View
214
Download
0
Category
Preview:
Citation preview
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
AL Maternity Care Program Medical-only PAHP
Risk-based Capitation
1915(b) Statewide 21,969
AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 498,406
AR Connect Care PCCM Fee-For-Service 1115 Statewide 418,425
AR Non-Emergency Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 445,003
AR Total Life Healthcare PACE Risk-based Capitation
PACE 72315, 72319, 72324, 72354, 72365, 72373, 72387, 72396, 72401, 72404, 72411, 72414, 72416, 72417, 72419, 72421, 72427, 72432, 72433, 72437, 72438, 72442, 72447, 72450, 72455, 72465, 72467, 72472, 72476
36
AZ AZ Physicians IPA (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 La Paz, Maricopa, Pima, Yuma 636
AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based Capitation
1115 LaPaz, Maricopa, Pima, Yuma 246,797
AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-based Capitation
1115 Yavapai 69
AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-based Capitation
1115 Yavapai 17,584
AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-based Capitation
1115 La Paz, Maricopa, Yuma 2,761
AZ Care 1st Health Plan Medicaid MCO Risk-based Capitation
1115 Maricopa 51,030
AZ Care 1st Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 201
AZ Cochise Co. Dept. of Health Services (PC) Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee 899
AZ Department of Economic Security/Childrens Medical and Dental Program (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Statewide 0
AZ Department of Economic Security/Childrens Medical and Dental Program (HP)
Medicaid MCO Risk-based Capitation
1115 Statewide 9,448
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 23
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
AZ Department of Economic Security/Division of Developmental Disabilities (PC)
Medicaid MCO Risk-based Capitation
1115 Statewide 22,715
AZ Department of Health Services (Behavioral Health)
MH/SUD PIHP Risk-based Capitation
1115 Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz, Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz, Yavapai, Yuma
116,014
AZ Evercare Select (PC) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Maricopa, Mohave, Navajo 3,178
AZ Health Choice Arizona (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
678
AZ Health Choice Arizona (HP) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yuma
194,505
AZ Maricopa County Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Maricopa 108
AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-based Capitation
1115 Maricopa 53,757
AZ Mercy Care Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 745
AZ Mercy Care Plan (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 306,039
AZ Mercy Care Plan (PC) Medicaid MCO Risk-based Capitation
1115 Maricopa 8,503
AZ Phoenix Health Plan (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
685
AZ Phoenix Health Plan (HP) Medicaid MCO Risk-based Capitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal, Yavapai
194,577
AZ Pima Health System (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Pima 1
AZ Pima Health System (HP) Medicaid MCO Risk-based Capitation
1115 Pima 1,865
AZ Pima Health System (PC) Medicaid MCO Risk-based Capitation
1115 Pima, Santa Cruz 4,312
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 24
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
AZ Pinal County Long Term Care (PC) Medicaid MCO Risk-based Capitation
1115 Gila, Pinal 1,476
AZ SCAN Medicaid MCO Risk-based Capitation
1115 Maricopa 3,090
AZ University Family Care (Family Planning Extension)
Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 212
AZ University Family Care (HP) Medicaid MCO Risk-based Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 69,308
AZ Yavapai County Long Term Care (PC) Medicaid MCO Risk-based Capitation
1115 Yavapai 1,013
CA Access Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 133,787
CA Access Dental Plan-Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 116,356
CA Alameda Alliance for Health Commercial MCO Risk-based Capitation
1915(b), 1932(a) Alameda 97,471
CA AltaMed Health Services Corporation PACE Risk-based Capitation
PACE LA 732
CA American Health Guard-Dental Plan-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 12,935
CA Anthem Blue Cross Partnership Plan - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 91,058
CA Anthem Blue Cross Partnership Plan-TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Alameda, Contra Costa, Fresno, San Francisco, San Joaquin, Santa Calra, Stanislaus, Tulare
