Features stringlengths 3 63 | Program type stringclasses 10
values | Statewide or region-specific? stringlengths 9 1.05k | Federal operating authority stringclasses 34
values | Program start date stringlengths 8 10 | Waiver expiration date (if applicable) stringdate 2021-12-27 00:00:00 2030-12-31 00:00:00 ⌀ | If the program ended in 2020; indicate the end date stringclasses 1
value | Populations enrolled: Low-income adults not covered under ACA Section VIII (excludes pregnant women and people with disabilities) stringclasses 4
values | Populations enrolled: Low-income adults covered under ACA Section VIII (excludes pregnant women and people with disabilities) stringclasses 4
values | Populations enrolled: Aged; Blind or Disabled Children or Adults stringclasses 4
values | Populations enrolled: Non-Disabled Children (excludes children in foster care or receiving adoption assistance) stringclasses 4
values | Populations enrolled: Individuals receiving Limited Benefits (excludes partial duals) stringclasses 4
values | Populations enrolled: Full Duals stringclasses 4
values | Populations enrolled: Children with Special Health Care Needs stringclasses 4
values | Populations enrolled: American Indian/Alaska Native stringclasses 3
values | Populations enrolled: Foster Care and Adoption Assistance Children stringclasses 3
values | Populations enrolled: Enrollment choice period stringclasses 6
values | Populations enrolled: Enrollment broker name (if applicable) stringclasses 30
values | Populations enrolled: Notes on enrollment choice period stringlengths 2 627 ⌀ | Benefits covered: Inpatient hospital physical health stringclasses 1
value | Benefits covered: Inpatient hospital behavioral health (MH and/or SUD) stringclasses 1
value | Benefits covered: Outpatient hospital physical health stringclasses 1
value | Benefits covered: Outpatient hospital behavioral health (MH and/or SUD) stringclasses 1
value | Benefits covered: Partial hospitalization stringclasses 1
value | Benefits covered: Physician stringclasses 1
value | Benefits covered: Nurse practitioner stringclasses 1
value | Benefits covered: Rural health clinics and FQHCs stringclasses 1
value | Benefits covered: Clinic services stringclasses 1
value | Benefits covered: Lab and x-ray stringclasses 1
value | Benefits covered: Prescription drugs stringclasses 1
value | Benefits covered: Prosthetic devices stringclasses 1
value | Benefits covered: EPSDT stringclasses 1
value | Benefits covered: Case management stringclasses 1
value | Benefits covered: SSA Section 1945-authorized Health Home stringclasses 1
value | Benefits covered: Home health services (services in home) stringclasses 1
value | Benefits covered: Family planning stringclasses 1
value | Benefits covered: Dental services (medical/surgical) stringclasses 1
value | Benefits covered: Dental (preventative or corrective) stringclasses 1
value | Benefits covered: Personal care (state plan option) stringclasses 1
value | Benefits covered: HCBS waiver services stringclasses 1
value | Benefits covered: Private duty nursing stringclasses 1
value | Benefits covered: ICF-IDD stringclasses 1
value | Benefits covered: Nursing facility services stringclasses 1
value | Benefits covered: Hospice care stringclasses 1
value | Benefits covered: Non-Emergency Medical Transportation stringclasses 1
value | Benefits covered: Institution for Mental Disease inpatient treatment for people ages 21-64 defined by 42 CFR $438.6(e) as an 'in lieu of' benefit stringclasses 1
value | Benefits covered: Other (e.g.; nurse midwife services; freestanding birth centers; podiatry; etc.) stringlengths 1 720 ⌀ | Quality assurance and improvement: HEDIS data required? stringclasses 2
values | Quality assurance and improvement: CAHPS data required? stringclasses 2
values | Quality assurance and improvement: Accreditation required? stringclasses 4
values | Quality assurance and improvement: Accrediting organization stringclasses 15
values | Quality assurance and improvement: EQRO contractor name (if applicable) stringclasses 29
values | Performance incentives: Payment bonuses/differentials to reward plans stringclasses 1
value | Performance incentives: Preferential auto-enrollment to reward plans stringclasses 1
value | Performance incentives: Public reports comparing plan performance on key metrics stringclasses 1
value | Performance incentives: Withholds tied to performance metrics stringclasses 1
value | Performance incentives: MCOs/PHPs required or encouraged to pay providers for value/quality outcomes stringclasses 1
value | Participating plans: Plans in Program stringlengths 4 1.26k | Notes: Program notes stringlengths 30 1.48k ⌀ | State stringlengths 2 2 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Integrated Care Network (ICN) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b);1915(b)/1915(c) | 10/1/2018 | 9/30/2023 | null | Voluntary | Voluntary | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | X | null | Alabama Select Network | Only includes nursing home level of care for SNF recipients and those on Elderly and Disabled and Alabama Community Transitions Waivers. | AL | |||||||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Mobile and Baldwin Counties | PACE | 1/1/2012 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | Open enrollment that begins the first of every month; disenrollment is effective the last day of the month chosen | X | X | X | X | X | X | X | null | X | X | X | null | null | X | null | X | null | X | X | X | null | X | null | X | X | X | null | Anything else that is determined to be medically necessary by the interdisciplinary team. | No | No | No | null | null | null | null | null | null | null | Mercy Life of Alabama | null | AL | |||||
Alabama Coordinated Health Network (ACHN) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b) | 10/1/2019 | 9/30/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | No | No | null | IPRO | X | null | X | null | null | Alabama Coordinated Health Network | 7 networks with one per region | AL | ||
Arkansas Total Care | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c),1915(b)/1915(i) | 10/1/2017 | 3/31/2027 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | X | Arkansas Total Care | This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of ... | AR | |
Summit Community Care | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c),1915(b)/1915(i) | 10/1/2017 | 3/31/2027 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | Qsource | 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | X | Summit Community Care | This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of ... | AR | |
Empower Healthcare Solutions | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c) | 10/1/2017 | 3/31/2027 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | Qsource | 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | X | X | X | X | X | X | X | null | Yes | No | No | null | Qsource | null | null | null | null | X | Empower Healthcare Solutions | This MCO is currently under three different Waiver types and each has their own expiration date as follows: C-Waiver 02/28/2027; B-Waiver 03/31/2027 and I-State Plan Amendment 03/01/2024. Members are enrolled into a managed care organization when an independent assessment shows that they meet tier 2 or tier 3 level of ... | AR | |
Delta Dental Plan Arkansas | Dental only (PAHP) | Statewide | 1915(b) | 1/1/2018 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | Delta Dental Smiles | null | AR | |
MCNA Insurance Company | Dental only (PAHP) | Statewide | 1915(b) | 1/1/2018 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | MCNA Dental | null | AR | |
Central Arkansas Development | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Central Arkansas Development | null | AR | |
Area Agency on Aging of Southeast | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Area Agency on Aging of Southeast | null | AR | |
Southeastrans, Inc | Non-Emergency Medical Transportation | Statewide | 1915(b),1902(a)(70) NEMT | 1/1/2019 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | null | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Southeastrans, Inc | null | AR | |
PCCM | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2014 | null | null | Mandatory | Voluntary | Exempt | Voluntary | null | AFMC | null | X | X | X | X | X | null | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | X | null | null | null | null | null | Yes | Yes | No | null | null | X | null | X | X | X | Primary Care Case Management | null | AR | |||||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 5/27/2008 | null | null | Voluntary | Exempt | null | null | null | null | X | null | X | null | null | null | null | null | X | X | X | X | null | X | null | X | null | null | X | X | X | null | null | X | X | X | null | null | No | No | No | null | null | null | null | null | null | null | PACE | PACE is incorporated into the AR Medicaid State Plan and is not under waiver authority. | AR | ||||||
Arkansas Health & Wellness Solutions | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | X | Arkansas Health & Wellness Solutions | ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program. | AR | ||||||
Arkansas Blue Cross Blue Shield | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | X | Arkansas Blue Cross Blue Shield | ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program. | AR | ||||||
