WI Southern Family Care Alliance Long Term Care PIHP 771WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO 111WI UnitedHealthcare of WI -- SSI Commercial MCO 880WI Unity Health Insurance -- Medicaid HMO Commercial MCO 16WI Western Wisconsin Cares Long Term Care PIHP 2,439Total 2,809,037
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AL Maternity Care Program Medical-only PIHP
Risk-based Capitation
1915(b) Statewide 21,324
AL Partnership Hospital Program Medical-only PIHP
Risk-based Capitation
1915(a) - 1902(a)(4)
Statewide 518,769
AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 443,327
AR Connect Care PCCM Fee-For-Service 1115 Statewide 411,351
AR Non-Emergency Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 451,863
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
21
AZ AZ Physicians IPA (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 La Paz, Maricopa, Pima, Yuma 604
AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based Capitation
1115 LaPaz, Maricopa, Pima, Yuma 220,485
AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-based Capitation
1115 Yavapai 56
AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-based Capitation
1115 LaPaz, Maricopa, Yuma 16,182
AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-based Capitation
1115 Yavapai 2,405
AZ Care 1st Health Plan Medicaid MCO Risk-based Capitation
1115 Maricopa 49,355
AZ Care 1st Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 208
AZ Cochise Co. Dept. of Health Services (PC) Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee 938
AZ Department of Economic Security/Childrens Medical and Dental Program (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Statewide 0
Page 23Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AZ Department of Economic Security/Childrens Medical and Dental Program (HP)
Medicaid MCO Risk-based Capitation
1115 Statewide 9,533
AZ Department of Economic Security/Division of Developmental Disabilities (PC)
Medicaid MCO Risk-based Capitation
1115 Statewide 21,753
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
104,101
AZ Evercare Select (PC) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Yuma 3,647
AZ Health Choice Arizona (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
791
AZ Health Choice Arizona (HP) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
177,142
AZ Maricopa County Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 109
AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-based Capitation
1115 Maricopa 51,234
AZ Mercy Care Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 994
AZ Mercy Care Plan (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 283,456
AZ Mercy Care Plan (PC) Medicaid MCO Risk-based Capitation
1115 Maricopa 8,388
AZ Phoenix Health Plan/Community Connection (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
710
AZ Phoenix Health Plan/Community Connection (HP)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
174,038
AZ Pima Health System (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Pima 12
AZ Pima Health System (HP) Medicaid MCO Risk-based Capitation
1115 Pima 2,153
Page 24Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
AZ Pima Health System (PC) Medicaid MCO Risk-based Capitation
1115 Pima, Santa Cruz 4,210
AZ Pinal County Long Term Care (PC) Medicaid MCO Risk-based Capitation
1115 Gila, Pinal 1,433
AZ SCAN Medicaid MCO Risk-based Capitation
1115 Maricopa 2,591
AZ University Family Care (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 159
AZ University Family Care (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 62,763
AZ Yavapai County Long Term Care (PC) Medicaid MCO Risk-based Capitation
1115 Yavapai 1,016
CA Access Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 104,353
CA Access Dental Plan-Sacramento Dental PAHP Risk-based Capitation
1915(a) Sacramento 51,946
CA Alameda Alliance for Health Commercial MCO Risk-based Capitation
1915(b), 1932(a) Alameda 88,767
CA AltaMed Health Services Corporation PACE Risk-based Capitation
PACE LA 622
CA American Health Guard-Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 16,938
CA Anthem Blue Cross Partnership Plan - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 86,166
CA Anthem Blue Cross Partnership Plan-TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Alameda, Contra Costa, Fresno, San Francisco, San Joaquin, Santa Calra, Stanislaus, Tulare
349,162
CA Caloptima-Orange HIO Risk-based Capitation
1915(b) Orange 327,163
CA Care 1st Health Plan/San Diego Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 9,126
CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 17,632
Page 25Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Central Coast Alliance For Health HIO Risk-based Capitation
1915(b) Monterey, Santa Cruz 96,468
CA Coalition of Elders Independence dba Center for Elders Independence
PACE Risk-based Capitation
PACE Alameda 413
CA Community Dental Services/Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 12,805
CA Community Dental Services-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 4,889
CA Community Eldercare of San Diego dba St. Paul's PACE
PACE Risk-based Capitation
PACE San Diego 77
CA Community Health Group Partnership Plan-San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 86,241
CA Contra Costa Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Contra Costa 53,869
CA Health Net Community Solutions, Inc. - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 34,498
CA Health Net Community Solutions, Inc.-San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 30,586
CA Health Net Community Solutions, Inc.-TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Fresno, Kern, LA, Stanislaus, Tulare 582,166
CA Health Net of CA-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 31,247
CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-based Capitation
1915(a) Sacramento 12,078
CA Health Plan of San Joaquin Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Joaquin 67,793
CA Health Plan of San Mateo *MCO/COHS Risk-based Capitation
1915(b) San Mateo 52,908
CA Inland Empire Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Riverside, San Bernardino 344,595
CA Kern Family Health Care Commercial MCO Risk-based Capitation
1915(b), 1932(a) Kern 100,487
Page 26Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA KP Cal, LLC Commercial MCO Risk-based Capitation
1915(a) Marin, Sonoma 2,328
CA KP Cal, LLC - Sacramento Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 24,405
CA KP Cal, LLC-San Diego Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 13,085
CA LA Care Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Los Angeles 763,736
CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 27,192
CA Liberty Dental Plan of CA-LA Dental PAHP Risk-based Capitation
1915(b), 1932(a) LA 7,095
CA Molina Healthcare of California Partner Plan, Inc. - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 22,791
CA Molina Healthcare of California Partner Plan, Inc. - San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 53,645
CA Molina Healthcare of California Partner Plan, Inc.-TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Riverside, San Bernardino 89,952
CA On Lok Senior Health Services dba On Lok Lifeways
PACE Risk-based Capitation
PACE San Francisco 995
CA Partnership Health Plan HIO Risk-based Capitation
1915(b) Napa, Solano, Yolo 94,280
CA Positive Healthcare/AHF Healthcare Centers
Medicaid MCO Risk-based Capitation
1915(a) Los Angeles 587
CA Safeguard Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, San Bernardino 21,801
CA San Francisco City & CO/Family Mosaic *Emotional and Mental Health Support PIHP
Risk-based Capitation
1915(a) San Francisco 157
CA San Francisco Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Francisco 34,567
CA Santa Barbara San luis Obispo Regional Health Authority
HIO Risk-based Capitation
1915(b) Santa Barbara 83,751
Page 27Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CA Santa Clara Family Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Santa Clara 89,930
CA Senior Care Action Network (SCAN) Medicaid MCO Risk-based Capitation
1915(a) LA, Riverside, San Barnardino 6,920
CA Sutter Health sacramento Sierra dba Sutter Senior Care
PACE Risk-based Capitation
PACE Sacramento, Yolo 204
CA Western Dental Services-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 55,845
CA Western Dental Services-Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 83,840
CA Western Health Advantage Community Health Plan-Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 16,070
CO Access Behavioral Care Mental Health PIHP
Risk-based Capitation
1915(b) Denver 80,507
CO Behavioral Healthcare, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) East Metro Denver 103,730
CO Colorado Access Medicaid MCO Risk-based Capitation
1915(a) Adams, Arapahoe, Boulder, Broomfield, Denver 2,315
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
157,160
CO Denver Health and Hospital Authority Medicaid MCO Risk-based Capitation
1915(a) Adams, Arapahoe, Denver, Jefferson 41,932
CO Foothills Behavioral Health Partners Mental Health PIHP
Risk-based Capitation
1915(b) Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 50,500
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
56,410
CO Primary Care Physician Program PCCM Fee-For-Service 1932(a) Statewide 22,426
CO Rocky Mountain Health Plan Authority Medical-only PIHP
Non-risk Capitation
1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 15,157
Page 28Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
CO Rocky Mountain PACE PACE Risk-based Capitation
PACE El Paso 37
CO Total Long Term Care PACE Risk-based Capitation
PACE Adams, Arapahoe, Denver, Jefferson 1,263
CO VOANS PACE, Inc PACE Risk-based Capitation
PACE Delta, Montrose 121
CT Aetna Better Health Commercial MCO Risk-based Capitation
1915(b) Statewide 83,069
CT Americhoice by United HealthCare Medicaid MCO Risk-based Capitation
1915(b) Statewide 39,163
CT Community Health Network of Connecticut Medicaid MCO Risk-based Capitation
1915(b) Statewide 220,384
CT HUSKY Primary Care PCCM Fee-For-Service 1915(b) Greater Waterbury, Greater Windham 168
DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation
1932(a) Statewide 63,915
DC Health Right Incorporated Medicaid MCO Risk-based Capitation
1932(a) Statewide 20,356
DC Health Services For Children with Special Needs
Medical-only PIHP
Risk-based Capitation
1915(a) Statewide 3,593
DC Medical Transportation Management Transp PAHP Non-risk Capitation
1902(a)(70) Statewide 50,174
DC Unison Health Plan of the Capital Area Medicaid MCO Risk-based Capitation
1932(a) Statewide 12,368
DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation
1115 Statewide 78,603
DE Diamond State Partners *Fee for Service Model
Fee-For-Service 1115 Statewide 8,487
DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-based Capitation
1115 Statewide 38,999
FL Access Health Solutions Medical-only PAHP
Non-risk Capitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucie, Volusia
57,539
Page 29Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Access Health Solutions (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Baker, Broward, Clay, Duval, Nassau 51,260
FL Adult Day Health Care *Adult Day Health Care
Facility
Fee-For-Service 1915(b)/(c) Lee, Palm Beach 37
FL AIDS Healthcare Foundation, Inc. Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 6,015
FL Alternative Medicine Integration Disease Management
PAHP
Non-risk Capitation
1915(b) Hillsborough, Pasco, Pinellas 428
FL Alzheimer's Waiver Service Provider *Community Care for the
Elderly Agencies
Fee-For-Service 1915(b)/(c) Broward, Dade, Palm Beach, Pinellas 310
FL American Eldercare Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Clay, Dade, Duval, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, Volusia
3,821
FL Amerigroup Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia
155,880
FL Amerigroup (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
2,301
FL Amerigroup (Reform) Commercial MCO Risk-based Capitation
1115 Broward 22,262
FL Atlantic Dental, Inc. Dental PAHP Risk-based Capitation
1915(b) Dade 175,971
FL Better Health (Reform) Medical-only PIHP
FFS w/Some Risk Capitation
1115 Broward County 4,410
FL Buena Vista Commercial MCO Risk-based Capitation
1915(b) Broward, Dade, Gadsden, Hendry, Jefferson, Leon, Liberty, Madison, Wakulla
20,981
FL Caremark Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 85
Page 30Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Children's Medical Services (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward, Duval 5,484
FL Citrus (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
1,226
FL Citrus Health Care Commercial MCO Risk-based Capitation
1915(b) Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk, Seminole
27,039
FL Commission for the Transportation of the Disadvantaged
Transp PAHP Flat Rate per Ride 1915(b) Statewide 70,965
FL First Coast Advantage (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Duval 29,032
FL Florida Health Partners, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) Hillsborough, Lee, Osceola, Pasco 188,934
FL Florida PACE Centers PACE Risk-based Capitation
PACE 33125, 33127, 33128, 33129, 33130, 33131, 33132, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33147, 33150, 33154, 33161, 33167, 33168, 33181
231
FL Freedom Health Plan Commercial MCO Risk-based Capitation
1915(b) Dade, Palm Beach 2,191
FL Freedom Health Plan (Reform) Commercial MCO Risk-based Capitation
1115 Broward 1,022
FL HealthEase Medicaid MCO Risk-based Capitation
1915(b) 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
179,142
FL HealthEase (Reform) Commercial MCO Risk-based Capitation
1115 Duval 23,508
FL HealthierFlorida (Pfizer Health Solutions, Inc.)
Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 10,171
FL Healthy Palm Beaches Medicaid MCO Risk-based Capitation
1915(b) Palm Beach 7,833
FL Hemophilia of the Sunshine State Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 130
Page 31Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL Hope Life Care Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Charlotte, Collier, Hendry, Lee 203
FL Hope Select Care PACE Risk-based Capitation
PACE Lee 98
FL Humana Family Commercial MCO Risk-based Capitation
1915(b) Broward, Dade, Palm Beach 36,703
FL Humana Family (Reform) Commercial MCO Risk-based Capitation
1115 Broward 15,063
FL Humana Medical Plan 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
605
FL Humana Senior's Choice Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Dade, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
303
FL JMH Health Plan Commercial MCO Risk-based Capitation
1915(b) Dade 15,200
FL Lakeview Center, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) Escambia 31,116
FL Little Havana Activities and Nutrition Centers
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 847
FL Magellan Behavioral Health of Florida Mental Health PIHP
Risk-based Capitation
1915(b) Dade, Leon, Palm Beach, Volusia 213,091
FL Managed Care of North America Dental PAHP Risk-based Capitation
1915(b) Dade 6,228
FL MediPass PCCM Fee-For-Service 1915(b) Statewide 455,877
FL Molina Health Care of Florida Medicaid MCO Risk-based Capitation
1915(b) Broward (Reform), Dade, Hillsborough, Palm Beach, Pasco, Pinellas, Polk
23,731
FL Molina Health Care of Florida (Reform) Commercial MCO Risk-based Capitation
1115 Broward County 5,023
FL Neighborly Care Network 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
522
Page 32Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL NetPass Medical-only PAHP
Risk-based Capitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucia, Volusia
13,568
FL NetPass (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 8,002
FL North Florida Behavioral Health Partnership
Mental Health PIHP
Risk-based Capitation
1915(b) Alachua 88,856
FL Preferred Medical Plan Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 14,512
FL Preferred Medical Plan (Reform) Commercial MCO Risk-based Capitation
1115 Broward 2,735
FL Prestige Health Choice Medicaid MCO Risk-based Capitation
1915(b) Dade, Hillsborough, Lee, Pinellas 16,327
FL Project Independence at Home Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 105
FL Provider Service Network *Shared Savings Model
FFS/Some Risk Capitation
1915(b) Dade 9,045
FL Public Health Trust of Dade County Mental Health PIHP
Risk-based Capitation
1915(b) Dade 47,332
FL South Florida Community Care Network (Reform)
Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 17,792
FL StayWell Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter
178,605
FL Sunshine State Health Plan Medicaid MCO Risk-based Capitation
1915(b) Dade, Hillbourough, Pasco, Pinellas 22,298
FL Total Health Choice Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 2,753
FL Total Health Choice (Reform) Commercial MCO Risk-based Capitation
1115 Broward 18,819
FL United Evercare Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 2,126
Page 33Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
FL United Health Care Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Citrus, Dade, Duval, Hernando, Highlands, Hillsborough, Lake, Manatee, Marion, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Volusia
80,591
FL United Health Care (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Dade, Duval, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia
2,198
FL United Health Care (Reform) Commercial MCO Risk-based Capitation
1115 Baker, Clay, Duval, Nassau 10,815
FL United Home Care Services Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 918
FL Universal Health Care Commercial MCO Risk-based Capitation
1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon, Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Wakulla
23,127
FL Universal Health Care (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Charlotte, Citrus, Clay, Collier, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole
682
FL Universal Health Care (Reform) Commercial MCO Risk-based Capitation
1115 Broward, Duval 7,003
FL Urban Jacksonville Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Clay, Duval, St. Johns 96
FL Vista Health Plan of South Florida Commercial MCO Risk-based Capitation
1915(b) Dade 18,945
FL Vista Independence Plan Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 1,233
FL YourCare Brevard Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard 62
GA Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, East Region, North Region, Southeast Region 177,441
GA Georgia Better Health Care PCCM Fee-For-Service 1932(a) Statewide 108,619
GA Non-Emergency Transportation Brokerage Program
Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 1,274,823
GA Peach State Health Plan Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, Southwest Region 239,247
Page 34Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
GA WellCare Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, East Region, North Region, Southeast Region, Southwest Region
421,656
HI Aloha Care Medicaid MCO Risk-based Capitation
1115 Statewide 68,037
HI Evercare Commercial MCO Risk-based Capitation
1115 Statewide 18,494
HI HMSA-Medical Commercial MCO Risk-based Capitation
1115 Big Island, Kauai, Oahu 97,164
HI Kaiser Permanente Commercial MCO Risk-based Capitation
1115 Maui, Oahu 22,223
HI Maui PACE PACE Risk-based Capitation
PACE Maui 17
HI Ohana Commercial MCO Risk-based Capitation
1115 Maui 22,239
IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Statewide 329,897
IA Medipass PCCM Fee-For-Service 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
170,659
IA Siouxland PACE PACE Risk-based Capitation
PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 55
ID Blue Cross of Idaho Dental PAHP Risk-based Capitation
1937 Statewide 129,308
ID Healthy Connections PCCM Fee-for-Service 1937 Statewide 166,524
Page 35Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
ID Medicare-Medicaid Coordinated Plan Medical-only PAHP
Risk-based Capitation
1937 Ada, Bannock, Benewah, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Gem, Jefferson, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls, Washington
1,030
IL Family Health Network Medicaid MCO Risk-based Capitation
1915(a) Cook 44,500
IL Harmony Health Plan Commercial MCO Risk-based Capitation
1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, Williamson
133,200
IL Illinois Health Connect PCCM Fee-For-Service 1932(a) Statewide 1,100,300
IL Meridian Health Plan Medicaid MCO Risk-based Capitation
1915(a) Adams, Brown, Henry, Mercer, Pike, Rock Island, Scott 200
IN Advantage Health Solutions-Care Select PCCM Fee-For-Service 1915(b) Statewide 28,691
IN Anthem-Healthy Indiana Plan Commercial MCO Risk-based Capitation
1115 Statewide 29,232
IN Anthem-Hoosier Healthwise Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 148,426
IN Enhanced Services Plan (ESP)-Healthy Indiana Plan
*High Risk Plan Fee-For-Service 1115 Statewide 469
IN Managed Health Services (MHS)-Hoosier Healthwise
Medicaid MCO Risk-based Capitation
1115, 1915(b) Statewide 191,413
IN MDwise-Care Select PCCM Fee-For-Service 1915(b) Statewide 35,498
IN MDwise-Healthy Indiana Plan Commercial MCO Risk-based Capitation
1115 Statewide 15,127
IN MDwise-Hoosier Healthwise Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 262,780
KS Children's Mercy's Family Health Partners Medicaid MCO Risk-based Capitation
1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 93,316
KS HealthConnect Kansas PCCM Fee-For-Service 1932(a) Statewide 24,050
KS Kansas Health Solutions Mental Health PAHP
Non-risk Capitation
1915(b)/(c) Statewide 243,352
KS Midland Care Services PACE Risk-based Capitation
PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie, Shawnee, Wabaunsee
54
Page 36Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-based Capitation
1932(a) Statewide 47,684
KS ValueOptions-Kansas Substance Use Disorders PIHP
Risk-based Capitation
1915(b)/(c) Statewide 243,352
KS Via Christi Healthcare Outreach Programs for Elders
PACE Risk-based Capitation
PACE Sedgwick 173
KY Human Service Transportation Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 638,083
KY Kentucky Patient Access and Care (KenPAC)
PCCM Fee-For-Service 1932(a) Statewide 304,973
KY Passport Health Plan Medicaid MCO Risk-based Capitation
1115 Jefferson County (Louisville) Kentucky and 15 surrounding counties
159,005
LA Community Care PCCM Fee-For-Service 1932(a) Statewide 729,219
LA Greater New Orleans PACE Risk-based Capitation
PACE 70001, 70002, 70003, 70005, 70006, 70032, 70043, 70053, 70112, 70113, 70114, 70115, 70116, 70117, 70118, 70119, 70121, 70122, 70124, 70125, 70126, 70127, 70128, 70129, 70130, 70131
119
MA Boston Medical Center HealthNet Plan Medicaid MCO Risk-based Capitation
1115 Boston/Greater Boston Region, Central Region, Southern Region, Western Region
181,342
MA Elder Service Plan of Cambridge Health Alliance
PACE Risk-based Capitation
PACE Allston, Cambridge, Somerville 194
MA Elder Service Plan of East Boston PACE Risk-based Capitation
PACE East Boston 297
MA Elder Service Plan of Harbor Health Services, Inc.