327,858
CA Caloptima-Orange HIO Risk-based Capitation
1915(b) Orange 358,909
CA Care 1st Health Plan/San Diego Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 13,012
CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 16,984
CA Central California Alliance For Health HIO Risk-based Capitation
1915(b) Merced, Monterey, Santa Cruz 177,532
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 25
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
CA Coalition of Elders Independence dba Center for Elders Independence
PACE Risk-based Capitation
PACE Alameda 449
CA Community Dental Services/Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 11,953
CA Community Dental Services-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 3,971
CA Community Eldercare of San Diego dba St. Paul's PACE
PACE Risk-based Capitation
PACE San Diego 107
CA Community Health Group Partnership Plan-San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 97,160
CA Contra Costa Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Contra Costa 59,028
CA Health Net Community Solutions, Inc. - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 49,580
CA Health Net Community Solutions, Inc.San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 29,887
CA Health Net Community Solutions, Inc.TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Fresno, Kern, LA, Stanislaus, Tulare 633,079
CA Health Net of CA-Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles 39,394
CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-based Capitation
1915(a) Sacramento 22,189
CA Health Plan of San Joaquin Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Joaquin 74,969
CA Health Plan of San Mateo *MCO/COHS Risk-based Capitation
1915(b) San Mateo 57,753
CA Inland Empire Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Riverside, San Bernardino 389,660
CA Kern Family Health Care Commercial MCO Risk-based Capitation
1915(b), 1932(a) Kern 104,658
CA KP Cal, LLC Commercial MCO Risk-based Capitation
1915(a) Marin, Sonoma 889
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 26
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
CA KP Cal, LLC - Sacramento Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 26,528
CA KP Cal, LLC-San Diego Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 13,412
CA LA Care Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Los Angeles 825,327
CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 27,661
CA Liberty Dental Plan of CA-LA Dental PAHP Risk-based Capitation
1915(b), 1932(a) LA 7,578
CA Molina Healthcare of California Partner Plan, Inc. - Sacramento
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Sacramento 26,956
CA Molina Healthcare of California Partner Plan, Inc. - San Diego
Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Diego 61,194
CA Molina Healthcare of California Partner Plan, Inc.-TPMP
Commercial MCO Risk-based Capitation
1915(b), 1932(a) Riverside, San Bernardino 95,190
CA On Lok Senior Health Services dba On Lok Lifeways
PACE Risk-based Capitation
PACE San Francisco 967
CA Partnership Health Plan HIO Risk-based Capitation
1915(b) Napa, Solano, Sonoma, Yolo 152,838
CA Positive Healthcare/AHF Healthcare Centers
Medicaid MCO Risk-based Capitation
1915(a) Los Angeles 761
CA Safeguard Dental-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, San Bernardino 20,656
CA San Francisco City & CO/Family Mosaic *Emotional and Mental Health Support PIHP
Risk-based Capitation
1915(a) San Francisco 106
CA San Francisco Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) San Francisco 38,241
CA Santa Barbara San luis Obispo Regional Health Authority
HIO Risk-based Capitation
1915(b) Santa Barbara 90,740
CA Santa Clara Family Health Plan Commercial MCO Risk-based Capitation
1915(b), 1932(a) Santa Clara 99,002
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 27 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
CA Senior Care Action Network (SCAN) Medicaid MCO Risk-based Capitation
1915(a) LA, Riverside, San Barnardino 7,440
CA Sutter Health sacramento Sierra dba Sutter Senior Care
PACE Risk-based Capitation
PACE Sacramento, Yolo 211
CA Western Dental Services-LA Dental PAHP Risk-based Capitation
1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 55,247
CA Western Dental Services-Sacramento Dental PAHP Risk-based Capitation
1915(b), 1932(a) Sacramento 88,030
CO Access Behavioral Care Mental Health PIHP
Risk-based Capitation
1915(b) Denver 91,556
CO Behavioral Healthcare, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) East Metro Denver 124,334