QCA Health Plan, Inc | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2014 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | X | QCA Health Plan, Inc | ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program. | AR | ||||||
Qualchoice Life & Health Insurance | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2015 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | X | Qualchoice Life & Health Insurance | ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program. | AR | ||||||
HMO Partners, Inc | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2021 | 12/31/2026 | null | Varies | Voluntary | Mandatory | Other | null | 42 days | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | null | No | No | No | null | null | null | null | null | null | X | HMO Partners, Inc | ARWorks Waiver ended 12/31/21 and ARHOME begin 1/1/22. Low-income adults not covered under ACA Section VIII are mandatorily enrolled, but can choose to disenroll from the program. | AR | ||||||
Arizona Health Care Cost Containment System | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/13/1982 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days. | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | X | null | X | X | X | X | Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy. | Yes | Yes | No | Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf. | Health Services Advisory Group | X | X | X | X | X | United Healthcare; Care 1st; DCS/CHP; Health Choice Arizona; Arizona Complete Health-Complete Care Plan; Mercy Care; Molina Complete Care of Arizona; Banner University Family Care | *Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to cho... | AZ | |
Arizona Health Care Cost Containment System (MLTSS) | MLTSS only (PIHP and/or PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/13/1982 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days. | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy. | Yes | Yes | No | Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf. | Health Services Advisory Group | X | X | X | X | X | DES/Division of Developmental Disabilities (MLTSS); United Healthcare (MLTSS); Mercy Care (MLTSS); Banner University Family Care (MLTSS) | *Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to cho... | AZ | |
Arizona Health Care Cost Containment System (SMI) | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/13/1982 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | The enrollment choice period for members who are auto-assigned is 90 days. After the initial enrollment choice period; members receive an annual enrollment choice period of 60 days. | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | X | null | X | X | X | X | Freestanding birth centers; podiatry; naturopathic physicians and adult occupational therapy. | Yes | Yes | No | Starting in Calendar Year 2020; HEDIS performance measures are being calculated by the MCOs with validation through the EQRO; NCQA accreditation will be required of the MCOs no later than October 2023. CAHPS surveys continue to be conducted by the EQRO on AHCCCS' behalf. | Health Services Advisory Group | X | X | X | X | X | Mercy Care RBHA (SMI); Arizona Complete Health- Complete Care Plan RBHA (SMI); Health Choice Arizona RBHA (SMI) | *Enrollment (voluntary with auto-enrollment) - members have choice and if they do not choose then there are rules for where they are auto-enrolled depending on the program. If an individual does not choose their plan prior to eligibility being determined; they are auto-enrolled in a health plan and given 90 days to cho... | AZ | |
County Organized Health Systems (COHS) Model | Comprehensive MCO + MLTSS | Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Merced, Modoc, Monterey, Napa, Orange, San Luis Obispo, San Mateo, Santa Barbara, Santa Cruz, Shasta, Siskiyou, Solano, Sonoma, Trinity, Ventura, Yolo | 1115(a) (Medicaid demonstration waivers) | 10/1/1995 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE) | Yes | Yes | No | null | Health Services Advisory Group | X | null | X | null | X | CenCal Health/San Luis Obispo; CenCal Health/Santa Barbara; Health Plan of San Mateo; Partnership HealthPlan of CA/Northeast; Partnership HealthPlan of CA/Northwest; Partnership HealthPlan/Southeast; Partnership HealthPlan/Southwest; Central California Alliance for Health/Merced; Central California Alliance for Health/... | Full duals have the option to enroll in Cal Medi-Connect in CCI counties, otherwise, they are mandatory for enrollment. Children with Special Health Care Needs (CSHCN) are mandatory in all COHS counties except Ventura. CSHCN is voluntary in Ventura. For CY 2021 rating period we had the following in place: Prop 56 ... | CA |
Regional Model | Comprehensive MCO | Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn, Imperial, Inyo, Mariposa, Mono, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, Tuolumne, Yuba | 1115(a) (Medicaid demonstration waivers) | 10/2/2013 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Voluntary | Voluntary | Other | Health Care Options/MAXIMUS | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | X | Molina Healthcare of CA-Imperial; Anthem Blue Cross Partnership Plan/San Benito; California Health & Wellness Plan/Imperial; California Health & Wellness Plan/Region 1; California Health & Wellness Plan/Region 2; Anthem Blue Cross Partnership Plan/Region 1; Anthem Blue Cross Partnership Plan/Region 2 | San Benito is voluntary due to only one commercial plan in the county. For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) th... | CA | |
Geographic Managed Care (GMC) Model | Comprehensive MCO + MLTSS | Sacramento, San Diego | 1115(a) (Medicaid demonstration waivers) | 6/1/1991 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Varies | Mandatory | Voluntary | Voluntary | Other | Health Care Options (Maximus) | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | X | KP Cal LLC-Placer; KP Cal LLC-El Dorado; KP Cal LLC-Amador; Aetna Better Health of CA/Sacramento; Blue Shield of California Promise/San Diego; Health Net/San Diego; KP Cal LLC/San Diego; Molina Healthcare of CA Partner Plan/San Diego; Aetna Better Health of CA/San Diego; UnitedHealthcare Community Plan/San Diego; Anthe... | Full duals are mandatory for managed care enrollment in CCI Counties (San Diego) and voluntary for all other counties (Sacramento). For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Behavioral Health Integration which we implemented via the 5% incentive pool Prop 56 Value Ba... | CA | |
Senior Care Action Network (SCAN) | Comprehensive MCO + MLTSS | Los Angeles, Riverside, San Bernardino | 1915(a) | 1/1/1996 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | null | X | X | X | X | X | X | X | X | X | X | null | X | null | X | null | null | null | null | null | null | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, speech therapy, and provisional post-partum care extension (PPCE) | Yes | No | No, but accreditation considered in plan selection criteria | Private credentialling organizations approved by DHCS | Health Services Advisory Group (HSAG) | null | null | null | null | null | SCAN Health Plan/Los Angeles; SCAN Health Plan Riverside/San Bernardino | null | CA | |||||
Program of All-Inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Alameda, Contra Costa, Fresno, Humboldt, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Clara, Kings, Tulare, Madera, San Joaquin, Stanislaus, Kern, Placer, El Dorado, Sutter, Yuba | PACE | 1/1/1998 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | null | X | X | X | null | PACE is responsible for covering all Medicaid services, all Medicare services, and any other service determined necessary by the PACE Interdisciplinary Team to maintain a participant in their home or community. | No | No | No | null | null | null | null | null | null | null | Bakersfield PACE (Tulare); InnovAge California PACE Sacramento (San Joaquin); InnovAge California PACE- Sacramento (Sutter); InnovAge California PACE- Sacramento (Yuba); Neighborhood PACE (Riverside); Neighborhood PACE (San Bernardino); Redwood Coast Pace/Humboldt; San Diego PACE; St. Paul's PACE/San Diego; Sutter Seni... | null | CA | |||||
Dental Managed Care/Los Angeles | Dental only (PAHP) | Los Angeles | 1115(a) (Medicaid demonstration waivers),1915(a) | 4/1/1998 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | 60 days | Health Care Operations (Maximus) | null | null | null | null | null | null | null | null | X | null | X | null | null | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | Yes | Yes | No, but accreditation considered in plan selection criteria | Private credentialling organizations approved by DHCS | Health Services Advisory Group | null | null | X | null | X | Health Net Dental Plan/Los Angeles; Access Dental Plan/Los Angeles; LIBERTY Dental Plan/Los Angeles | null | CA |
Dental Managed Care/Sacramento | Dental only (PAHP) | Sacramento | 1115(a) (Medicaid demonstration waivers) | 1/1/1995 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | 60 days | Health Care Operations (Maximus) | null | null | null | null | null | null | null | null | X | null | X | null | null | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | Yes | Yes | No, but accreditation considered in plan selection criteria | Private credentialling organizations approved by DHCS | Liberty and Health Net: Attest Health Care Advisors and for Access: Crowe LLP | null | null | X | null | X | Health Net Dental Plan/Sacramento; Access Dental Plan/Sacramento; LIBERTY Dental Plan/Sacramento | null | CA |