PACE Risk-based Capitation
PACE Greater Boston 293
MA Elder Service Plan of the North Shore, Inc. PACE Risk-based Capitation
PACE Northeastern MA 652
MA Fallon Community Health Plan Commercial MCO Risk-based Capitation
1115 Central Region 12,259
MA MA Behavioral Health Partnership MH/SUD PIHP Risk-based Capitation
1115 Statewide 304,821
MA Neighborhood Health Plan Commercial MCO Risk-based Capitation
1115 Boston/Greater Region, Central/Western Region, Northeast/Southeast Region
135,287
Page 37Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MA Network Health Medicaid MCO Risk-based Capitation
1115 Boston/Greater Boston Region, Central/Western Region, Northeast/Southeast Region
107,286
MA Primary Care Clinician Plan PCCM Fee-For-Service 1115 Statewide 284,404
MA Summit Elder Care PACE Risk-based Capitation
PACE Worchester 592
MA Uphams Elder Service Plan PACE Risk-based Capitation
PACE Boston 150
MD AMERIGROUP - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide except for Allegany and Washington Count 624
MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-based Capitation
1115 Statewide except Allegany and Wahington Counties 182,360
MD Hopkins Elder Plus PACE Risk-based Capitation
PACE 21052, 21202, 21205, 21206, 21213, 21214, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237
138
MD JAI Medical System Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County 11,012
MD JAI Medical Systems - PAC Medical-only PAHP
Risk-based Capitation
1115 Baltimore City, Baltimore County 6,136
MD Maryland Physicians Care Medicaid MCO Risk-based Capitation
1115 Statewide except Cecil County 100,608
MD Maryland Physicians Care - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 11,128
MD Medstar Family Choice Medicaid MCO Risk-based Capitation
1115 Anne Arundel North, Baltimore City, Baltimore County, Harford
24,795
MD Priority Partners - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 3,640
MD Priority Partners MCO Medicaid MCO Risk-based Capitation
1115 Statewide except North and East Baltimore County and Cecil County
143,839
MD The Diamond Plan Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County, Cecil, Harford 7,870
MD United Health Care Medicaid MCO Risk-based Capitation
1115 Statewide 119,056
Page 38Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MD United HealthCare - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 8,818
ME MaineCare Primary Care Case Management
PCCM Fee-For-Service 1932(a) Statewide 178,353
MI Access Alliance of Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 54,216
MI BlueCaid of Michigan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Washtenaw, Wayne 20,128
MI Care Resources PACE Capitation PACE Kent 154
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
48,143
MI CMH Affiliation of Mid-Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee, Newago
84,957
MI CMH for Central Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 39,138
MI CMHSA Network of West Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Kent 88,718
MI Comprehensive Senior Care Corporation PACE Risk-based Capitation
PACE Calhoun 18
MI Detroit-Wayne County CMH Agency Mental Health PIHP
Risk-based Capitation
1915(b) Wayne 400,370
MI Genesee County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b) Genesee 84,805
MI Great Lakes Health Plan Medicaid MCO Risk-based Capitation
1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron, Jackson, Kalamazoo, Lenawee, Livingston, Macomb, Oakland, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne
193,811
Page 39Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MI Health Plan of Michigan Medicaid MCO Risk-based Capitation
1915(b) Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Crawford, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newago, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne
202,710
MI HealthPlus Partners, Inc. Medicaid MCO Risk-based Capitation
1915(b) Bay, Genesee, Lapeer, Saginaw, Shiawassee, Tuscola 67,721
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
295,794
MI Henry Ford Health System-Center for Senior Independence
PACE Risk-based Capitation
PACE 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
194
MI Lakeshore Behavioral Health Alliance Mental Health PIHP
Risk-based Capitation
1915(b) Muskegon, Ottawa 58,964
MI Life Circles PACE Risk-based Capitation
PACE Muskegon, Ottawa 21
MI LifeWays Mental Health PIHP
Risk-based Capitation
1915(b) Hillsdale, Jackson 31,591
MI Macomb County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b) Macomb 87,717
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
71,083
MI Midwest Health Plan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne 66,934
Page 40Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
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
205,469
MI Northcare Mental Health PIHP
Risk-based Capitation
1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft
41,636
MI Northern Affiliation Mental Health PIHP
Risk-based Capitation
1915(b) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle
43,437
MI Northern Lakes CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b) Crawford, Grand Traverse, Lake, Leelanau, Mason, Missaukee, Oceana, Roscommon, Wexford
40,434
MI Oakland County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b) Oakland 95,564
MI Omnicare Health Plan Medicaid MCO Risk-based Capitation
1915(b) Oakland, Wayne 54,184
MI Physicians Health Plan of Mid-Michigan - Family Care
Medicaid MCO Risk-based Capitation
1915(b) Ingham, Ionia, Montcalm, Shiawassee 17,843
MI Priority Health Government Programs, Inc. Medicaid MCO Risk-based Capitation
1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm, Muskegon, Oceana, Osceola, Ottawa
59,560
MI ProCare Health Plan Medicaid MCO Risk-based Capitation
1915(b) Wayne 1,113
MI Saginaw County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b) Saginaw 38,276
MI Southeast Partnership Mental Health PIHP
Risk-based Capitation
1915(b) Lenawee, Livingston, Monroe, Washtenaw 67,544
MI Southwest Alliance Mental Health PIHP
Risk-based Capitation
1915(b) Allegan, Cass, Kalamazoo, St. Joseph 67,132
MI Thumb Mental Health Alliance Mental Health PIHP
Risk-based Capitation
1915(b) Lapeer, Sanilac, St. Clair 41,820
MI Total Health Care Medicaid MCO Risk-based Capitation
1915(b) Genesee, Macomb, Oakland, Wayne 53,576
Page 41Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
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
26,540
MI Venture Behavioral Health Mental Health PIHP
Risk-based Capitation
1915(b) Barry, Berrien, Branch, Calhoun, VanBuren 81,054
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, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Lac Qui Parle, 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, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine
99,354
MN First Plan Blue Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Carlton, Cook, Koochiching, Lake, St. Louis 8,679
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
45,170
MN Itasca Medical Care Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Itasca, Koochiching 5,017
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
119,185
MN Metropolitan Health Plan Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Anoka, Carver, Hennepin, Mower, Polk, Scott 14,352
Page 42Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
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
18,248
MN South Country Health Alliance Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena, Waseca
27,698
MN UCARE Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, 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
88,306
MO Alexian Brothers Community Services PACE Risk-based Capitation
PACE St. Louis City, St. Louis County 183
MO Blue Advantage Plus of Kansas City Medicaid MCO Risk-based Capitation
1915(b) Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair
29,057
MO Childrens Mercy Family Health Partners Medicaid MCO Risk-based Capitation
1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon
51,512
MO Harmony Health Plan of Missouri 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
15,318
MO HealthCare USA Medicaid MCO Risk-based Capitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington
187,157
MO LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 481,926
Page 43Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
MO Missouri Care 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
40,763
MO Molina Healthcare of Missouri Medicaid MCO Risk-based Capitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington
77,507
MS LogistiCare Soultions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 512,796
MT Billings Clinic PACE Risk-based Capitation
PACE 59002, 59006, 59015, 59024, 59037, 59044, 59047, 59064, 59079, 59088, 59101, 59102, 59105, 59106
24
MT McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 368
MT Passport to Health PCCM Fee-For-Service 1915(b) Statewide 371
NC Carolina Access PCCM Fee-For-Service 1932(a) Statewide 77,803
NC Community Care of North Carolina (Access II/III)
PCCM Fee-For-Service 1932(a) Statewide 921,106
NC Elderhaus PACE Risk-based Capitation
PACE Brunswick, New Hanover 26
NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Rowan, Stanly, Davidson, Union and Cabarrus Counties 72,734
NC Piedmont SeniorCare PACE Risk-based Capitation
PACE Caswell, Yancy 24
ND ExperienceHealth ND Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 2,427
ND Northland PACE PACE Risk-based Capitation
PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602, 58652, 58655, 58656
25
Page 44Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
ND Primary Care Case Management PCCM Fee-For-Service 1932(a) Statewide 29,339
NE Magellan Behavioral Health *Specialty Physician Case Management
(SPCM) Program
Fee-For-Service 1915(b) Statewide 179,512
NE Primary Care Plus PCCM Fee-For-Service 1915(b), 1932(a) Douglas, Lancaster, Sarpy 38,623
NE Share Advantage Commercial MCO Risk-based Capitation
1915(b), 1932(a) Douglas, Lancaster, Sarpy 36,119
NH McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 96,553
NJ AmeriChoice of New Jersey, Inc. Commercial MCO Risk-based Capitation
1915(b), 1932(a) Statewide 222,083
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
90,055
NJ Health Net of New Jersey, Inc. Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Bergen, Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Union
41,914
NJ Horizon NJ Health Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Statewide 324,911
NJ Life at Loudes PACE Risk-based Capitation
PACE 08002, 08003, 08004, 08007, 08009, 08012, 08021, 08026, 08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045, 08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095, 08099, 08101, 08102, 08103, 08104, 08105, 08106, 08107, 08108, 08109, 08110
14
NJ Life St. Francis PACE Risk-based Capitation
PACE 08505, 08518, 08554 17
NJ University Health Plans, Inc. Commercial MCO Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Sussex, Union, Warren
46,651
NM AMERIGROUP Community Care of New Mexico, Inc.