CO Colorado Access Medicaid MCO Risk-based Capitation
1915(a) Adams, Arapahoe, Boulder, Broomfield, Denver 1,945
CO Colorado Health Partnerships Mental Health PIHP
Risk-based Capitation
1915(b) Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos, Costilla, Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont, Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson, Kiowa, La Plata, Lake, Las Animas, Mesa, Mineral, Moffat, Montezuma, Montrose, Otero, Ouray, Park, Pitkin, Prowers, Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan, San Miguel, Summit, Teller
180,658
CO Denver Health and Hospital Authority Medicaid MCO Risk-based Capitation
1915(a) Adams, Arapahoe, Denver, Jefferson 41,841
CO ePCCM *Enhanced PCCM
Fee-For-Service 1932(a) Statewide 2,746
CO Foothills Behavioral Health Partners Mental Health PIHP
Risk-based Capitation
1915(b), 1932(a)/1915(c)
Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 59,560
CO Northeast Behavioral Health Partnership Mental Health PIHP
Risk-based Capitation
1915(b) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan, Morgan, Phillips, Sedgwick, Washington, Weld, Yuma
66,437
CO Primary Care Physician Program PCCM Fee-For-Service 1932(a) Statewide 23,766
CO Rocky Mountain Health Plan Authority Medical-only PIHP
Non-risk Capitation
1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 16,786
CO Rocky Mountain PACE PACE Risk-based Capitation
PACE El Paso 80
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 28 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
CO Total Long Term Care PACE Risk-based Capitation
PACE Adams, Arapahoe, Denver, Jefferson 1,451
CO VOANS PACE, Inc PACE Risk-based Capitation
PACE Delta, Montrose 171
CT Aetna Better Health Commercial MCO Risk-based Capitation
1915(b) Statewide 88,706
CT Americhoice by United HealthCare Medicaid MCO Risk-based Capitation
1915(b) Statewide 45,475
CT Benecare *Dental ASO Fee-For-Service 1915(b) Statewide 542,524
CT Community Health Network of Connecticut Medicaid MCO Risk-based Capitation
1915(b) Statewide 244,565
CT HUSKY Primary Care PCCM Fee-For-Service 1915(b) Greater Hartford, Greater New Haven, Greater Waterbury, Greater Windham
425
CT Value Options *Mental Health ASO
Fee-For-Service 1915(b) Statewide 379,171
DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation
1932(a) Statewide 104,240
DC Health Services For Children with Special Needs
Medical-only PIHP
Risk-based Capitation
1915(a) Statewide 4,145
DC Medical Transportation Management Transp PAHP Non-risk Capitation
1902(a)(70) Statewide 44,480
DC Unison Health Plan of the Capital Area Medicaid MCO Risk-based Capitation
1932(a) Statewide 50,135
DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation
1115 Statewide 86,689
DE Diamond State Partners *Fee for Service Model
Fee-For-Service 1115 Statewide 7,847
DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-based Capitation
1115 Statewide 45,031
FL Access Health Solutions Medical-only PAHP
Non-risk Capitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee, Indian River, Manatee, Martin, Nassau, Okeechobee, Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St. Lucie, Volusia
43,343
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 29
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL AHF MCO of Florida, Inc.(Reform) Commercial MCO Risk-based Capitation
1115 County 33
FL AIDS Healthcare Foundation, Inc. Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 5,258
FL Alternative Medicine Integration Disease Management
PAHP
Non-risk Capitation
1915(b) Hillsborough, Pasco, Pinellas 476
FL American Eldercare Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Citrus, Clay, Dade, Duval, Escambia, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Nassau, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Volusia, Walton
4,516
FL Amerigroup (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval, Hernando, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie, Volusia
2,876
FL Amerigroup of Florida, Inc. Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia
166,201
FL Atlantic Dental, Inc. Dental PAHP Risk-based Capitation
1915(b) Dade 184,981
FL Better Health, LLC (Reform) Medical-only PIHP
FFS w/Some Risk Capitation
1115 Broward County 32,821
FL Caremark Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 88
FL Children's Medical Services (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward, Duval 6,647
FL Citrus (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Alachua, Brevard, Broward, Citrus, Dade, Duval, Hernando, Hillsborough, Lake, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, Volusia