Two-Plan Model | Comprehensive MCO + MLTSS | Alameda, Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare | 1115(a) (Medicaid demonstration waivers) | 1/1/1996 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Varies | Mandatory | Voluntary | Voluntary | Other | Health Care Options/MAXIMUS | Approximately 45 days | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group | X | X | X | null | X | L.A. Care Health Plan/Los Angeles; Contra Costa Health Plan; Alameda Alliance for Health; Inland Empire Health Plan/Riverside; Inland Empire Health Plan/San Bernardino; Molina Healthcare of CA Partner Plan/Riverside; Molina Healthcare of CA Partner Plan/San Bernardino; San Francisco Health Plan; Health Plan of San Joaq... | Full duals are mandatory for managed care enrollment in CCI Counties (Los Angeles, Riverside, San Bernardino, and Santa Clara) and voluntary for all other counties (Alameda, Contra Costa, Fresno, Kern, Kings, Madera, San Francisco, San Joaquin, Stanislaus, and Tulare). For CY 2021 rating period we had the following ... | CA | |
Positive Healthcare/Los Angeles | Comprehensive MCO | Los Angeles | 1915(a) | 4/1/2002 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | X | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | Yes | No | null | Health Services Advisory Group (HSAG) | null | null | null | null | X | Positive Healthcare/Los Angeles | AHF was formerly a Primary Care Case Management (PCCM) model and became a full-risk plan effective July 2019, however, their enrollment remains limited to specific populations. For CY 2021 rating period we had the following in place: Prop 56 Value Based Purchasing - Medi-Cal managed care health plans (MCPs) that wi... | CA | ||||
Rady Children's Hospital San Diego (RCHSD) | Comprehensive MCO | San Diego | 1115(a) (Medicaid demonstration waivers) | 8/1/2018 | 12/31/2021 | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | X | null | X | X | null | Optional benefits: podiatry, chiropractic services, acupuncture, audiology, occupational therapy, and speech therapy, and provisional post-partum care extension (PPCE). | Yes | No | No | NCQA | Health Services Advisory Group (HSAG) | null | null | null | null | null | Rady Children's Hospital San Diego (RCHSD) | RCH was a pilot program which began in August 2018 serving special needs children and this contract will be terminating December 2021. The five eligible conditions for participation are Cystic Fibrosis, Hemophilia, Sickle Cell, Acute Lymphoblastic Leukemia, and Diabetes. | CA | ||||
Accountable Care Collaborative (ACC) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1915(b) | 7/1/2018 | 6/30/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Maximus Health Services, Inc. | Beneficiaries are passively enrolled and can choose their primary care provider at any time. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | Note that all members enrolled in ACC are eligible for all 1932(a) state plan benefits (most of these benefits are state plan benefits and are paid FFS). They also get benefits covered under the 1915(b) waiver. All plans are responsible for providing behavioral health benefits under the 1915(b) waiver. | Yes | Yes | No | null | Health Services Advisory Group, Inc. | X | null | X | X | X | RAE 1: Rocky Mountain Health Plans; RAE 2: Northeast Health Partners; RAE 3: Colorado Access; RAE 4: Health Colorado, Inc.; RAE 5: Colorado Access; RAE 6: Colorado Community Health Alliance; RAE 7: Colorado Community Health Alliance; Denver Health Medicaid Choice (DMHC); Rocky Mountain Health Plans Prime | The Accountable Care Collaborative (ACC) program has seven regional plans called Regional Accountable Entities (RAEs). The RAEs operate as both PCCM Entity and PIHP program types. The state pays the RAEs a full-risk capitation payment for behavioral health services under the PIHP authority. The RAEs also get an adminis... | CO |
Program of All-inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Adams, Arapahoe, Broomfield, Denver, Jefferson, Boulder, Weld (Southwest), Pueblo, El Paso, Delta, Montrose | PACE | 10/1/1991 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | Maximus Health Services, Inc. | There is no enrollment period; existing Medicaid members that meet the level of care may apply for PACE at any time. Members are enrolled on the first of the month. | X | X | X | X | X | X | X | null | X | X | X | X | null | X | null | X | null | X | X | X | null | X | null | X | X | X | null | PACE is an all-inclusive program. Some of the other available services include optometry, podiatry, rehabilitative services, adult day health center services, and transportation. | No | No | No | null | null | null | null | null | null | null | InnovAge - Loveland (PACE); VOANS (PACE); TRU Community Care (PACE); InnovAge - Thornton (PACE); Total Longterm Care; Rocky Mountain Health Care Services (PACE); InnovAge - Pueblo (PACE); InnovAge - Aurora (PACE); InnovAge - Lakewood (PACE) | null | CO | |||||
Medicaid Managed Care Program | Comprehensive MCO | Statewide | 1932(a);1945 Health Homes | 4/1/1994 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Exempt | 30 days | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | null | null | X | X | X | Freestanding birth centers | Yes | Yes | Yes | NCQA | Qlarant | X | null | X | X | X | AmeriHealth Caritas District of Columbia; CareFirst Community Health Plan District of Columbia; MedStar Family Choice-DC | Full duals are eligible for enrollment if there is a Medicaid-enrolled dependent child in the household. Nursing facilities are covered by MCO for the first 30 consecutive days. The managed care P4P program is funded through a pre-determined withhold (generally the established profit margin for each MCO that is factore... | DC | ||
Child and Adolescent Supplemental Security Income Program | Comprehensive MCO | Statewide | 1915(a) | 1/1/1996 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Other | null | Enrollment is voluntary; else beneficiary stays in fee-for-service. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | Freestanding birth centers | Yes | Yes | Yes | NCQA | Qlarant | null | null | null | null | null | Health Services for Children with Special Needs | Aged; Blind; or Disabled children and adults are eligible up to the age of 26. CASSIP enrollees receive medically necessary services for physical health; behavioral health; nursing home care; intermediate care facilities for individuals with intellectual disabilities; and residential treatment services. | DC | ||||
Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2007 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No; but accreditation considered in plan selection criteria | null | null | null | null | null | null | null | Medical Transportation Management; Inc. | The DC Department of Health Care Finance pays for non-emergency medical transportation only for its fee-for-service members. For managed care members; non-emergency medical transportation is paid by the District's Medicaid managed care organizations for low-income adults and children. Effective 10/1/2020 (FY 2021); the... | DC | |||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 2/1/2013 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | X | X | X | X | null | Yes | Yes | No | null | null | null | null | null | null | null | Saint Francis Life | null | DE | |||||
Diamond State Health Plan & Diamond State Health Plan Plus | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1996 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | Automated Health Systems | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | X | X | null | X | Freestanding birth centers; home-delivered meals; emergency response system; home modifications; day habilitation | Yes | Yes | Yes | NCQA; NCI-AD | Mercer Government Human Services Consulting | X | null | X | null | X | Highmark Health Options of Delaware; AmeriHealth Caritas of Delaware | null | DE | |
ModivCare Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 7/1/2002 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | ModivCare | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | ModivCare Non-Emergency Medical Transportation | null | DE | |
Managed Medical Assistance Program | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 8/1/2014 | 6/30/2030 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Automated Health Systems | Beneficiaries are enrolled immediately after being determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so. | X | X | X | X | X | X | X | X | X | X | X | X | X | null | null | X | X | null | null | null | null | X | null | X | X | X | X | Midwife; birth center; podiatry; and targeted case management. In addition; the Agency also negotiated expanded benefits above the Medicaid state plan service package. These expanded benefits vary by plan and include expanded outpatient hospital visits; physician home visits; and many other expanded benefits. The follo... | Yes | Yes | Yes | NCQA; AAAHC; Nationally recognized accrediting organizations | Health Services Advisory Group | X | null | X | null | X | Aetna Better Health; Florida Community Care; Humana Medical Plan; Molina Healthcare of Florida; Prestige Health Choice; Community Care Plan; Simply Healthcare Plans; Inc.; Staywell Health Plan of Florida; Sunshine Sate Health Plan; Inc.; United Healthcare of Florida; Inc.; Magellan Complete Care; LLC; Clear Health Alli... | Individuals fully eligible for Medicare and Medicaid are required to enroll in an MMA plan for covered Medicaid services. These individuals will continue to have their choice of Medicare providers as this program will not impact individual's Medicare benefits. Medicare-Medicaid beneficiaries will be afforded the opport... | FL | ||