Commercial MCO Risk-based Capitation
1915(b)/(c) Statewide 19,080
Page 45Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
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 9,560
NM Evercare of New Mexico Commercial MCO Risk-based Capitation
1915(b)/(c) Statewide 17,891
NM Lovelace Community Health Plan Commercial MCO Risk-based Capitation
1915(b) Statewide 80,679
NM Molina Healthcare of New Mexico Medicaid MCO Risk-based Capitation
1915(b) Statewide 69,035
NM Presbyterian Health Plan Commercial MCO Risk-based Capitation
1915(b) Statewide 148,732
NM Total Community Care (PACE) PACE Risk-based Capitation
PACE Bernalillo County, Sandoval County, Valencia County 376
NM ValueOptions of New Mexico Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 312,498
NV Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Statewide 46,921
NV Health Plan of Nevada Commercial MCO Risk-based Capitation
1932(a) Clark, Washoe 59,381
NV Logisticare Transp PAHP Risk-based Capitation
1932(a) Statewide 178,711
NY Affinity Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester
204,166
NY Affinity/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 81
NY Amerigroup Medicaid MCO Risk-based Capitation
1115 New York City, Putnam 98,618
NY Amerigroup Community Connections Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 585
NY Broome County MC PCCM Fee-For-Service 1115 Broome 3,366
NY Capital District Physicians Health Plan Commercial MCO Risk-based Capitation
1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Washington
53,410
Page 46Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY CCM Select Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 1,254
NY Comprehensive Care Management (CCM) PACE Risk-based Capitation
PACE New York City, Westchester 2,488
NY Eddy Senior Care PACE Risk-based Capitation
PACE Albany, Schenectady 113
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
105,454
NY GHI *PPO Risk-based Capitation
1115 Statewide 6,148
NY GHI HMO Select Commercial MCO Risk-based Capitation
1115 Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Greene, Kings, Manhattan, Montgomery, Orange, Otsego, Putnam, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Sullivan, Ulster, Warren, Washington, Westchester
36,547
NY GHI/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 940
NY Guildnet Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 6,522
NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 162
NY Health Advantage/Elant Choice Long Term Care PIHP
Risk-based Capitation
1915(a) Orange 136
NY Health First Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk 381,548
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
39,462
NY Health Now/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 166
NY HealthPlus Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens, Richmond 258,988
Page 47Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY HHH Choices Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 754
NY HIP Combined Commercial MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester
255,511
NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 1,950
NY HomeFirst Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 3,236
NY Hudson Health Plan Medicaid MCO Risk-based Capitation
1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 64,812
NY Independent Care Systems Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 1,369
NY Independent Health/Hudson Valley&WNY Commercial MCO Risk-based Capitation
1115 Erie, Niagara 31,030
NY Independent Living For Seniors PACE Risk-based Capitation
PACE Monroe 253
NY Liberty Health Advantage/Medicaid Advantage
Commercial MCO Risk-based Capitation
1115 Statewide 703
NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 51
NY MetroPlus Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens 339,331
NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens 2,962
NY MetroPlus/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 8
NY MVP Health Plan Commercial MCO Risk-based Capitation
1115 Dutchess, Ulster 32,276
NY Neighborhood Health Provider/Medicaid Advantage
Commercial MCO Risk-based Capitation
1115 Statewide 195
NY Neighborhood Health Providers Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens, Richmond 199,517
Page 48Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY NYPS Select Health Special Needs Medicaid MCO Risk-based Capitation
1115 Statewide 1,334
NY NYS Catholic Health Plan 1199 Commercial MCO Risk-based Capitation
1115 Statewide 4,219
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
393,919
NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage
Commercial MCO Risk-based Capitation
1115 Statewide 240
NY PACE CNY PACE Risk-based Capitation
PACE Onondaga 340
NY Partners In Community Care Long Term Care PIHP
Risk-based Capitation
1915(a) Orange, Rockland 270
NY Physician Case Management Program PCCM Risk-based Capitation
1115 Erie 4,947
NY SCHC TotalCare Medicaid MCO Risk-based Capitation
1115 Onondaga, Oswego, Tompkins 31,284
NY Senior Health Partners Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 1,599
NY Senior Network Health Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 378
NY Senior Whole Health Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 135
NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 599
NY Southern Tier Pediatrics PCCM Risk-based Capitation
1115 Chemung, Steuben 4,050
NY Southern Tier Priority PCCM Risk-based Capitation
1115 Chemung, Schuyler, Steuben 4,276
NY Total Aging in Place Long Term Care PIHP
Risk-based Capitation
1915(a) Erie 147
Page 49Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
NY Total Senior Care PACE Risk-based Capitation
PACE Cattaraugus 16
NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 551
NY United Healthcare Commercial MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 209,812
NY Univera Community Health Medicaid MCO Risk-based Capitation
1115 Allegany, Cattaraugus, Chautauqua, Erie 36,123
NY VidaCare Inc. Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 1,374
NY VNS Choice Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 7,375
NY VNS Choice Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 21
NY Wellcare Commercial MCO Risk-based Capitation
1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, New York, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster
89,419
NY WellCare Advantage Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 127
NY WellCare Advocate Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 283
OH Amerigroup Ohio Medicaid MCO Risk-based Capitation
1932(a) Southwest, West Central 59,762
OH Buckeye Community Health Plan Medicaid MCO Risk-based Capitation
1932(a) East Central, Northeast, Northwest, Southwest 140,296
OH CareSource Medicaid MCO Risk-based Capitation
1932(a) Central, East Central, Northeast, Northeast Central, Northwest, Southeast, Southwest, West Central
689,818
OH Concordia Care PACE Risk-based Capitation
PACE Cuyahoga 238
OH Molina Healthcare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Central, Southeast, Southwest, West Central 201,551
OH Paramount Advantage Medicaid MCO Risk-based Capitation
1932(a) Northwest 76,841
Page 50Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OH TriHealth Senior Link PACE Risk-based Capitation
PACE Butler, Clermont, Hamilton, Warren 454
OH Unison Health Plan of Ohio Medicaid MCO Risk-based Capitation
1932(a) East Central, Northeast Central, Southeast 108,213
OH WellCare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Northeast 97,347
OK Cherokee Elder Care PACE Risk-based Capitation
PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434, 74441, 74451, 74452, 74464, 74471
49
OK SoonerCare American Indian PCCM PCCM Fee-For-Service 1115 Statewide 11,831
OK SoonerCare PCCM PCCM Fee-For-Service 1115 Statewide 400,642
OK SoonerRide Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 553,385
OR Accountable Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Benton, Crook, Deschutes, Jefferson, Lincoln 30,076
OR Capitol Dental Care Inc. Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk, Umatilla, Union, Wasco, Washington, Yamhill
131,921
OR Care Oregon Medicaid MCO Risk-based Capitation
1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson, Klamath, Marion, Morrow, Multnomah, Polk, Umatilla, Washington, Yamhill
114,606
OR Cascade Comprehensive Care Medicaid MCO Risk-based Capitation
1115 Klamath 6,678
OR Central Oregon Independent Health Solutions
Medicaid MCO Risk-based Capitation
1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler
22,859
OR Clackamas County Mental Health Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Gilliam, Hood River, Marion, Sherman, Wasco 27,427
OR Deschutes County CDO Substance Use Disorders PAHP
Risk-based Capitation
1115 Deschutes 15,615
OR Doctors of the Oregon Coast South Medicaid MCO Risk-based Capitation
1115 Coos 8,444
OR Douglas County IPA Commercial MCO Risk-based Capitation
1115 Douglas 12,369
Page 51Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OR FamilyCare (Mental Health) Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Multnomah, Washington 12,727
OR FamilyCare Health Plans Commercial MCO Risk-based Capitation
1115 Clackamas, Jackson, Josephine, Morrow, Multnomah, Umatilla, Washington
23,132
OR Greater Oregon Behavioral Health, Inc. Mental Health PIHP
Risk-based Capitation
1115 Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur, Morrow, Umatilla, Union, Wallowa, Wheeler
46,127
OR Hayden Family Dentistry Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Coos, Crook, Deschutes, Douglas, Gilliam, Grant, Harney, Jackson, Jefferson, Klamath, Lake, Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk, Sherman, Umatilla, Wasco, Wheeler
60,900
OR Inter-Community Health Network Medicaid MCO Risk-based Capitation
1115 Benton, Linn 17,999
OR Jefferson Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Coos, Curry, Douglas, Jackson, Josephine, Klamath 55,904
OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-based Capitation
1115 Clackamas, Marion, Multnomah, Polk 6,355
OR Lane Care MHO Mental Health PIHP
Risk-based Capitation
1115 Lane 38,210
OR Lane Individual Practice Association Medicaid MCO Risk-based Capitation
1115 Benton, Lane, Linn 31,541
OR Managed Dental Care of Oregon Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill
10,509
OR Marion Polk Community Health Plan Medicaid MCO Risk-based Capitation
1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 45,642
OR Mid Valley Behavioral Care Network Mental Health PIHP
Risk-based Capitation
1115 Linn, Marion, Polk, Tillamook, Yamhill 79,755
OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-based Capitation
1115 Douglas, Jackson, Josephine 12,880
OR Multicare Dental Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 28,057
OR Multnomah County Verity Mental Health PIHP
Risk-based Capitation
1115 Multnomah 74,430
Page 52Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
OR Northwest Dental Services Dental PAHP Risk-based Capitation
1115 Baker, Coos, Crook, Curry, Deschutes, Douglas, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Malheur, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler
58,028
OR ODS Community Health Inc. Medicaid MCO Risk-based Capitation
1115 Baker, Deschutes, Jackson, Malheur, Union, Wallowa 7,232