1,969
FL Citrus Health Care, Inc. Commercial MCO Risk-based Capitation
1915(b) Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk, Seminole
50,091
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 30 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL Community Based Care Partnership, Ltd. Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 7,935
FL Coventry Health Care of Florida, Inc. d/b/a Buena Vista
Commercial MCO Risk-based Capitation
1915(b) Broward, Dade, Gadsden, Hendry, Jefferson, Leon, Liberty, Madison, Palm Beach, Wakulla
22,289
FL Coventry Health Care of Florida, Inc. d/b/a Vista
Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 20,367
FL First Coast Advantage (Reform) Medical-only PIHP
FFS/Some Risk Capitation
1115 Duval 45,806
FL Florida Health Partners, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington
241,809
FL Florida PACE Centers PACE Risk-based Capitation
PACE 33010, 33012, 33013, 33014, 33054, 33122, 33125, 33126, 33127, 33128, 33129, 33130, 33131, 33132, 33133, 33134, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33143, 33144, 33145, 33146, 33147, 33150, 33154, 33155, 33161, 33165, 33166, 33167, 33168, 33172, 33173, 33174, 33175, 33181, 33182, 33183, 33184
189
FL Freedom Health Plan, Inc. Commercial MCO Risk-based Capitation
1915(b) Dade, Hernando, Hillsborough, Manatee, Marion, Palm Beach, Pasco, Polk
2,471
FL Freedom Health Plan, Inc. (Reform) Commercial MCO Risk-based Capitation
1115 Broward 10,092
FL HealthEase of Florida, Inc. Medicaid MCO Risk-based Capitation
1915(b) Brevard, Broward, Calhoun, Citrus, Dade, Duval, Escambia, Gadsden, Highlands, Hillsborough, Jefferson, Lake, Leon, Liberty, Madison, Manatee, Marion, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, Volusia, Wakulla
157,552
FL HealthierFlorida (Pfizer Health Solutions, Inc.)
Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 14,812
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 31 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL Hemophilia of the Sunshine State (Lynnfield Drug, Inc.)
Disease Management
PAHP
Non-risk Capitation
1915(b) Statewide 155
FL Hope Select Care PACE Risk-based Capitation
PACE Charlotte, Lee 111
FL Humana Medical Plan Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Duval, Flagler, Hillsborough, Manatee, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia
908
FL Humana Medical Plan, Inc. Commercial MCO Risk-based Capitation
1915(b) Broward, Dade, Palm Beach 42,390
FL Humana Medical Plan, Inc. (Reform) Commercial MCO Risk-based Capitation
1115 Broward 7,818
FL Humana Senior's Choice Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie
412
FL Integral Health Plan Medicaid MCO Risk-based Capitation
1915(b) Collier, Manatee, Polk 9,558
FL Lakeview Center, Inc. Mental Health PIHP
Risk-based Capitation
1915(b) Escambia, Okaloosa, Santa Rosa, Walton 50,616
FL Life Hope Care Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Charlotte, Collier, Hendry, Lee 2
FL Little Havana Activities and Nutrition Centers
Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 1,195
FL Magellan Behavioral Health of Florida Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Collier, Columbia, Dade, Desoto, Dixie, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Indian River, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion, Martin, Monroe, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St Johns, St Lucie, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, Washington
244,408
FL Managed Care of North America Dental PAHP Risk-based Capitation
1915(b) Dade 52,522
FL Medica Health Plans of Florida, Inc. Commercial MCO Risk-based Capitation
1915(b) Dade 1,726
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 32 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL Medica Health Plans of Florida, Inc. (Reform)
Commercial MCO Risk-based Capitation
1115 Broward 1,663
FL MediPass PCCM Fee-For-Service 1915(b) Statewide 581,485
FL Molina Healthcare of Florida, Inc. Commercial MCO Risk-based Capitation
1915(b) Dade, Hillsborough, Palm Beach, Pasco, Pinellas, Polk 33,847
FL Molina Healthcare of Florida, Inc. (Reform) Commercial MCO Risk-based Capitation
1115 Broward 20,359
FL Neighborly Care Network Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Citrus, Dade, Hernando, Hillsborough, Indian River, Manatee, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie
730
FL Neighborly PACE PACE Risk-based Capitation
PACE Pinellas 60
FL North Florida Behavioral Health Partnership
Mental Health PIHP