Long-Term Care Program | MLTSS only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 8/1/2013 | 12/27/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Automated Health Systems | Beneficiaries are enrolled the beginning of the first month after they are determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so. | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | X | null | null | null | X | X | X | null | X | X | X | null | Home Health Prosthetic Devices; Intermittent and Skilled Nursing Services. In addition; the Agency also negotiated expanded benefits above the Medicaid state plan service package and 1915. These expanded benefits vary by plan and include; but are not limited to; cellular phone service; mobile personal emergency respo... | Yes | Yes | Yes | NCQA; AAAHC; Nationally recognized accrediting organizations | Health Services Advisory Group | X | null | null | null | null | Aetna Better Health; Florida Community Care; Humana Medical Plan; Inc.; Molina Healthcare of Florida; Inc.; Sunshine State Health Plan; Inc.; United Healthcare of Florida; Inc.; Staywell; Simply Healthcare Plans; Inc. | A recipient must be 18 years of age or older and meet Nursing Facility level of care in order to enroll. Recipients aged 18 to 64 must be eligible for Medicaid by reason of a disability as determined by the Social Security Administration. Recipients enrolled with a plan have 120 days to change plans. | FL | ||
Dental | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 12/1/2018 | 6/30/2030 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Automated Health Systems | Beneficiaries are enrolled immediately after being determined eligible. Beneficiaries are then given 120 days to pick another plan if they wish to do so. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | NCQA; Nationally recognized accrediting organizations | Health Services Advisory Group | X | null | null | X | null | DentaQuest; Liberty; MCNA Dental | Dental services are available to recipients in the Medically Needy program. Recipients are enrolled in the same plan each month that the recipient meets the share of cost requirement. | FL | |
Program of All- Inclusive Care for the Elderly | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 1/1/2003 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | Automated Health Systems | Continuous while slots are available. | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | null | X | null | null | X | X | X | null | All other FL Medicaid covered services and other services as determined by the multidisciplinary team. | No | No | No | null | null | null | null | null | null | null | Florida Pace Center; Hope Select Care; Morselife Home Care; Inc.; Suncoast Neighborly Care; Inc.; NE PACE Partners | At the time of the enrollment; an individual must be able to live in a community setting without jeopardizing his or her health or safety. While enrolled in a PACE program; the participant must receive all Medicare and Medicaid benefits solely through the PACE organization. | FL | |||||
Georgia Families | Comprehensive MCO | Statewide | 1932(a) | 6/1/2006 | null | null | Mandatory | Mandatory | Exempt | Exempt | 30 days | Maximus | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | null | X | X | X | null | null | null | X | null | null | null | null | null | Yes | Yes | Yes | NCQA; JCAHO; URAC | Health Services Advisory Group (HSAG) | null | X | null | null | null | Amerigroup Community Care; CareSource Georgia; Peach State Health Plan | Georgia Families is a program that delivers health care services to members of Medicaid and Peach Care for Kids. The program is a partnership between the Department of Community Health (DCH) and private care management organizations (CMOs). Georgia Families provides members a choice of health plans; allowing them to s... | GA | |||||
Georgia Families 360 | Comprehensive MCO | Statewide | 1932(a) | 3/3/2014 | null | null | Exempt | Mandatory | 30 days | Maximus | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | null | null | X | X | X | null | null | X | X | null | null | null | Podiatry; Nurse Midwife | Yes | Yes | Yes | NCQA; JCAHO | Health Services Advisory Group (HSAG) | X | null | null | null | null | Amerigroup Community Care | Georgia Families 360 enrolls children; youth; and young adults in foster care; children and youth receiving adoption assistance; and select youth involved in the juvenile justice system. | GA | |||||||
Planning for Healthy Babies | Other Prepaid Health Plan (PHP) (limited benefits) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/2011 | 12/31/2029 | null | Voluntary | Exempt | Exempt | Other | null | Women who are enrolled in the P4HB program are granted a 30 day period to select a CMO of their choice. Furthermore; effective 1/1/2015; once a woman selects a CMO; she transitions to her selected CMO the day following her CMO selection. If the woman does not select a CMO within the 30 day choice period; she is auto as... | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | CareSource Georgia; Peach State Health Plan; Amerigroup Community Care | null | GA | ||||||
Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/7/1997 | null | null | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Voluntary | Exempt | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | NEMT; NEMT | The Georgia Department of Community Health's (DCH) Non-Emergency Medical Transportation (NEMT) services are defined as medically necessary; cost-effective transportation for any eligible Medicaid member (and escort; if required) with no other means of transportation available to any Medicaid-reimbursable service to rec... | GA | |
Med-QUEST | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan;1902(a)(70) NEMT | 8/1/2019 | 7/31/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | null | Applicants are allowed to pre-select a health plan upon completing the Medicaid application to avoid auto-assignment. Staff will process the pre-enrollment; which pends up to 90 days to receive eligibility. If the client does not select a health plan upon submitting the Medicaid application; Med-QUEST assigns a health ... | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | null | Smoking Cessation Services; Urgent Care Services; Vaccinations; Vision and Hearing Services; Podiatry Services | Yes | Yes | Yes | NCQA | Health Services Advisory Group | X | X | X | X | X | AlohaCare Integration (QI); Hawaii Medical Service Association (HMSA) (QI); Kaiser Foundation Health Plan (QI); 'Ohana Health Plan (QI); UnitedHealthcare Community Plan (QI) | null | HI |
Iowa Health Link | Comprehensive MCO + MLTSS | Statewide | 1915(b);1915(b)/1915(c);1937 Alt Benefit Plan;1945 Health Homes | 4/1/2016 | 3/31/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | Tobacco Cessation; Vision Care Exams | Yes | Yes | Yes | NCQA | Health Services Advisory Group (HSAG) | null | null | X | X | X | Amerigroup of Iowa; Inc.; Iowa Total Care | EPSDT is not covered under Hawki (State CHIP Plan); Private duty nursing and personal care services are covered as a benefit under EPSDT as provided through a home health agency for up to 16 hours per day; ICF/ID Must meet level of care; nursing facility - must meet level of care; Hospice --use utilization management ... | IA | |
PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 8/1/2018 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | null | X | X | X | X | X | X | X | X | X | X | null | No | No | No | null | null | null | null | null | null | null | PACE | null | IA | |||||
Dental Wellness Plan | Dental only (PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers);1937 Alt Benefit Plan | 5/1/2014 | 12/31/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | No | No | null | Health Services Advisory Group (HSAG) | null | null | null | X | X | Delta Dental of Iowa; MCNA Dental Plans; Inc. | Delta Dental covers all of our Hawki (State CHIP) members | IA | |
Healthy Connections | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 10/1/2006 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Voluntary | Voluntary | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No; but accreditation considered in plan selection criteria | NCQA | null | null | null | null | null | null | Multiple Primary Care Providers | NCQA is the accrediting organization for tier 3 of the Healthy Connections program. | ID | |
Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 9/1/2010 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | MTM (Medical Transportation Management) | null | ID | ||
Idaho Behavioral Health Plan | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(i) | 9/1/2013 | 3/21/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Mandatory | null | null | null | null | null | null | X | null | X | X | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | null | null | null | null | Peer Support; Family Support | Yes | Yes | Yes | NCQA | null | X | null | X | X | X | United Healthcare/Optum Idaho | null | ID | ||