OR Oregon Dental Service Dental PAHP Risk-based Capitation
1115 Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Grant, Hood River, Jackson, Jefferson, Josephine, Lane, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Wasco, Washington, Yamhill
48,745
OR Oregon Health Management Service Medicaid MCO Risk-based Capitation
1115 Douglas, Jackson, Josephine 4,351
OR PCCM PCCM Fee-For-Service 1115 Statewide 12,207
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
555
OR Providence Health Assurance Medicaid MCO Risk-based Capitation
1115 Clackamas, Multnomah, Washington, Yamhill 17,183
OR Tuality Health Care Medicaid MCO Risk-based Capitation
1115 Washington 7,276
OR Washington County Health (Mental Health)
Mental Health PIHP
Risk-based Capitation
1115 Washington 34,889
OR Willamette Dental Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Deschutes, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Washington
56,673
PA Access Plus Program PCCM Fee-For-Service 1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
262,583
PA Albright LIFE Medical-only PIHP
Risk-based Capitation
1915(a) Clinton, Lancaster, Lycoming 46
Page 53Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA AmeriChoice of Pennsylvania Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 57,378
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan
Commercial MCO Risk-based Capitation
1915(b) Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, York
87,673
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL
Commercial MCO Risk-based Capitation
1915(a) Carbon, Lackawanna, Luzerne, Monroe, Pike 2,262
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
121,194
PA Community Care Behavioral Health - Northeast
MH/SUD PIHP Risk-based Capitation
1915(b) Lackawanna, Luzerne, Susquehanna, Wyoming 74,059
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
298
PA Counties of Armstrong/Indiana - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Armstrong, Indiana 17,134
PA Counties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania
MH/SUD PIHP Risk-based Capitation
1915(b) Bedford 13,280
PA Counties of Carbon/Monroe/Pike - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Carbon, Monroe, Pike 30,595
PA Counties of Crawford/Mercer/Venango - Value Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Crawford, Mercer, Venango 35,594
PA Counties of Franklin/Fulton - Community Behavorial Healthcare Network of Pennsylvania
MH/SUD PIHP Risk-based Capitation
1915(b) Franklin, Fulton 13,874
PA Counties of Lycoming/Clinton - Community Behavioral Healthcare Network of Pennsylvania
MH/SUD PIHP Risk-based Capitation
1915(b) Clinton, Lycoming 18,341
PA County of Adams - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Adams 6,971
PA County of Allegheny - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Allegheny 133,123
Page 54Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
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 19,792
PA County of Berks - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Berks 48,242
PA County of Blair County - Community Behavioral Healthcare Network of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Blair 17,435
PA County of Bucks - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Bucks 35,983
PA County of Butler - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Butler 13,462
PA County of Cambria - Value Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Cambria 17,308
PA County of Chester - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Chester 24,311
PA County of Cumberland - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Cumberland 13,100
PA County of Dauphin - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Dauphin 30,360
PA County of Delaware - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Delaware 56,058
PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Erie 39,483
PA County of Fayette - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Fayette 24,132
PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lancaster 44,157
PA County of Lawrence - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Lawrence 12,361
PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lebanon 12,248
PA County of Lehigh - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Lehigh 41,315
Page 55Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA County of Montgomery - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Montgomery 47,007
PA County of Northampton - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Northampton 25,482
PA County of Perry - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Perry 3,517
PA County of Philadelphia - Community Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Philadelphia 353,115
PA County of Washington - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Washington 20,798
PA County of Westmoreland - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Westmoreland 35,123
PA County of York - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) York 37,574
PA Everyday LIFE PACE Risk-based Capitation
PACE Lehigh, Northampton 5
PA Gateway Health Plan, Inc. Commercial MCO Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York
192,419
PA Gateway Health Plan, Inc. -VOL Commercial MCO Risk-based Capitation
1915(a) Blair, Cambria, Carbon, Clarion, Columbia, Erie, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Northumberland, Pike, Schuylkill, Somerset, Susquehanna, Wyoming
19,681
PA Health Partners of Philadelphia Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 124,518
PA Keystone Mercy Health Plan Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 263,884
PA LIFE - Beaver County PACE Risk-based Capitation
PACE Beaver 122
PA LIFE - Geisinger PACE Risk-based Capitation
PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union, Wyoming
98
Page 56Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
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
320
PA LIFE - University of Pennsylvania PACE Risk-based Capitation
PACE 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153
341
PA LIFE at Home PACE Risk-based Capitation
PACE Chester, Delaware 59
PA LIFE Butler County Medical-only PIHP
Risk-based Capitation
1915(a) Butler 16
PA LIFE Lutheran Services PACE Risk-based Capitation
PACE Franklin 15
PA LIFE NWPA Medical-only PIHP
Risk-based Capitation
1915(a) Erie 28
PA Logisticare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Philadelphia 406,732
PA McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntington, Jefferson, Juniata, Lackwanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
50,788
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
234
PA New Courtland LIFE Medical-only PIHP
Risk-based Capitation
1915(a) Philadelphia County zip codes 19118, 19119, 19120, 19126, 19127, 19128, 19129, 19132, 19138, 19141,
113
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
145
PA Unison Health Plan / MedPLUS Commercial MCO Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York
90,679
Page 57Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
PA Unison Health Plan/MedPlus - 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
30,188
PA UPMC Health Plan, Inc./UPMC for You Commercial MCO Risk-based Capitation
1915(b) Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, Westmoreland
90,899
PA UPMC Health Plan, Inc./UPMC for You - VOL
Commercial MCO Risk-based Capitation
1915(a) Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango
5,607
PA Value Behavioral Health of PA (Greene County)
MH/SUD PIHP Risk-based Capitation
1915(b) Greene 5,998
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
14,134
PR APS Healthcare MH/SUD PIHP Risk-based Capitation
1915(a) Aguas Buenas, Arecibo, Barceloneta, Caguas, Camuy, Canovanas, Carolina, Cayey, Ceiba, Ciales, Cidra, Culebra, Fajardo, Florida, Gurabo, Hatillo, Humacao, Juncos, Lares, Las Piedras, Loiza, Luquillo, Manati, Morovis, Naguabo, Quebradillas, Rio Grande, San Lorenzo, Trujillo Alto, Utuado, Vega Baja, Vieques, Yabucoa
323,126
PR FHC Healthcare MH/SUD PIHP Risk-based Capitation
1915(a) Adjuntas, Aibonito, Arroyo, Barranquitas, Coamo, Guanica, Guayama, Guayanilla, Jayuya, Juana Diaz, Maunabo, Orocovis, Patillas, Penuelas, Ponce, Salinas, Santa Isabel, Villalba, Yauco
182,176
PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO Risk-based Capitation
1915(a) Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, Cayey, Cidra, Coamo, Guayama, Gurabo, Humacao, Juana Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa
210,422
Page 58Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
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
8,338
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
40,124
PR MCS Health Management Options, Inc. Commercial MCO Risk-based Capitation
1915(a) Aguada, Aguadilla, Añasco, 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
260,470
Page 59Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
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
48,755
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
32,093
PR Salud Dorada con Medicare 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 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
3,292
Page 60Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
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
18,405
PR Triple-S, Inc. Commercial MCO Risk-based Capitation
1915(a) Adjuntas, Arecibo, Barceloneta, Bayamón, Camuy, Cataño, Ciales, Comerío, Corozal, Dorado, Florida, Guanica, Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati, Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta, Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco
323,026
RI Blue Cross & Blue Shield of Rhode Island Commercial MCO Risk-based Capitation
1115 Statewide 13,638
RI Neighborhood Health Plan of Rhode Island
Medicaid MCO Risk-based Capitation
1115 Statewide 74,027
RI PACE Organization of Rhode Island PACE Risk-based Capitation
PACE Statewide except for Zip Codes Block Island 02807 164
RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-based Capitation
1115 Statewide 41,717
RI United HealthCare of New England Commercial MCO Risk-based Capitation
1115 Statewide 32,578
SC Absolute Total Care Medicaid MCO Risk-based Capitation
1915(a) Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkely, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
46,270
Page 61Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
SC BlueChoice Health Plan Medicaid MCO Risk-based Capitation
1915(a) Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dorchester, Fairfield, Florence, Greenville, Hampton, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Newberry, Oconee, Orangeburg, Pickens, Richland, Spartanburg, Sumter, Union, Williamsburg, York
19,464
SC Carolina Crescent Health Plan Medicaid MCO Risk-based Capitation
1915(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
33,867
SC CHCcares of South Carolina Medicaid MCO Risk-based Capitation
1915(a) Aiken, Bamberg, Barnwell, Berkley, Calhoun, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Dorchester, Edgefield, Fairfield, Kershaw, Lancaster, Lexington, McCormick, Newberry, Orangeburg, Richland, Saluda, Sumter, Union, York
4,254
SC First Choice by Select Health of South Carolina, Inc.