Risk-based Capitation
1915(b) Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union
100,328
FL Personal Health Plan Medicaid MCO Risk-based Capitation
1915(b) Palm Beach 11,046
FL Preferred Medical Plan, Inc. Commercial MCO Risk-based Capitation
1915(b) Broward, Dade 16,062
FL Prestige Health Choice Medicaid MCO Risk-based Capitation
1915(b) Dade, Hillsborough, Lee, Orange, Pasco, Pinellas, Seminole 43,780
FL Project Independence at Home Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 507
FL Public Health Trust of Dade County Mental Health PIHP
Risk-based Capitation
1915(b) Dade 69,075
FL Public Health Trust of Miami-Dade County Commercial MCO Risk-based Capitation
1915(b) Dade 15,124
FL Simply Healthcare Plans, Inc. Commercial MCO Risk-based Capitation
1915(b) Dade, Hillsborough, Osceola, Pinellas, Polk, Seminole 2,950
FL South Florida Community Care Network *Shared Savings Model
FFS/Some Risk Capitation
1915(b) Dade 8,713
FL South Florida Community Care Network (Reform)
Medical-only PIHP
FFS/Some Risk Capitation
1115 Broward 30,246
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 33 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL Sunrise Community, Inc. *Adult Day Health Care
Fee-For-Service 1915(b)/(c) Lee, Palm Beach 36
FL Sunrise Home Health Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 71
FL Sunshine State Health Plan Medicaid MCO Risk-based Capitation
1915(b) Dade, Hillbourough, Pasco, Pinellas, Polk 24,015
FL Sunshine State Health Plan (Reform) Medicaid MCO Risk-based Capitation
1115 Baker, Broward, Clay, Duval, Nassau 88,803
FL The Commission for the Transportation of the Disadvantaged
Transp PAHP Flat Rate per Ride 1915(b) Statewide 30,318
FL United Health Care (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Dade, Duval, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, Volusia
1,167
FL United Healthcare of Florida, Inc. (Reform) Commercial MCO Risk-based Capitation
1115 Baker, Clay, Duval, Nassau 7,867
FL United Home Care Services Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Dade 35
FL UnitedHealthcare of Florida, Inc. Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Citrus, Dade, Duval, Hernando, Highlands, Hillsborough, Lake, Manatee, Marion, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Volusia
93,797
FL Universal Health Care (NHD) Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Clay, Collier, Dade, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole
1,092
FL Universal Health Care, Inc. Commercial MCO Risk-based Capitation
1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon, Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Wakulla
35,290
FL Universal Health Care, Inc. (Reform) Commercial MCO Risk-based Capitation
1115 Broward, Duval 16,521
FL Urban Jacksonville Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Clay, Duval, St. Johns 160
FL Vista Independence Plan Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Broward, Dade, Palm Beach 1,363
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 34 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
FL WellCare of Florida, Inc. Commercial MCO Risk-based Capitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee, Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter
189,167
FL World Net, Inc. Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Escambia, Okaloosa, Santa Rosa, Walton 47
FL YourCare Brevard Long Term Care PIHP
Risk-based Capitation
1915(a)/(c) Brevard 144
GA Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, East Region, North Region, Southeast Region 221,242
GA Georgia Better Health Care PCCM Fee-For-Service 1932(a) Statewide 123,580
GA Non-Emergency Transportation Brokerage Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 1,362,416
GA Peach State Health Plan Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, Southwest Region 252,313
GA WellCare Medicaid MCO Risk-based Capitation
1932(a) Atlanta Region, Central Region, East Region, North Region, Southeast Region, Southwest Region
457,059
HI Aloha Care Medicaid MCO Risk-based Capitation
1115 Statewide 76,184
HI Evercare Commercial MCO Risk-based Capitation
1115 Statewide 19,498
HI HMSA-Medical Commercial MCO Risk-based Capitation
1115 Big Island, Kauai, Oahu 112,361
HI Kaiser Permanente Commercial MCO Risk-based Capitation
1115 Maui, Oahu 25,131
HI Maui PACE PACE Risk-based Capitation
PACE Maui 14
HI Ohana Commercial MCO Risk-based Capitation
1115 Maui 22,025
IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Statewide 387,279
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 35 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
