Tag: GB-Managed Care

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Managed Care

Buyer: NV
Due Date: 5/13/2021Scope Summary: provide risk-based capitated Managed Care Organization (Vendor) services designed in support of the Title XIX (Medicaid) and Title XXI State Child Health Insurance Program (CHIP is also known as Nevada Check Up) medical assistance programsMin Quals:

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Managed Care Plan Quality Performance

MANAGED CARE – FSSA leader says he ‘never’ would have pursued Pathways, program more than $300 million over budget
MANAGED CARE - FSSA leader says he 'never' would have pursued Pathways, program more than $300 million over budgetAlternative Headline: Indiana's
MANAGED CARE – New law brings managed care to people with intellectual disabilities
MANAGED CARE - New law brings managed care to people with intellectual disabilitiesAlternative Headline: FL Expands IDD Care Access[MM Curator Summary]: A
POLICY – Skyline Health advocates for sound Medicaid policy
POLICY - Skyline Health advocates for sound Medicaid policyAlternative Headline: Skyline Fights Medicaid Cuts[MM Curator Summary]: Skyline Health CEO Matt Kollman is
Special needs advocate speaks on Medicaid cuts
Special needs advocate speaks on Medicaid cutsAlternative Headline: Medicaid Cuts Threaten Disability Care[MM Curator Summary]: Virginia families fear devastating effects from upcoming
MANAGED CARE – UnitedHealthcare cooperates with DOJ investigation into Medicaid billing
MANAGED CARE - UnitedHealthcare cooperates with DOJ investigation into Medicaid billingAlternative Headline: UHC Under Federal Probe[MM Curator Summary]: UnitedHealthcare is under federal
MANAGED CARE – State’s Medicaid managed care plan compliance improving
MANAGED CARE - State's Medicaid managed care plan compliance improvingAlternative Headline: NY Medicaid Mental Health Gains[MM Curator Summary]: New York Medicaid plans
MANAGED CARE – Mission Mobile Medical Group Launches Executive-in-Residence Program; David B. Vliet Named to Inaugural Cohort
MANAGED CARE - Mission Mobile Medical Group Launches Executive-in-Residence Program; David B. Vliet Named to Inaugural CohortAlternative Headline: EIR Program Targets
MANAGED CARE – MCO cuts impacting Kentucky addiction recovery centers
MANAGED CARE - MCO cuts impacting Kentucky addiction recovery centersAlternative Headline: Medicaid Cuts Hit Recovery Care[MM Curator Summary]: Kentucky’s Medicaid cuts are
MANAGED CARE – Digitizing Prior Authorization Could Ease Burden on Patients and Providers
MANAGED CARE - Digitizing Prior Authorization Could Ease Burden on Patients and ProvidersAlternative Headline: Insurers Simplify Prior Authorization[MM Curator Summary]: Insurers’ pledge
Actions taken

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Copies of managed care plan contracts

MANAGED CARE – Magellan Health Appoints Dr. Caroline Carney as Chief Executive Officer
MANAGED CARE - Magellan Health Appoints Dr. Caroline Carney as Chief Executive OfficerAlternative Headline: Carney Named CEO of Magellan[MM Curator Summary]: Dr.
MANAGED CARE – Fortuna Gets Funding to Expand Medicaid Enrollment Solution
MANAGED CARE - Fortuna Gets Funding to Expand Medicaid Enrollment SolutionAlternative Headline: Fortuna Boosts Medicaid Tech[MM Curator Summary]: Fortuna Health raised $18M
MANAGED CARE – Healthcare company Molina laying off hundreds of employees in Henrico
MANAGED CARE - Healthcare company Molina laying off hundreds of employees in HenricoAlternative Headline: Molina Exits Virginia Medicaid[MM Curator Summary]: Molina Healthcare
MANAGED CARE – Sunflower Health Plan Champions Health Improvement Through Community Engagement in Kansas
MANAGED CARE - Sunflower Health Plan Champions Health Improvement Through Community Engagement in KansasAlternative Headline: Sunflower Boosts Care Access Statewide[MM Curator
MANAGED CARE – CABS Health Network and CookUnity Launch Medicaid Meal Initiative to Tackle Food Insecurity in New York City
MANAGED CARE - CABS Health Network and CookUnity Launch Medicaid Meal Initiative to Tackle Food Insecurity in New York CityAlternative
MANAGED CARE – Trividia Health, Inc. Announces Preferred Listing of the TRUE METRIX® Blood Glucose Meter and Test Strips for...
MANAGED CARE - Trividia Health, Inc. Announces Preferred Listing of the TRUE METRIX® Blood Glucose Meter and Test Strips for
MANAGED CARE – FreedomCare Expands Home Care Services in Illinois Through the Medicaid Home Services Program
MANAGED CARE - FreedomCare Expands Home Care Services in Illinois Through the Medicaid Home Services ProgramAlternative Headline: FreedomCare Expands in Illinois[MM
MANAGED CARE – TrueCare Appoints Key Executives to Lead Operations and Compliance
MANAGED CARE - TrueCare Appoints Key Executives to Lead Operations and ComplianceAlternative Headline: TrueCare Expands Executive Team[MM Curator Summary]: TrueCare names two seasoned
MANAGED CARE – Amid scrutiny, DeSantis says $10 million payment to his wife’s Hope Florida program is not illegal but...
MANAGED CARE - Amid scrutiny, DeSantis says $10 million payment to his wife's Hope Florida program is not illegal but
MANAGED CARE – Majority of Medicaid Managed Care Plans Cover Opioid Overdose Reversal Drug Naloxone
MANAGED CARE - Majority of Medicaid Managed Care Plans Cover Opioid Overdose Reversal Drug NaloxoneAlternative Headline: Most Medicaid Plans Cover Naloxone[MM
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What are the capitation rates paid to plans?