Medicaid MCO Risk-based Capitation
1915(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
184,059
SC Logisticare Transp PAHP Risk-based Capitation
1902(a)(70) Region 3, Region 4, Region 5, Region 6 508,817
SC Medical Transportation Management (MTM)
Transp PAHP Risk-based Capitation
1902(a)(70) Region 1, Region 2 254,408
SC Medically Fragile Children Medical-only PAHP
Risk-based Capitation
1915(a) Anderson, Berkeley, Charleston, Dorchester, Greenville, Lexington, Oconee, Pickens, Richland
142
SC Palmetto SeniorCare (PACE) PACE Risk-based Capitation
PACE Lexington, Richland 375
SC South Carolina Solutions PCCM Fee-For-Service 1932(a) Statewide 90,136
Page 62Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
SC The Oaks PACE PACE Risk-based Capitation
PACE Orangeburg County 32
SC Unison Health Plan of SC Medicaid MCO Risk-based Capitation
1915(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Sumter, Union, Williamsburg, York
53,868
SD PRIME PCCM Fee-For-Service 1932(a) Statewide 85,476
TN Alexian Brothers Community Services PACE Risk-based Capitation
PACE Hamilton 309
TN AmeriChoice - East TN Medicaid MCO Risk-based Capitation
1115 East Tennessee 172,670
TN AmeriChoice - Middle TN Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 189,868
TN AmeriChoice - West TN Medicaid MCO Risk-based Capitation
1115 West Tennessee 162,647
TN AmeriGroup Community Care Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 189,937
TN Doral Dental of Tennessee, LLC *Dental Benefit Manager
Administrative Services Fee
1115 Statewide 678,776
TN Premier Behavioral Systems of TN MH/SUD PIHP Risk-based Capitation
1115 Statewide 71,661
TN SXC Health Solution Corperation *Pharmacy Benefit Manager
Administrative Services Fee
1115 Statewide 1,230,750
TN Volunteer State Health Plan (Bluecare) - East
Medicaid MCO Risk-based Capitation
1115 East Tennessee 249,726
TN Volunteer State Health Plan (Bluecare) - West
Medicaid MCO Risk-based Capitation
1115 West Tennessee 194,241
Page 63Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TN Volunteer State Health Plan (TennCare Select)
*Prepaid Inpatient Health
Plan (PIHP), partial risk,
partial capitation
Partial Capitation 1115 Statewide 71,661
TX Aetna Commercial MCO Risk-based Capitation
1915(b) Atascosa, Bexar, Comal, Denton, Guadalupe, Hood, Johnson, Kendall, Medina, Parker, Tarrant, Wilson, Wise
38,597
TX Amerigroup (STAR) Medicaid MCO Risk-based Capitation
1915(b) Bastrop, Brazoria, Burnet, Caldwell, Collin, Dallas, Denton, Ellis, Fort Bend, Galveston, Harris, Hays, Hood, Hunt, Johnson, Kaufman, Lee, Montgomery, Navarro, Parker, Rockwell, Tarrant, Travis, Waller, Williamson, Wise
351,524
TX Amerigroup (STAR+PLUS) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Atascosa, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Comal, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Lee, Medina, Montgomery, Travis, Waller, Williamson, Wilson
54,887
TX Bienvivir Senior Health Service PACE Risk-based Capitation
PACE 79901, 79902, 79903, 79904, 79905, 79907, 79915, 79924, 79925, 79930, 79935, 79936
761
TX Community First Commercial MCO Risk-based Capitation
1915(b) Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson 72,332
TX Community Health Choice Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 98,795
TX Cook Children's Medicaid MCO Risk-based Capitation
1915(b) Denton, Hood, Johnson, Parker, Tarrant, Wise 40,990
TX Driscoll Medicaid MCO Risk-based Capitation
1915(b) Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Victoria
36,982
TX El Paso First Premier Commercial MCO Risk-based Capitation
1915(b) El Paso 39,914
TX Evercare Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Bastrop, Blanco, Brazoria, Burnet, Caldwell, Crosby, Floyd, Fort Bend, Galveston, Garza, Hale, Harris, Hays, Hockley, Lamb, Lee, Lubbock, Lynn, Montgomery, Terry, Travis, Waller, Williamson
54,488
TX First Care Commercial MCO Risk-based Capitation
1915(b) Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry
24,937
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
128
Page 64Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TX McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 54,794
TX Molina (STAR) Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,145
TX Molina (STAR+Plus) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Atascosa, Bexar, Brazoria, Comal, Fort Bend, Galveston, Guadalupe, Harris, Kendall, Medinal, Montgomery, Waller, Wilson
17,079
TX Parkland Community Health Plan Medicaid MCO Risk-based Capitation
1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 122,684
TX PCCM PCCM Fee-For-Service 1932(a) Anderson, Andrews, Angelina, Archer, Armstrong, Austin, Bailey, Bandera, Baylor, Bell, Bordon, Bosque, Bowie, Brazos, Brewster, Briscoe, Brooks, Brown, Burleson, Callahan, Cameron, Camp, Carson, Cass, Castro, Chambers, Cherokee, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Colorado, Comanche, Concho, Cooke, Coryell, Cottle, Crane, Crockett, Dallam, Dawson, Deaf Smith, Delta, DeWitt, Dickens, Dimmit, Donley, Duval, Eastland, Ector, Edwards, Erath, Falls, Fannin, Fayette, Fisher, Foard, Franklin, Freestone, Frio, Gaines, Gillespie, Glasscock, Goliad, Gonzales, Gray, Grayson, Gregg, Grimes, Hall, Hamilton, Hansford, Hardeman, Hardin, Harrison, Hartley, Haskell, Hemphill, Henderson, Hildalgo, Hill, Hopkins, Houston, Howard, Hutchinson, Irion, Jack, Jackson, Jasper, Jeff Davis, Jefferson, Jim Hogg, Jones, Karnes, Kenedy, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lamar, Lampasas, Lavaca, Leon, Liberty, Limestone, Lipscomb, Live Oak, Llano, Loving, Madison, Marion, Martin, Mason, Matagorda, Maverick, McCulloch, McLennan, McMullen, Menard, Midland, Milam, Mills, Mitchell, Montague, Moore, Morris, Motley, Nacogdoches, Newton, Nolan, Ochiltree, Oldham, Orange, Palo Pinto, Panola, Parmer, Pecos, Polk, Potter, Presidio, Rains, Randall, Reagan, Real, Red River, Reeves, Roberts, Robertson, Runnels, Sabine, San Augustine, San Jacinto, San Saba, Schleicher, Scurry, Shackelford, Shelby, Sherman, Smith, Somervell, Starr, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Throckmorton, Titus, Tom Green, Trinity, Tyler, Upshur, Upton, Uvalde, Val Verde, Van Zandt, Walker, Ward, Washington, Webb, Wharton, Wheeler, Wichita, Wilbarger, Willacy, Winkler, Wood, Yoakum, Young, Zapata, Zavala
732,219
Page 65Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-based Capitation
1915(a) Statewide 29,508
TX Superior HealthPlan (STAR) Medicaid MCO Risk-based Capitation
1915(b) Atascosa, Bastrop, Bexar, Burnet, Caldwell, Comal, Crosby, El Paso, Floyd, Garza, Guadalupe, Hale, Hays, Hockley, Hudspeth, Kendall, Lamb, Lee, Lubbock, Lynn, Medina, Terry, Travis, Williamson, Wilson
211,806
TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Aransas, Atascosa, Bee, Bexar, Calhoun, Comal, Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces, Refugio, San Patricio, Victoria, Wilson
35,680
TX Texas Children's Health Plan Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 153,468
TX Unicare Commercial MCO Risk-based Capitation
1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 23,699
TX United Commercial MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,587
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
306,513
UT Bear River Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Box Elder, Cache, Rich 12,284
UT Central Utah Counseling Center Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,115
UT Davis Behavioral Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Davis 16,430
UT Four Corners Community Behavioral Health
Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Carbon, Emery, Grand 4,544
UT Healthy U Medical-only PIHP
Non-risk Capitation
1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 29,338
UT Molina Healthcare of Utah (Molina) Medical-only PIHP
Non-risk Capitation
1115, 1915(b) Davis, Salt Lake, Utah, Weber 42,116
UT Non-Emergency Medical Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 176,036
UT Northeastern Counseling Center Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Daggett, Duchesne, Uintah 4,207
Page 66Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
UT Select Access PCCM Fee-For-Service 1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 58,484
UT Southwest Behavioral Health Services Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Beaver, Garfield, Iron, Kane, Washington 18,006
UT Valley Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Salt Lake, Summit, Tooele 83,812
UT Wasatch Mental Health Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Utah County 34,822
UT Weber Human Services Mental Health PIHP
Risk-based Capitation
1115, 1915(b) Morgan, Weber 20,342
VA AllCare for Seniors PACE Risk-based Capitation
PACE Buchanan, Dickerson, Russell, Tazewell 27
VA AmeriGroup Community Care Medicaid MCO Risk-based Capitation
1915(b) Alexandria City, Arlington County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Loudoun County, Manassas City, Manassas Park City, Prince William County
24,889
VA Anthem Healthkeepers Plus Commercial MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alexandria City, Amelia County, Arlington County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Franklin City, Frederick County, Fredericksburg City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas City, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Richmond City, Richmond County, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Westmoreland County, Williamsburg City, Winchester City, York County
163,028