IA Medipass PCCM Fee-For-Service 1932(a) Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas, Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet, Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Henry, Howard, Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Kossuth, Lee, Linn, Lucas, Lyon, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott, Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren, Warren, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright
199,397
IA Siouxland PACE PACE Risk-based Capitation
PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 71
ID Blue Cross of Idaho Dental PAHP Risk-based Capitation
1937 Statewide 161,797
ID Healthy Connections PCCM Fee-for-Service 1937 Statewide 186,988
ID Medicare-Medicaid Coordinated Plan Medical-only PAHP
Risk-based Capitation
1937 Ada, Bannock, Benewah, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Gem, Jefferson, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls, Washington
956
IL Family Health Network Medicaid MCO Risk-based Capitation
1915(a) Cook 47,200
IL Harmony Health Plan Commercial MCO Risk-based Capitation
1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, Williamson
134,200
IL Illinois Health Connect PCCM Fee-For-Service 1932(a) Statewide 1,189,400
IL Meridian Health Plan Medicaid MCO Risk-based Capitation
1915(a) Adams, Brown, Cook, Henry, Mercer, Pike, Rock Island, Scott 800
IN Advantage Health Solutions-Care Select PCCM Fee-For-Service 1915(b) Statewide 32,974
IN Anthem-Healthy Indiana Plan Commercial MCO Risk-based Capitation
1115 Statewide 30,347
IN Anthem-Hoosier Healthwise Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 165,823
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 36 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
IN Enhanced Services Plan (ESP)-Healthy Indiana Plan
*High Risk Plan Fee-For-Service 1115 Statewide 977
IN Managed Health Services (MHS)-Hoosier Healthwise
Medicaid MCO Risk-based Capitation
1115, 1915(b) Statewide 206,301
IN MDwise-Care Select PCCM Fee-For-Service 1915(b) Statewide 40,833
IN MDwise-Healthy Indiana Plan Commercial MCO Risk-based Capitation
1115 Statewide 14,891
IN MDwise-Hoosier Healthwise Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 282,526
KS Children's Mercy's Family Health Partners Medicaid MCO Risk-based Capitation
1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 107,181
KS HealthConnect Kansas PCCM Fee-For-Service 1932(a) Statewide 23,065
KS Kansas Health Solutions Mental Health PAHP
Non-risk Capitation
1915(b)/(c) Statewide 258,423
KS Medical Transportation Management Inc. (MTM)
Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 130,275
KS Midland Care Services PACE Risk-based Capitation
PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie, Shawnee, Wabaunsee
79
KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-based Capitation
1932(a) Statewide 56,422
KS ValueOptions-Kansas Substance Use Disorders PIHP
Risk-based Capitation
1915(b)/(c) Statewide 258,423
KS Via Christi Healthcare Outreach Programs for Elders
PACE Risk-based Capitation
PACE Sedgwick 200
KY Human Service Transportation Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 716,854
KY Kentucky Patient Access and Care (KenPAC)
PCCM Fee-For-Service 1932(a) Statewide 315,085
KY Passport Health Plan Medicaid MCO Risk-based Capitation
1115 Jefferson County (Louisville) Kentucky and 15 surrounding counties
166,060
LA Community Care PCCM Fee-For-Service 1932(a) Statewide 752,027
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 37
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
LA Francican PACE Baton Rouge PACE Risk-based Capitation
PACE East Baton Rouge, West Baton Rouge 108
LA Greater New Orleans PACE Risk-based Capitation
PACE 70001, 70002, 70003, 70005, 70006, 70032, 70043, 70053, 70112, 70113, 70114, 70115, 70116, 70117, 70118, 70119, 70121, 70122, 70124, 70125, 70126, 70127, 70128, 70129, 70130, 70131
134
MA Boston Medical Center HealthNet Plan Medicaid MCO Risk-based Capitation
1115 Boston/Greater Boston Region, Central Region, Southern Region, Western Region
182,351
MA Commonwealth Care Alliance Medicaid MCO Risk-based Capitation
1915(a)/(c) Essex County, Hampden County, Middlesex County, Norfolk County, Plymouth County, Suffolk County
2,717
MA Elder Service Plan of Cambridge Health Alliance
PACE Risk-based Capitation
PACE Allston, Cambridge, Somerville 222
MA Elder Service Plan of East Boston PACE Risk-based Capitation
PACE East Boston 298
MA Elder Service Plan of Harbor Health Services, Inc.