Idaho Smiles | Dental only (PAHP) | Statewide | 1915(b) | 8/1/2008 | 6/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | No | Yes | No | NCQA; AAAHC | null | null | null | null | X | null | MCNA (Managed Care of North America; Inc.) | null | ID | ||
Medicare/Medicaid Coordinated Plan | Comprehensive MCO + MLTSS | Ada; Bannock; Bingham; Boise; Bonner; Bonneville; Boundary; Canyon; Cassia; Clark; Elmore; Fremont; Gem; Jefferson; Kootenai; Madison; Minidoka; Nez Perce; Owyhee; Payette; Power; and Twin Falls counties | 1915(a)/1915(c) | 7/1/2014 | 9/30/2022 | null | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | null | null | X | X | null | X | X | X | null | null | Medicaid Primary Services not covered by Medicare | No | No | Yes | NCQA | Telligen | null | null | X | X | X | Blue Cross of Idaho; Molina of Idaho | null | ID | ||||||
Idaho Medicaid Plus | Comprehensive MCO + MLTSS | Ada; Bannock; Bingham; Boise; Bonner; Bonneville; Boundary; Canyon; Cassia; Clark; Elmore; Fremont; Gem; Jefferson; Kootenai; Madison; Minidoka; Nez Perce; Owyhee; Payette; Power; and Twin Falls counties | 1915(b)/1915(c) | 11/1/2018 | 9/30/2022 | null | Mandatory | Voluntary | Exempt | Other | null | 90 days - Enrollment open for ninety days | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | null | null | X | X | X | X | X | X | null | null | Medicaid Primary Services not covered by Medicare | No | No | Yes | NCQA | Telligen | null | null | X | X | X | Blue Cross of Idaho; Molina of Idaho | null | ID | ||||||
HealthChoice Illinois | Comprehensive MCO + MLTSS | Statewide | 1915(b);1932(a)/1915(c) | 1/1/2018 | 6/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | X | X | X | X | Telehealth; ambulatory; surgical treatment center; assisted living; assistive/augmentative communication devices; audiology; behavioral; blood and blood components; chiropractic; diabetes prevention; durable medical equipment; environmental accessibility; immunization; physical/occupational and speech therapy; podiatry... | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | X | X | X | X | Aetna Better Health; Blue Cross Community Health Plans; CountyCare Health Plan; Meridian Health; Molina HealthCare; YouthCare | HealthChoice Illinois is a statewide program that was implemented on January 1; 2018 and is comprised of populations that were previously included in the Integrated Care Program; the Family Health Plan/Affordable Care Act Program and the Managed Long Term Services and Supports Program. Low income pregnant women are man... | IL | |||
HealthChoice Illinois - Managed Long Term Services and Supports | MLTSS only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 1/1/2018 | 9/30/2023 | null | Mandatory | Mandatory | Voluntary | Exempt | Pre-assigned | Maximus | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | X | null | X | null | non-medical behavioral health; telehealth | Yes | Yes | Yes | NCQA | Health Services Advisory Group | null | X | X | X | X | Aetna Better Health; Blue Cross Community Health Plans; CountyCare Health Plan; Meridian Health; Molina HealthCare | The Program includes enrollees of multiple 1915(c) waivers; which have different end dates as follows: The current Persons with Disabilities 1915(c) waiver will expire on 06/30/2026; the current Elderly 1915(c) waiver will expire on 09/30/2026; the current Traumatic Brain Injury 1915(c) waiver will expire on 06/30/202... | IL | |||||
Healthy Indiana Plan | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 2/1/2015 | 12/31/2030 | null | Mandatory | Mandatory | Voluntary | Exempt | Other | Maximus | Members are auto-assigned if no health plan selection is made at application. Individuals who are auto-assigned have a 60 day window to make a health plan change. Members cannot change plans after having made a POWER account contribution. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | X | X | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | X | X | X | Anthem; Caresource Indiana; Inc; Managed Health Services; MDWise | Home health and nursing facility care is covered for a short period of time; no more than 100 days. IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver. | IN | |||||
Hoosier Care Connect | Comprehensive MCO | Statewide | 1915(b) | 4/1/2015 | 3/31/2023 | null | Mandatory | Voluntary | Voluntary | 60 days | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | X | X | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | X | X | X | Anthem; United Healthcare Community Plan; Managed Health Services | Home health and nursing facility care is covered for a short period of time; no more than 30 days. IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver. | IN | ||||||
Hoosier Healthwise | Comprehensive MCO | Statewide | 1932(a) | 1/1/2000 | null | null | Mandatory | Voluntary | Exempt | Other | Maximus | Members are auto-assigned if no health plan selection is made at application. Individuals who are auto-assigned have a 90 day window to make a health plan change. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | X | null | X | X | Podiatry; Chiropractic; Vision | Yes | Yes | Yes | NCQA | Qsource | X | null | X | X | X | Anthem; Caresource Indiana; Inc; Managed Health Services; MDWise | IMD stays are primarily covered under Indiana's SMI (serious mental illness) waiver; Nursing facility and home health care is limited to short term needs. | IN | ||||||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Regions covered include Lake; Johnson; Allen; Fayette; Franklin; Henry; Randolph; Union; Wayne; the following Marion County zip codes; 46107; 46201; 46202; 46203; 46204; 46217; 46218; 46219; 46221; 46222; 46225; 46227; 46229; 46237; 46239; 46241; 46259; and the following Elkhart; Marshall; and St. Joseph County zip c... | PACE | 10/1/2012 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | null | X | null | X | X | X | null | null | No | No | No | null | null | null | null | null | null | null | Franciscan Senior Health and Wellness-DYER; Franciscan Senior Health and Wellness- Indy; Reid Health Pace Center; Saint Joseph Pace | The PACE state plan amendment was approved with an effective date of 10/1/2012. But; Indiana's first PACE program agreement was not effective until 1/1/2015. In 2021 we saw an expansion to our PACE programs with current plans expanding and new plans being added. | IN | |||||
KanCare | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers);1915(a);1905(t);1937 Alt Benefit Plan;1945 Health Homes | 1/1/2013 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | 60 days | Gainwell Technologies | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | Yes | Yes | Yes | NCQA | Kansas Foundation for Medical Care | null | null | X | X | X | Aetna Better Health of Kansas; Sunflower State Health Plan; United HealthCare Community Plan of Kansas | Kansas operates KanCare Medicaid Managed Care Program under the 1115(a) demonstration waiver concurrently with seven 1915(c) waivers. | KS | ||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Dickinson; Douglas; Ellsworth; Harvey; Jackson; Jefferson; Leavenworth; Lincoln; Lyon; Marion; Marshall; McPherson; Nemaha; Osage; Ottawa; Pottawatomie; Reno; Rice; Saline; Sedgwick; Shawnee; Wabaunsee; and Wyandotte counties | PACE | 8/1/2002 | null | null | Voluntary | Voluntary | Voluntary | Exempt | null | Gainwell Technologies | null | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | X | null | X | X | null | null | null | null | X | X | X | null | Adult day care; recreational therapy; meals; social services; social work counseling; etc. | No | No | No | null | null | null | null | null | null | null | Via Christi; Midland Care; Bluestem PACE; Inc. | null | KS | |||||
Kentucky Managed Care | Comprehensive MCO | Statewide | 1915(b) | 1/1/2021 | 12/25/2025 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | null | 90 | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | null | null | null | null | null | X | null | null | null | Yes | Yes | Yes | NCQA; URAC | Island Peer Review Organization | null | null | null | null | X | Aetna Better Health of Kentucky; Anthem BCBS; Humana; Passport by Molina; United Healthcare; Wellcare of Kentucky | null | KY | |
Kentucky Non-Emergency Medical Transportation | Non-Emergency Medical Transportation | Statewide | 1915(b) | 12/1/1998 | 12/31/2021 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Mandatory | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | NEMT Human Services Transportation Delivery | null | KY | |
Healthy Louisiana | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b) | 12/12/2015 | 6/30/2027 | null | Mandatory | Mandatory | Varies | Exempt | Mandatory | null | Maximus Health Services | null | null | X | null | X | X | X | X | X | X | null | null | null | X | X | null | null | null | null | null | X | X | null | null | null | null | X | X | null | Yes | Yes | Yes | NCQA | IPRO; Myers & Stauffer LC | null | null | X | X | X | Aetna Better Health of Louisiana; AmeriHealth Caritas Louisiana; Healthy Blue; Louisiana Healthcare Connections; UnitedHealthcare Community Plan | Children enrolled in the Coordinated System of Care (CSC) PIHP program receive specific behavioral services through that program and physical health and other health care coverage through the Healthy LA MCO program. Medicaid members who are considered "BH only" receive those specific BH services through the Healthy LA ... | LA | ||||