Page 67Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA LogistiCare Solutions Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 520,773
VA MEDALLION PCCM Fee-For-Service 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
54,101
VA Mountain Empire PACE Risk-based Capitation
PACE Lee, Norton, Scott, Wise 48
VA Optima Family Care Commercial MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Brunswick County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Danville City, Dinwiddie County, Emporia City, Essex County, Fluvanna County, Franklin City, Frederick County, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Rappahannock County, Richmond City, Richmond County, Rockingham County, Shenandoah County, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Williamsburg City, Winchester City, York County
130,954
VA Riverside Peninsula PACE Risk-based Capitation
PACE Hampton, Newport News, Poquoson, Southeastern portion of York County
114
VA Sentara Senior Community Care PACE Risk-based Capitation
PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 126
Page 68Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VA Southern Health CareNet Commercial MCO Risk-based Capitation
1915(b) Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlottesville, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Fluvanna County, Goochland County, Greene County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Lynchburg, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Northumberland County, Nottoway County, Orange County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Staunton, Surry County, Sussex County, Waynesboro, Westmoreland County
18,896
VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Amelia County, Appomattox County, Augusta County, Bedford City, Bedford County, Botetourt County, Brunswick County, Buckingham County, Buena Vista City, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Culpeper County, Cumberland County, Danville, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Nottoway County, Orange County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Rappahannock County, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Shenandoah County, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Winchester City, Wythe County
128,905
VT Global Committment to Health Medicaid MCO Risk-based Capitation
1115 Statewide 137,385
Page 69Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
VT Vermont PACE PACE Risk-based Capitation
PACE Chittereden, Dorset, Grand Isle, Manchester, Rupert, South Hero
76
WA Asuris Northwest Health Commercial MCO Risk-based Capitation
1932(a) Spokane County 2,003
WA City of Seattle Human Services Disease Management
PAHP
Risk-based Capitation
1932(a) King 8,386
WA Columbia United Providers Commercial MCO Risk-based Capitation
1932(a) Clark 37,848
WA Community Health Plan Commercial MCO Risk-based Capitation
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
189,559
WA Group Health Cooperative Commercial MCO Risk-based Capitation
1932(a) King, Kitsap, Pierce, Snohomish, Spokane, Thurston 20,656
WA Kaiser Foundation Health Plan Commercial MCO Risk-based Capitation
1932(a) Clark, Cowlitz 876
WA Molina Healthcare Commercial MCO Risk-based Capitation
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
291,562
WA Molina Healthcare (WMIP) Commercial MCO Risk-based Capitation
1932(a) Snohomish 2,990
WA PCCM Tribal Clinics PCCM Fee-For-Service 1932(a) Statewide 4,495
WA Providence ElderPlace - Seattle PACE Risk-based Capitation
PACE King 319
WA Regence Blue Shield Commercial MCO Risk-based Capitation
1932(a) Clallam, Grays Harbor, Island, Pacific, Pierce, San Juan, Skagit, Snohomish, Yakima
36,093
WA Regional Support Network Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 949,263
Page 70Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI Abri Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago
14,403
WI Abri Health Plan -- SSI Commercial MCO Risk-based Capitation
1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago
1,783
WI Care Wisconsin First, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Columbia, Dodge, Green Lake, Jefferson, Marquette, Washington, Waukesha, Waushara
2,774
WI Care Wisconsin Health Plan, Inc. (Partnership)
Medicaid MCO Risk-based Capitation
1932(a)/1915(c) Dane County 1,115
WI Children's Community Health Plan - Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Columbia, Dane, Iowa, Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha
21,705
WI CHP-LTS, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Chippewa, Dunn, Eau Claire, Pierce, St. Croix 922
WI Community Care Health Plan, Inc. Commercial MCO Risk-based Capitation
1932(a)/1915(c) Milwaukee 1,147
WI Community Care of Central Wisconsin Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Marathon, Portage, Wood 6,122
WI Community Care Organization (PACE) PACE Risk-based Capitation
PACE Milwaukee 577
WI Community Care, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha
3,803
WI Community Health Partnership -- Partnership
Commercial MCO Risk-based Capitation
1932(a) Chippewa, Dunn, Eau Claire 935
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
29,955
WI Dane County Human Services Department -- CCF
MH/SUD PIHP Risk-based Capitation
1915(a) Dane 134
WI Dean Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Grant, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Sauk, Walworth, Waukesha
41,704
Page 71Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WI Group Health Cooperative Of Eau Claire -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, Lafayette, Lincoln, Marathon, Pepin, Pierce, Polk, Price, Rusk, Sauk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn
30,529
WI Group Health Cooperative of Eau Claire County SSI
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Jackson, La Crosse, Monroe, Trempealeau, Vernon 760
WI Group Health Cooperative Of South Central WI -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane, Monroe, Vernon 3,867
WI Gundersen Lutheran Health Plan - Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Trempealeau, Vernon
13,317
WI Health Tradition Health Plan -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, La Crosse, Monroe, Trempealeau, Vernon
8,069
WI Independent Care (iCare) - Medicaid HMO Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha
5,200
WI Independent Care Health Plan -- SSI Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha
8,372
WI Lakeland Care District Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Fond du Lac 1,040
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
76,347
WI Managed Health Services -- SSI Medicaid MCO Risk-based Capitation
1932(a) Kensosha, Milwaukee, Racine, Waukesha 4,751
WI MercyCare Insurance Company -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane, Green, Jefferson, Rock, Walworth 13,309
WI Milwaukee County Department on Aging Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Milwaukee 6,796
WI Milwaukee County Human Services Department -- Wraparound Milwaukee
MH/SUD PIHP Risk-based Capitation
1915(a) Milwaukee 771
Page 72Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
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
47,302
WI Network Health Plan - SSI Commercial MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Racine, Waukesha 2,657
WI Northern Bridges Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Ashland, Barron, Bayfield, Burnett, Douglas, Iron, Polk, Price, Rusk, Sawyer, Washburn
870
WI Partnership Health Plan, Inc. Commercial MCO Risk-based Capitation
1932(a)/1915(c) Chippewa, Dunn, Eau Claire 1,884
WI Physicians Plus Health Plan - Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane 4,573
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
40,823
WI Southwest Family Care Alliance Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Crawford, Green, Juneau, Lafayette, Richland, Sauk 917
WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
187,573
WI UnitedHealthcare of WI -- SSI Commercial MCO Risk-based Capitation
1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Walworth, Washburn, Washington, Waukesha, Waupace, Waushara, Winnebago, Wood
7,346
WI Unity Health Insurance -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Green, Jefferson, Sauk 11,130
WI Western Wisconsin Cares Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, Vernon
3,067
Page 73Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed Care Entity
Reimbursement Arrangement
Operating Authority Geographic Area Served
Number of Enrollees
WV Carelink Health Plan Commercial MCO Risk-based Capitation
1915(b), 1937 Boone, Brooke, Clay, Fayette, Hancock, Jackson, Kanawha, Lincoln, Logan, Marshall, Mingo, Nicholas, Ohio, Pleasants, Putnam, Raleigh, Tyler, Webster, Wetzel, Wirt, Wood
45,168
WV Health Plan of the Upper Ohio Valley Commercial MCO Risk-based Capitation
1915(b), 1937 Barbour, Brooke, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler, Upshur, Wetzel, Wirt, Wood
29,142
WV Physician Assured Access System PCCM Fee-For-Service 1915(b) Statewide 14,747
WV Unicare Health Plan of WV Commercial MCO Risk-based Capitation
1915(b), 1937 Barbour, Berkeley, Boone, Braxton, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hampshire, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming
75,384
TOTAL NUMBER OF ENROLLEES: 50,224,705
Page 74Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)
75
Arizona – The State Medicaid Enrollment increase was due to the economy. Bridgeway2 is now providing family planning services for the SOBRA family planning population.