Dental Final Base Rates RY20-21
Statewide Medicaid Managed Care (SMMC) Statewide Medicaid Prepaid Dental Health Program (Dental Program) Monthly Base Rates Effective Date: October 1,
MMA Final Base Rates RY20-21
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Program Gross of Prescribed Drugs High Risk Pool (PDHRP) Withhold Amount
LTC Final Base Rates RY20-21
Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program Monthly Base Rates Effective Date: October 1, 2020 through September 30,
MMA Final Base Rates SMMC-Imp 2019-09
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Program Monthly Base Rates Effective Date: SMMC Implementation to January 31,
LTC Final Base Rates SMMC Impl 2019-09
Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program Monthly Base Rates Effective Date: SMMC Implementation1 to September 2019
Dental Cap Rates SMMC 2019-09
Statewide Medicaid Managed Care (SMMC) Statewide Medicaid Prepaid Dental Health Program (Dental Program) Monthly Base Rates Effective Date: SMMC Implementation
MMA Final Base Rates RY19-20
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Program Gross of Prescribed Drugs High Risk Pool (PDHRP) Withhold Amount
LTC Final Base Rates RY19-20
Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program Monthly Base Rates Effective Date: October 1, 2019 through September 30,
Dental Final Rates RY19-20
Statewide Medicaid Managed Care (SMMC) Statewide Medicaid Prepaid Dental Health Program (Dental Program) Monthly Base Rates Effective Date: October 1,
MMA Final Base Rates 2018-10 SMMC Impl
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Program Monthly Base Rates Effective Date: October 1, 2018 to SMMC
MMA Final Base Rates 2017-10 2018-09
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) Program Monthly Base Rates for Standard Plans, Child Welfare Specialty Plan,

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What is the enrollment by plan?

MANAGED CARE – CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System Overhaul
MANAGED CARE - CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System OverhaulAlternative Headline: Managed Medicaid Spurs Overhaul[MM Curator
Florida Managed Care Enrollment- March 2021
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What are the health plans in Florida?

Plans by Region 2-24-2021
Plan Website Links
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What are the basics about Medicaid Managed Care in Florida?

MANAGED CARE – CareSource announces John Koehn as Massachusetts market president following its recent affiliation with Commonwealth Care Alliance
MANAGED CARE - CareSource announces John Koehn as Massachusetts market president following its recent affiliation with Commonwealth Care AllianceAlternative Headline: New
MANAGED CARE – Molina cuts 2025 earnings outlook again on ACA, Medicaid pressures
MANAGED CARE - Molina cuts 2025 earnings outlook again on ACA, Medicaid pressuresAlternative Headline: Molina Cuts Outlook Again[MM Curator Summary]: Molina slashed
MANAGED CARE – How Wayspring and Highmark Health Are Changing the SUD Care Playbook
MANAGED CARE - How Wayspring and Highmark Health Are Changing the SUD Care PlaybookAlternative Headline: Outreach Boosts SUD Care[MM Curator Summary]: A
MANAGED CARE – Medicaid work requirements in reconciliation bill revive calls to update managed care texting ban
MANAGED CARE - Medicaid work requirements in reconciliation bill revive calls to update managed care texting banAlternative Headline: Medicaid Cuts, Texting
MANAGED CARE – Digitizing Prior Authorization Could Ease Burden on Patients and Providers
MANAGED CARE - Digitizing Prior Authorization Could Ease Burden on Patients and ProvidersAlternative Headline: Insurers Simplify Prior Authorization[MM Curator Summary]: Insurers’ pledge
MANAGED CARE – 30-day public comment period underway for new Medicaid managed care program
MANAGED CARE - 30-day public comment period underway for new Medicaid managed care programAlternative Headline: Florida Expands IDD Care Pilot[MM Curator
MANAGED CARE – Three years of Healthy Opportunities Pilot at Access East changing lives across eastern North Carolina
MANAGED CARE - Three years of Healthy Opportunities Pilot at Access East changing lives across eastern North CarolinaAlternative Headline: HOP Boosts
MANAGED CARE – TrueCare Appoints Key Executives to Lead Operations and Compliance
MANAGED CARE - TrueCare Appoints Key Executives to Lead Operations and ComplianceAlternative Headline: TrueCare Expands Executive Team[MM Curator Summary]: TrueCare names two seasoned
MANAGED CARE – Retirement Systems of Alabama Reduces Stake in Molina Healthcare, Inc
MANAGED CARE - Retirement Systems of Alabama Reduces Stake in Molina Healthcare, IncAlternative Headline: Institutional Shifts in Molina Stock[MM Curator Summary]: Institutional
MANAGED CARE – CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System Overhaul
MANAGED CARE - CarDon CEO Zach Cattell: Managed Medicaid is ‘Biggest Wrench’ Pushing System OverhaulAlternative Headline: Managed Medicaid Spurs Overhaul[MM Curator
  • Most members are required to receive services through a Medicaid managed care plan
  • There are 3 main Medicaid managed care programs in this market:
    • Managed Medical Assistance
    • Long-Term Care
    • Dental
  • State began managed care program in 2013

Type of managed care in state

  • Managed Medical Assistance: Medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services.
  • Long-Term Care: LTC services like care in a nursing facility, assisted living, or at home.
  • Dental: All Medicaid recipients who receive a dental benefit enroll in a dental plan
https://ahca.myflorida.com/Medicaid/recent_presentations/2019/SenateHealthPolicy_010419.pdf