Dental Benefit Management Program | Dental only (PAHP) | Statewide | 1915(b) | 7/1/2014 | 6/30/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Maximus Health Services | Enrollee has the opportunity to choose a DBPM at Medicaid application. If no plan is chosen the enrollee is pre-assigned. | null | null | null | null | null | null | null | X | X | X | null | null | X | null | null | null | null | X | X | null | null | null | null | null | null | null | null | null | Yes | Yes | No | null | Myers & Stauffer LC | null | null | null | null | null | DentaQuest; MCNA of Louisiana | EPSDT dental benefits are provided by the DBPM for members ages 0-20. Adult Denture benefits are provided to members age 21+. Effective 1/1/2021 LDH contracted with a second dental plan; DentaQuest; to provide a second plan to all eligible members and expanded enrollment in the DBPMs to include beneficiaries in ICF/DD ... | LA | |
Coordinated System of Care | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 3/1/2012 | 6/30/2027 | null | Voluntary | Exempt | null | null | null | null | null | X | null | X | null | X | X | X | X | null | null | null | X | X | null | null | null | null | null | null | X | null | null | null | null | null | null | Mental health rehabilitation services including: Psychosocial rehabilitation; Crisis Intervention; Crisis stabilization; Youth Support and Training (YST); Parent Support and Training (PST); Short-term Respite; and Independent Living/Skills Building (ILSB) | No | No | Yes | NCQA | null | null | null | null | null | null | Magellan | Children enrolled in the Coordinated System of Care (CSC) PIHP program receive specific behavioral services through that program and physical health and other health care coverage through the Healthy LA MCO program. Medicaid members who are considered "BH only" receive those specific BH services through the Healthy LA ... | LA | ||||||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Baton Rouge; Greater New Orleans; Lafayette: 70112; 70113; 70114; 70115; 70116; 70117; 70118; 70119; 70122; 70124; 70125; 70126; 70127; 70128; 70129; 70130; 70131; 70032; 70043; 70001; 70002; 70003; 70005; 70006; 70053; 70121; 70501; 70503; 70506; 70507; 70508; 70517; 70518; 70520; 70529; 70578; 70583; 70584; 70592; 7... | PACE | 9/1/2007 | null | null | Voluntary | Voluntary | null | null | null | null | X | X | X | X | null | X | X | X | X | null | null | null | null | X | null | X | null | X | X | X | X | X | null | X | X | X | null | All specialized services authorized by IDT; including podiatry. | No | No | No | null | null | null | null | null | null | null | PACE - Baton Rouge; PACE - Greater New Orleans; PACE - Lafayette | null | LA | ||||||
Healthy Louisiana | Comprehensive MCO | Statewide | 1915(b);1932(a) | 2/1/2012 | 6/30/2027 | null | Mandatory | Mandatory | Varies | Mandatory | Varies | Voluntary | Mandatory | Other | Maximus Health Services | Enrollee has the opportunity to choose an MCO at Medicaid application. If no plan is chosen; the enrollee is pre-assigned. | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | null | null | null | X | X | X | Similar to Private Duty Nursing; Louisiana offers Extended Home Nursing to recipients under 21 only; Certified Nurse Midwives are covered and practice within the scope of their license; Podiatry services are covered; but limited to a list of payable procedures. | Yes | Yes | Yes | NCQA; URAC | IPRO; Myers & Stauffer LC | null | null | X | X | X | Aetna Better Health of Louisiana; AmeriHealth Caritas Louisiana; Healthy Blue; Louisiana Healthcare Connections; UnitedHealthcare Community Plan | Personal care (state plan option) services are available to enrollees aged 0 - 20. Mandatory vs. Voluntary Enrollment for Aged; Blind; or Disabled Children and Adults: Some of our disabled children can voluntarily opt out. | LA | ||
Primary Care Accountable Care Organization (Primary Care ACO) | Primary Care Case Management Entity (PCCM Entity) | Statewide | 1115(a) (Medicaid demonstration waivers) | 3/1/2018 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Other | Maximus until 12/2/21; Automated Health Systems (12/3/2021 - present) | 14 days with 90 day plan selection period for new enrollees. Annual 90 day plan selection period for existing enrollees. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | Innovative Resource Group; LLC D/B/A Kepro | X | null | X | X | X | Mass General Brigham ACO; Community Care Cooperative; Inc.; Steward Health Choice | Services; other than behavioral health; provided to PCC Plan enrollees are paid for by MassHealth through FFS directly to providers not through capitation. Behavioral health services are provided by the Massachusetts Behavioral Health Partnership. Regarding quality assurance and improvement; MassHealth does not require... | MA | ||
Primary Care Clinician Program | Primary Care Case Management (PCCM) | Statewide | 1115(a) (Medicaid demonstration waivers) | 1/1/1995 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | null | Maximus until 12/2/2022; Automated Health Systems 12/3/2022 - present | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | Innovative Resource Group; LLC D/B/A Kepro | null | null | null | null | null | Multiple primary care providers | Services; other than behavioral health; provided to PCC Plan enrollees are paid for by MassHealth through FFS directly to providers not through capitation. Behavioral health services are provided by the Massachusetts Behavioral Health Partnership. Regarding quality assurance and improvement; MassHealth calculates HEDIS... | MA | ||
Managed Care Organization | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/7/1998 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Other | Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present | 14 days with a 90 day plan selection period for new enrollees. Annual 90 day plan selection period for existing enrollees. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | X | null | null | X | X | X | Acupuncture; audiology; breast pump; chiropractic; diabetes self-management; training; dialysis; DME; early intervention; emergency services; fluoride varnish; hearing aids; infertility diagnosis; dentures; medical nutrition therapy; orthotics; podiatry; radiology and diagnostic tests; tobacco cessation; vision care; s... | Yes | Yes | Yes | NCQA | Innovative Resource Group; LLC D/B/A Kepro | X | null | X | X | X | Tufts Health Together; BMC HealthNet Plan | Private duty nursing is covered under capitation for SKSC population only. | MA | ||
Accountable Care Partnership Plans | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 3/1/2018 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Other | Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present | 14 days with a 90-day selection period for new enrollees. Annual 90-day selection period for existing employees. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | null | null | null | null | X | X | X | X | Acupuncture; audiology; breast pump; chiropractic; diabetes self- management training; dialysis; DME; early intervention; emergency services; fluoride varnish; hearing aids; infertility diagnosis; dentures; medical nutrition therapy; orthotics; podiatry; radiology and diagnostic tests; tobacco cessation; vision care; s... | Yes | Yes | Yes | NCQA | Innovative Resource Group; LLC D/B/A Kepro | X | null | X | X | X | Cambridge Health Alliance (CHA) in partnership with Tufts Health Public Plans (THPP); Atrius Health in partnership with Tufts Health Public Plans (THPP); Beth Israel Deaconess Care Organization (BIDCO) in partnership with Tufts Health Public Plans (THPP); Boston Children's Health ACO in partnership with Tufts Health Pu... | null | MA | ||
MassHealth BH/SUD PIHP | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/1/1997 | 9/30/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Other | Maximus until 12/2/2021; Automated Health Systems 12/3/2021 - present | Daily | null | X | null | X | X | X | X | null | X | null | X | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | X | Children's Behavioral Health Initiative (CBHI) services; Emergency Services Program; and Diversionary Services: Community Crisis Stabilization; Community-Based Acute Treatment for Children and Adolescents (CBAT); Acute Treatment Services (ATS) for Substance Use Disorders (Level III-7); Clinical Support Services (CSS) f... | Yes | No | Yes | NCQA | Innovative Resource Group; D/B/A Kepro | X | null | X | null | null | Massachusetts Behavioral Health Partnership | Full duals are only enrolled mandatorily if less than 21 years of age. | MA | |
Senior Care Options | Comprehensive MCO + MLTSS | Counties of Barnstable; Berkshire; Bristol; Essex; Franklin; Hampden; Hampshire; Middlesex; Norfolk; Plymouth; Suffolk; and Worcester | 1915(a)/1915(c) | 7/1/2004 | 12/31/2023 | null | Voluntary | Voluntary | Voluntary | null | Other | Maximus until 12/2/2021; Automated Health systems 12/3/2021 | Medicaid members are eligible to enroll all year; with enrollment effective the first day of the month following the month in which the member decided to enroll. Dual eligible members are eligible to enroll in accordance with the Medicare Advantage enrollment period; with enrollment effective the first day of the month... | X | null | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | X | X | X | X | X | X | null | All MassHealth covered LTSS and all services described in the Commonwealth 1915(c) Frail Elder Waiver. | Yes | Yes | No | null | Innovative Resource Group; D/B/A Kepro | null | null | X | null | X | Boston Medical Center Healthnet Plan; Commonwealth Care Alliance; Navicare HMO; Senior Whole Health; Tufts Health Plan; United Healthcare | null | MA | |||||