Georgia – The State Medicaid Enrollment increase was due to the economy.
Hawaii – APS BHS, Child &Adolescent Mental Health Division, Department, and Early Intervention Programs, Department of Health are no longer valid mental PHIP plans under the Hawaii Quest Expanded (QEx) due to the removal of their mental health carve-out portion of their Hawaii Quest Expanded (QEx). The mental health portion is now under the fee-for-service model.
Massachusetts - The State Medicaid Enrollment increase was due to the economy and the unemployment rate.
Michigan – North Country CMH6 is now Northern Affiliation6.
Mississippi – Due to the inclusion of the 1902(a)(70) NEMT program, the State has managed care
enrollment.
Missouri – Mercy Care Plus2 is now Molina Healthcare of Missouri2. The State Medicaid Managed Care Enrollment is higher than normal due to the inclusion of the 1902(a)(70) NEMT program.
Nebraska – Mercy Care Plus plan2 is now Molina Healthcare of Missouri2.
New Jersey – The State Medicaid Enrollment increase was due to the economy and unemployment rate.
New York – The 1115 Expansion Enrollment decrease was due to the State aligning the Medicaid Resource Level to the Family Health Plus (FHP) Level from $3,000 to $13,000. The State Medicaid Enrollment increase was due to the economy. Care Plus Health Plan2 is now AmeriGroup2. CarePlus Connections14 is now AmeriGroup Community Connections14. Suffolk Health Plan2 was bought out by Neighborhood Health Providers2.
North Carolina – The State Medicaid Enrollment and State Medicaid Managed Care Enrollment increases were due to statewide outreach efforts, the economy, and the inclusion of the CHIP Expansion enrollment.
Ohio – The State Medicaid Enrollment increase was due to economy and the unemployment rate. Buckeye Community Health Plan1, CareSource1, Molina Healthcare of Ohio1, Unison Health Plans of Ohio1, and WellCare of Ohio1 were defined as Medicaid MCO but changed their status to Commercial MCO.
Pennsylvania – The total transportation enrollment for Logisticare Solutions, LLC11 of 34,978 for 2008 reporting period was incorrectly.
Rhode Island – Neighborhood Health Plan of Rhode Island2 was operating under 1115(a) and 1915(a) authorities but it’s currently only operating under 1115(a).
South Carolina – Total Carolina Care Inc.2 is now Absolute Total Care2. Amerigroup Community Care2 merged with Absolute Total Care2. Logisticare and MTM are the two transportation brokers under the 1902(a)(70). The State was unable to accurately separate the number of enrollees in Logisticare and MTM ; therefore, the total number of enrollees of 683,966 were divided with 2/3 in LogistiCare and 1/3 in MTM.
2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)
76
South Dakota – The South Dakota Dental Program does not operate under any waiver authority or
managed care entity type. This program solely operates under the authority of the South Dakota State Plan. At the State’s request, it will no longer be reported in this report.
Tennessee – Volunteer State Health Plan (BlueCare)1 was divided into 2 separate regions – Volunteer State Health Plan (BlueCare)2 East and Volunteer State Health Plan (BlueCare)2 West. AmeriGroup Community Care2, Volunteer State Health Plan (Bluecare) East2, Volunteer State Health Plan (Bluecare) West2 were defined as Commercial-only MCO but changed their status to Medicaid-only MCO. TennCare Select4 is now Volunteer State Health Plan (TennCare Select)4. For reporting purposes, TennCare Select plan enrollment is incorporated under the Medical-only PIHP category.
Texas – The State Medicaid Enrollment increase was due partly to the Women’s Health Program and normal growth.
___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10 Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term-Care PIHP
NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
77
Arkansas – Total Life Healthcare9 is a new PACE organization.
California – Life Circles9 and Comprehensive Senior Care Corporation9 are new PACE organizations.
Colorado – Rocky Mountain PACE9 and VOANS PACE9 are new PACE organizations.
District of Columbia – Medical Transportation Management11 is a new transportation PAHP under the Non-Emergency Medical Transportation Program.
Florida – Prestige Health Choice2 and Molina Health Care of Florida2 are new MCO plans under the Managed Health Care program. Alternative Medicine Integration10, CareMark10, and Hemophilia of the Sunshine State10 are new Disease Management PAHP plans under the Managed Health Care program. Managed Care of North America8 is a new Dental PAHP under the Managed Health Care Program. Molina Health Care of Florida (Reform)1 is a new plan under Florida Medicaid Reform program.
Hawaii – Maui PACE9 is a new PACE organization. Evercare1 and Ohana1 are new MCO plans.
Illinois - Meridian Health Plan2 is a new MCO plan under the Voluntary Managed Care program.
Iowa – Sioux PACE9 is a new PACE organization.
Maryland – AMERIGROUP-PAC5 and Priority Partners –PAC5 are new medical-only PAHP plans under the HealthChoice program.
Michigan – Health Kids Dental8 is a new Dental PAHP plan under Healthy Kids Dental program.
Montana – Billings Clinic 9is a new PACE organization.
Nevada – Amerigroup Community Care2 is a new MCO plan under the Mandatory Health Maintenance Program.
New Jersey – LIFE St. Francis9 and LIFE at Lourdes9 are new PACE organizations.
New Mexico – AMERIGROUP Community Care of New Mexico, Inc.1 and Evercare of New Mexico1 are new MCO plans under the Coordinated Long-term Care Services program. Blue Cross Blue Shield of New Mexico1 is a new MCO plan under the NEW MEXICO SALUD! program.
New York – Senior Whole Health/Medicaid Advantage Plus14 is a new LTC PIHP under the F-SHRP Medicaid Advantage program. Total Senior Care9 is a new PACE Organization. Health Plus2 is a new MCO plan under the Federal-State Health Reform Partnership (F-SHRP) program. NYPS Catholic Health Plan 11991 is a new MCO plan under the Partnership Plan Medicaid Managed Care Program.
North Dakota – Northland PACE9 is a new PACE organization.
North Carolina – Piedmont Senior Care9 and Elderhaus9 are new PACE organizations.
Oklahoma – Cherokee Elder Care9 is a new PACE organization.
NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
78
Tennessee – SXC Health Solutions12 is a new plan under TennCare program. Volunteer State Health
Plan (Bluecare) was broken into regions – AmeriChoice – West TN2 and Volunteer State Health Plan (Bluecare) – East2 are new plans under TennCare program.
Wisconsin – Gundersen Lutheran Health Plan1 and Physicians Plus Health Plan1 are new MCO plans under the BadgerCare Plus program. Care Wisconsin First, Inc.14, CHP-LTS, Inc., Community Care of Central Wisconsin14, Community Care, Inc.14, Lakeland Care District14, Milwaukee County Dept. on Aging14, Northern Bridges14, Southern Family Care Alliance14, and Western Wisconsin Cares14 are new Long Term Care PIHP plans under the Family Care program. Partnership Health Plan Inc.1 is a new MCO plan under the Wisconsin Partnership Program.
___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8Dental PAHP 9PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP
TERMINATED MEDICAID MANAGED CARE PLANS AS OF 6/30/2009
79
Florida – Pediatric Associates (Reform)4 terminated under the Florida Medicaid Reform program. Vista Health Plan of South Florida1, Community Based Care Partnership6, and Buena Vista1 were terminated under the Managed Health Care program. StayWell (Reform)1 was terminated under the Florida Medicaid Reform program.
Hawaii – Summerlin1 was terminated under the Hawaii Quest Expanded (QEx) program.
Iowa – Coventry HealthCare1 plan was terminated under the Iowa Medicaid Managed Care program.
Nevada – Anthem Blue Cross Blue Shield Partnership1 plan was terminated under the Mandatory Health Maintenance program.
New York - Manhattan PHSP/CenterCare2, NY Presbyterian Hospital Health Plan1, and Preferred Care1 were terminated under the Federal-State Health Reform Partnership (FSHRP), Partnership-Family Health Plus, and Partnership Plan Medicaid Managed Care Program.
Ohio – Anthem Blue Cross Blue Shield Partnership Plan2 was terminated under the State Plan Amendment for Ohio's Full-Risk Managed Care Program.
Puerto Rico – COSVIMed1 and MAPFRE1 were terminated under the Medicare Platino program.
Tennessee – First Health Services Corporation12, Preferred health Partnership/PHP2, TLC Family Healthplan2, Unison Health Plan-BHHP1, UAHC Health Plan of Tennessee2, Inc, Tennessee Behavioral Health13 plans were terminated under the TennCare program.
Texas - Evercare of Texas2 was terminated under ICM program.
Washington – United Healthcare Services Inc.10 was terminated under the Chronic Care
Management Program (CCMP). ___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP
80
Medicaid Managed Care Enrollment Report Glossary as of June 30, 2009
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.
• Other – The structure of the managed care plan is not considered a PCCM, PIHP, PAHP, Commercial MCO, Medicaid-only MCO, HIO, or PACE.
81
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.