PACE Risk-based Capitation
PACE Greater Boston 335
MA Elder Service Plan of the North Shore, Inc. PACE Risk-based Capitation
PACE Northeastern MA 736
MA Evercare SCO Medicaid MCO Risk-based Capitation
1915(a)/(c) Bristol County, Essex County, Hampden County (partial), Middlesex County, Norfolk County, Plymouth County (partial), Suffolk County, Worcester County (partial)
4,916
MA Fallon Community Health Plan Commercial MCO Risk-based Capitation
1115 Central Region 11,775
MA MA Behavioral Health Partnership MH/SUD PIHP Risk-based Capitation
1115 Statewide 322,823
MA NaviCare Medicaid MCO Risk-based Capitation
1915(a)/(c) Worcester County 516
MA Neighborhood Health Plan Commercial MCO Risk-based Capitation
1115 Boston/Greater Region, Central/Western Region, Northeast/Southeast Region
140,405
MA Network Health Medicaid MCO Risk-based Capitation
1115 Boston/Greater Boston Region, Central/Western Region, Northeast/Southeast Region
112,736
MA Primary Care Clinician Plan PCCM Fee-For-Service 1115 Statewide 322,823
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 38
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MA Senior Whole Health Medicaid MCO Risk-based Capitation
1915(a)/(c) Bristol County, Essex County, Middlesex County, Norfolk County, Plymouth County, Suffolk County, Worcester County
6,527
MA Summit Elder Care PACE Risk-based Capitation
PACE Worchester 714
MA Uphams Elder Service Plan PACE Risk-based Capitation
PACE Boston 182
MD AMERIGROUP - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide except Allegany, Cecil, Garrett, St. Mar 3,608
MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-based Capitation
1115 Statewide except Allegany, Cecil, Garrett, St. Mar 196,779
MD Hopkins Elder Plus PACE Risk-based Capitation
PACE 21052, 21202, 21205, 21206, 21213, 21214, 21217, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237
147
MD JAI Medical System Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County 13,106
MD JAI Medical Systems - PAC Medical-only PAHP
Risk-based Capitation
1115 Baltimore City, Baltimore County 6,485
MD Maryland Physicians Care Medicaid MCO Risk-based Capitation
1115 Statewide 123,319
MD Maryland Physicians Care - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 15,850
MD Medstar Family Choice Medicaid MCO Risk-based Capitation
1115 Anne Arundel North, Baltimore City, Baltimore County, Western Harford County
27,068
MD Priority Partners - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 6,195
MD Priority Partners MCO Medicaid MCO Risk-based Capitation
1115 Statewide 176,874
MD The Coordinating Center *Selective Contract
Fee-For-Service 1915(b)/(c) Statewide 687
MD The Diamond Plan Medicaid MCO Risk-based Capitation
1115 Baltimore City, Baltimore County, Harford 10,330
MD United Health Care Medicaid MCO Risk-based Capitation
1115 Statewide except Prince Georges County 127,019
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 39
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MD United HealthCare - PAC Medical-only PAHP
Risk-based Capitation
1115 Statewide 9,779
ME MaineCare Primary Care Case Management
PCCM Fee-For-Service 1932(a) Statewide 194,464
MI Access Alliance of Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 57,789
MI BlueCaid of Michigan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Washtenaw, Wayne 20,115
MI Care Resources PACE Capitation PACE Kent 201
MI CareSource of Michigan Medicaid MCO Risk-based Capitation
1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Benzie, Berrien, Calhoun, Cass, Charlevoix, Cheboygan, Crawford, Genesee, Gladwin, Grand Traverse, Ionia, Iosco, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Manistee, Mason, Mecosta, Missaukee, Montmorency, Newaygo, Oceana, Ogemaw, Osceola, Oscoda, Ottawa, Presque Isle, Roscommon, Saginaw, St. Joseph, Van Buren