Plan All-Inclusive Care for the Elderly (PACE) | Program of All-inclusive Care for the Elderly (PACE) | Counties of Bristol; Essex; Franklin; Hampden; Hampshire; Middlesex; Norfolk; Plymouth; Suffolk; Worcester; and Berkshire | PACE | 7/10/1990 | null | null | Voluntary | Voluntary | Voluntary | null | null | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | null | X | X | X | X | X | null | X | X | X | X | X | null | The PACE program covers all medically necessary services for the enrolled population; including but not limited to all covered Medicare and Medicaid services. | No | No | No | null | null | null | null | null | null | null | Element Care Inc; Serenity Care PACE Program; Mercy Life Inc; Neighborhood PACE; Elder Service Plan of Cambridge Health Alliance; Upham's Elder Service Plan; Elder Service Plan of Harbor Health; Fallon Health Summit Eldercare | The Enrollment numbers do not include private pay enrollees; if any. | MA | |||||
HealthChoice | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/1/1997 | 12/31/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Other | Maryland Health Benefit Exchange | Individuals may apply for Medicaid and HealthChoice at any time. | X | null | X | null | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | X | null | X | X | null | null | Nurse midwives; freestanding birthing centers; podiatry (routine footcare for <21 and diabetics); diabetes prevention and telehealth. | Yes | Yes | Yes | NCQA | Qlarant Quality Solutions; Inc. | X | null | X | null | X | Aetna Better Health of Maryland; Amerigroup Community Care; CareFirst BCBS Community Health Plan Maryland; Jai Medical Systems; Kaiser Permanente of the Mid-Atlantic States; Maryland Physicians Care; MedStar Family Choice; Priority Partners; UnitedHealthcare of the Mid-Atlantic | The nursing facility services provided by HealthChoice is only for the first 90 days in the facility. Individuals requiring services beyond 90 days are then disenrolled into the fee-for-service program. | MD | ||
PACE | Program of All-inclusive Care for the Elderly (PACE) | 21202; 21205; 21206; 21213; 21214; 21217; 21218; 21219; 21220; 21221; 21222; 21224; 21227; 21231; 21237; 21052 | PACE | 11/1/2002 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | null | X | null | null | X | X | X | X | X | X | X | X | X | null | X | null | null | null | X | null | X | null | X | null | null | null | Multidisciplinary assessment and treatment planning; Social work services; Nutritional counseling; Recreational therapy; Certain meals; Medical specialty services; prosthetics; orthotics; corrective vision devices; such as eyeglasses and lenses; hearing aids; dentures; and repair and maintenance of these items; Assiste... | No | No | No | null | null | null | null | null | null | null | Hopkins ElderPlus | null | MD | |||||
MaineCare | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 5/1/1999 | null | null | Mandatory | Mandatory | Voluntary | Voluntary | null | null | 28 Days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | No | No | null | null | X | null | X | null | null | Multiple Primary Care Providers | null | ME | |||||
NET | Non-Emergency Medical Transportation | Statewide | 1915(b) | 8/1/2011 | 3/31/2022 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Pre-assigned | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Modivcare; Penquis CAP; MidCoast Connector | null | ME | |||
MI Choice | MLTSS only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 10/1/2003 | 9/30/2023 | null | Voluntary | Voluntary | Voluntary | Exempt | Other | null | Enrollments and disenrollments are allowed at any time. Enrollments are always voluntary for qualified individuals. Must meet NFLOC to qualify. | null | null | null | X | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | X | X | null | null | null | X | X | Adult Day Health; Chore; Community Health Workers; Community Living Support; Community Transition; Counseling; Environmental Accessibility Adaptions; Fiscal Intermediary; Goods and Services; Home Delivered Meals; Nursing Services; Personal Emergency Response Systems (PERS); Private Duty Nursing/Respiratory Care; Respit... | No | No | No | null | null | null | null | null | null | null | A & D Home Health Care; Inc.; Area Agency on Aging 1-B; Area Agency on Aging of Northwest Michigan; Area Agency on Aging of Western Michigan; Detroit Area Agency on Aging; Macomb-Oakland Regional Center Home Care; Inc. (MORC); Northern Healthcare Management; Region 2 Area Agency on Aging; Region 3B Area Agency on A... | Cover HCBS only. Must be elderly or a disabled adult (at least 18 years of age); meet Nursing Facility Level of Care (NFLOC); and require supports coordination and at least one additional waiver service to qualify. *Attestation is not required; but some plans do this voluntarily. | MI | |||||
PACE | Program of All-inclusive Care for the Elderly (PACE) | Statewide | PACE | 11/1/2003 | null | null | Voluntary | Voluntary | Exempt | Exempt | null | null | null | X | X | X | X | null | null | null | null | null | X | X | X | null | X | null | X | null | X | X | X | X | null | null | X | null | X | null | Transportation | No | No | No | null | null | null | null | null | null | null | Senior Care Partners; Senior Community Care; Thome PACE; Ascension Living PACE; Care Resources; Community PACE; Great Lakes PACE; Huron Valley PACE; Life Circles; PACE Central Michigan; PACE North; PACE of Southeast MI; PACE of Southwest MI | Enrollment is voluntary and is not restricted to individuals who are Medicare beneficiaries and/or Medicaid recipients. The PACE organization receives a prospective monthly payment for each Medicare participant based on a rate similar to the rate paid to Medicare Advantage; and a prospective monthly payment for each M... | MI | |||||
Healthy Kids Dental | Dental only (PAHP) | Statewide | 1915(b) | 4/1/2009 | 12/31/2022 | null | Mandatory | Mandatory | Voluntary | Mandatory | Other | null | 90 days for new enrollees. For all other enrollees; they are able to switch plans one time per year. | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | X | null | X | X | Blue Cross Blue Shield of Michigan; Delta Dental of Michigan | MDHHS contracts for the administration of the Medicaid dental benefit called Healthy Kids Dental in all 83 counties. The contractor administers the Medicaid dental benefit to all Medicaid beneficiaries under age 21 in the participating counties. The dental services provided through the contractors mimic the dental se... | MI | |||||
Healthy Michigan Plan | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers) | 4/1/2014 | 12/31/2023 | null | Voluntary | Voluntary | Exempt | Other | Michigan Enrolls | New enrollees have up to 90 days to switch Medicaid Health Plans; otherwise there is a rolling open enrollment based on the last digit of the individual's case number. | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | null | X | X | X | null | null | null | null | X | X | X | null | Ambulance and other emergency medical transportation; certified midwife services; chiropractic services; DME and supplies; emergency services; end stage renal disease services; health education; hearing and speech services; hearing aids (under 21 years old); medically necessary weight reduction services; parenting and ... | Yes | Yes | Yes | NCQA | Health Services Advisory Group (HSAG) | X | X | X | X | X | Aetna Better Health of Michigan; Blue Cross Complete of Michigan; HAP Empowered; McLaren Health Plan; Meridian Health Plan of Michigan; Molina Healthcare of Michigan; Priority Health Choice; Total Health Care; UnitedHealthcare Community Plan; Upper Peninsula Health Plan | Due to a policy change; Medicare eligibles are excluded from Healthy Michigan Plan. In order to provide greater access and to support coordination of care for behavioral health services; the Michigan Department of Health and Human Services has removed the 20-visit maximum limitation for outpatient behavioral services ... | MI | ||||||
Comprehensive Health Care Program | Comprehensive MCO | Statewide | 1915(b) | 7/1/1997 | 12/31/2023 | null | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Voluntary | Mandatory | Other | Michigan Enrolls | New enrollees have up to 90 days to switch Medicaid Health Plans; otherwise there is a rolling open enrollment based on the last digit of the individuals case number. | X | null | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | null | null | null | null | null | null | null | null | null | X | Ambulance and other emergency medical transportation; certified midwife services; chiropractic services; DME and supplies; emergency services; end stage renal disease services; health education; hearing and speech services; hearing aids (under 21 years old); medically necessary weight reduction services; parenting and ... | Yes | Yes | Yes | NCQA | Health Services Advisory Group (HSAG) | X | X | X | X | X | Aetna Better Health of Michigan; Blue Cross Complete of Michigan; HAP Empowered; McLaren Health Plan; Meridian Health Plan of Michigan; Molina Healthcare of Michigan; Priority Health Choice; Total Health Care; UnitedHealthcare Community Plan; Upper Peninsula Health Plan | Due to a policy change; Medicare eligibles are excluded from Healthy Michigan Plan. In order to provide greater access and to support coordination of care for behavioral health services; the Michigan Department of Health and Human Services has removed the 20-visit maximum limitation for outpatient behavioral services ... | MI | |
Specialty Prepaid Inpatient Health Plans | Behavioral Health Organization (BHO) only (PIHP and/or PAHP) | Statewide | 1915(b)/1915(c) | 10/1/1998 | 9/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Mandatory | Other | null | No lock-in period. | null | X | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | Assertive Community Treatment; Assessments; Assistive Technology; Behavior Management Review; Child Therapy; Clubhouse; Community Living Supports; Crisis Interventions; Crisis Residential Enhanced Pharmacy; Environmental Modifications. | No | No | No | null | null | null | null | null | null | null | CMH Partnership of Southeast Michigan; Detroit Wayne Mental Health Authority; Lakeshore Regional Entity; Macomb County CMH Services; Mid-State Health Network; Northcare Network; Northern Michigan Regional Entity; Oakland County CMH Authority; Region 10 PIHP; Southwest MI Behavioral Health | 7;607 beneficiaries received HCBS services as of 07/01/2021. | MI | |
Prepaid Medical Assistance Plan Plus (PMAP+) | Comprehensive MCO + MLTSS | Statewide | 1915(b);1932(a);1945 Health Homes | 7/1/1985 | 12/31/2022 | null | Mandatory | Mandatory | Mandatory | Voluntary | Voluntary | Mandatory | Mandatory | 30 days | null | null | X | X | X | X | X | X | X | null | X | X | null | X | X | X | X | X | X | X | X | null | null | null | null | X | X | X | X | ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; EDBI; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Residential Mental Health Services (ITRS; Children... | Yes | Yes | No | null | null | null | X | null | X | X | Blue Plus; Health Partners; Hennepin Health; Itasca Medical; Prime West Health; South Country Health Alliance; UCare | null | MN | ||
Minnesota Senior Care Plus (MSC+) | Comprehensive MCO + MLTSS | Statewide | 1915(b)/1915(c);1945 Health Homes | 6/1/2005 | 6/30/2026 | null | Mandatory | Mandatory | Mandatory | Mandatory | 30 days | null | null | X | X | X | X | X | X | X | null | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SU... | Yes | Yes | No | null | null | null | X | null | X | X | Blue Plus; Health Partners; Itasca Medical Care; Medica; Prime West Health; South Country Alliance; UCare | null | MN | |||||
Minnesota Senior Health Option (MSHO) | Comprehensive MCO + MLTSS | Statewide | 1915(a)/1915(c);1945 Health Homes | 3/1/1997 | 6/30/2026 | null | Voluntary | Voluntary | Mandatory | Exempt | 30 days | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | X | X | null | X | X | X | null | ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SU... | No | Yes | No | null | null | null | X | null | X | X | Blue Plus; Health Partners; Itasca Medical care; Medica; Prime West Health; South Country Health Alliance; UCare | null | MN | |||||
Special Needs Basic Care (SNBC) | Comprehensive MCO + MLTSS | Statewide | 1915(a);1945 Health Homes | 1/1/2008 | null | null | Voluntary | Voluntary | Voluntary | 30 days | null | null | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | null | X | X | null | null | X | null | X | X | X | X | ambulatory surgery; outpatient therapy; Durable Medical Equipment; Home Health; intensive outpatient therapy; SUD outpatient therapy; medication assisted therapy; psychotherapy; day treatment; mobile crisis; chiropractic; acupuncture; MH targeted case management; Inpatient Detox; Inpatient Mental Health; Residential SU... | Yes | Yes | No | null | null | null | X | null | X | X | Health Partners; Hennepin Health; Medica; Prime West; South Country Health Alliance; UCare | null | MN | ||||||
MO HealthNet Managed Care/1915b | Comprehensive MCO | Statewide | 1115(a) (Medicaid demonstration waivers);1915(b) | 9/1/1995 | 6/30/2024 | null | Mandatory | Mandatory | Voluntary | Mandatory | Voluntary | Mandatory | Mandatory | Other | WIPRO Infocrossing | Pregnant women have 7 days. 15 days for the rest of the population; however children in the care and custody of the State of Missouri are enrolled the same day. | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | X | X | null | null | X | X | X | Ambulatory Surgical Care; Asthma Education and In-Home Environmental Assessments; Comprehensive Day Rehabilitation; Durable Medical Equipment; Emergency; Hearing; Immunization; Inpatient Substance Use Disorders; Outpatient Substance Use Disorders; Obesity; Prenatal Case Management; Podiatry; Vision | Yes | Yes | Yes | NCQA | Primaris Holdings; Inc. | null | null | X | X | null | Home State Health Eastern; Healthy Blue Eastern; UnitedHealthcare Eastern; Healthy Blue Western; Home State Health Western; UnitedHealthcare Western; Healthy Blue Central; Home State Health Central; UnitedHealthcare Central; Healthy Blue Southwestern; Home State Health Southwestern; UnitedHealthcare Southwestern | HCBS services within Missouri are limited and are therefore not covered under the 1915(c) waiver. Home health services provided through managed care are limited to 100 visits per year and are intended to be covered for a short term. Long-term home health services are provided outside of managed care. | MO | ||
Non-Emergency Medical Transportation Program (NEMT) | Non-Emergency Medical Transportation | Statewide | 1902(a)(70) NEMT | 10/1/2006 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Medicaid State Plan | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | No | No | No | null | null | null | null | null | null | null | Logisticare Solutions | null | MO | ||
Mississippi Coordinated Access Network (MississippiCAN) | Comprehensive MCO | Statewide | 1932(a) | 1/1/2011 | null | null | Mandatory | Varies | Mandatory | Voluntary | Voluntary | Voluntary | Other | Conduent Healthcare Solutions | Enrollment choice period open for 90 days | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | X | X | X | null | X | null | null | X | X | X | Vaccines; podiatry; chiropractic; vision and eyeglasses; etc | Yes | Yes | Yes | NCQA | The Carolinas Center for Medical Excellence (CCME) | null | null | null | X | X | Magnolia Health; UnitedHealthcare Community Plan; Molina Healthcare of Mississippi | Mississippi has a separate CHIP program. Personal care services are part of EPSDT services. The MississippiCAN program does not include Medicaid beneficiaries enrolled in Home and Community Based Waivers or residents of residential facilities; except Psychiatric Residential Treatment Facilities. Personal care services ... | MS | |||
Passport to Health | Primary Care Case Management (PCCM) | Statewide | 1915(b) | 1/1/1993 | 6/30/2024 | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Conduent | 45 days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | No | No | No | null | null | null | null | null | null | null | Passport to Health; Team Care | A member can only be enrolled in one PCCM at one time; they must choose either a Passport; CPC+ or Patient Centered Medical Home provider. The program-level counts of Passport to Health include people who also participate in the Tribal Health Improvement Plan. | MT | ||
Comprehensive Primary Care Plus (CPC)+ | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2018 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Exempt | Mandatory | null | Conduent | null | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | Yes | No; but accreditation considered in plan selection criteria | null | null | X | null | null | null | null | Multiple Primary Care Providers | CPC+ is a subset of Passport to Health. The 1915(b) waiver authority for Passport to Health requires a large percentage of the Medicaid population to mandatorily choose a PCCM primary care provider. However; members have a choice of providers; including the option of choosing between a CPC+ provider or a Patient Center... | MT | |||
Patient Centered Medical Home | Primary Care Case Management (PCCM) | Statewide | 1932(a) | 1/1/2016 | null | null | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | Mandatory | null | Conduent | 45 days | null | null | null | null | null | null | null | null | null | null | null | null | null | X | null | null | null | null | null | null | null | null | null | null | null | null | null | null | Yes | Yes | Yes | NCQA | null | null | null | null | null | null | Multiple Primary Care Providers | The Patient Centered Medical Home program is a subset of Passport to Health. The 1915(b) waiver authority for Passport to Health requires a large percentage of the Medicaid population to mandatorily choose a PCCM primary care provider. However; members have a choice of providers; including the option of choosing betwee... | MT | |||
Standard Plan | Comprehensive MCO + MLTSS | Statewide | 1115(a) (Medicaid demonstration waivers) | 7/1/2021 | 10/31/2024 | null | Mandatory | Mandatory | Mandatory | Voluntary | Exempt | Pre-assigned | Maximus | null | X | X | X | X | X | X | X | X | X | X | X | X | X | X | null | X | X | null | null | X | null | X | null | X | X | X | X | null | Yes | Yes | No | null | HSAG | null | null | X | null | X | Healthy Blue of North Carolina; UnitedHealthcare; Carolina Complete Health; Wellcare; Amerihealth Caritas | null | NC |
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