37,272
MI CMH Affiliation of Mid-Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee, Newago
90,563
MI CMH for Central Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 41,801
MI CMH Partnership of Southeast Michigan Mental Health PIHP
Risk-based Capitation
1915(b) Lenawee, Livingston, Monroe, Washtenaw 75,655
MI Comprehensive Senior Care Corporation PACE Risk-based Capitation
PACE Calhoun 78
MI Detroit-Wayne County CMH Agency Mental Health PIHP
Risk-based Capitation
1915(b) Wayne 431,254
MI Genesee County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b) Genesee 90,490
MI Great Lakes Health Plan Medicaid MCO Risk-based Capitation
1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron, Jackson, Kalamazoo, Lenawee, Livingston, Macomb, Oakland, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne
226,503
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 40 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MI Health Plan of Michigan Medicaid MCO Risk-based Capitation
1915(b) Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Crawford, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newago, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego,
MI HealthPlus Partners, Inc. Medicaid MCO Risk-based Capitation
1915(b)
Ottawa, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne
Bay, Genesee, Lapeer, Saginaw, Shiawassee, Tuscola
MI Healthy Kids Dental Dental PAHP Risk-based Capitation
1915(b) Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Benzie, Branch, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ionia, Iosco, Iron, Isabella, Kalkaska, Keweenaw, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Manistee, Marquette, Menominee, Midland,
MI Henry Ford Health System-Center for Senior Independence
PACE Risk-based Capitation
PACE
Missaukee, Monroe, Montmorency, Ogemaw, Ontonagon, Oscoda, Otsego, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren
48201, 48202, 48203, 48204, 48205, 48206, 48207, 48208, 48209, 48210, 48211, 48212, 48213, 48214, 48215, 48216, 48217, 48218, 48219, 48221, 48223, 48224, 48225, 48226, 48227, 48228, 48229, 48230, 48234, 48235, 48236, 48238,
MI Lakeshore Behavioral Health Alliance Mental Health PIHP
Risk-based Capitation
1915(b)
48239, 48240
Muskegon, Ottawa
MI Life Circles PACE Risk-based Capitation
PACE Muskegon, Ottawa
MI LifeWays Mental Health PIHP
Risk-based Capitation
1915(b) Hillsdale, Jackson
MI Macomb County CMH Services Mental Health PIHP
Risk-based Capitation
1915(b) Macomb
MI McLaren Health Plan Medicaid MCO Risk-based Capitation
1915(b) Arenac, Bay, Clinton, Crawford, Eaton, Genesee, Gratiot, Ingham, Ionia, Isabella, Lapeer, Macomb, Montcalm,
262,642
70,358
313,554
199
63,558
95
33,797
105,352
77,686
Oakland, Ogemaw, Oscoda, Roscommon, Saginaw, Shiawassee, Tuscola
MI Midwest Health Plan Medicaid MCO Risk-based Capitation
1915(b) Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne 70,077
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 41
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MI Molina Healthcare of Michigan Medicaid MCO Risk-based Capitation
1915(b) Alcona, Allegan, Arenac, Bay, Benzie, Clare, Crawford, Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Isabella, Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, St. Clair, Tuscola, Wayne, Wexford
217,673
MI Network 180 Mental Health PIHP
Risk-based Capitation
1915(b) Kent 95,087
MI Northcare Mental Health PIHP
Risk-based Capitation
1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft
44,169
MI Northern Affiliation Mental Health PIHP
Risk-based Capitation
1915(b) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle
45,472
MI Northwest CMH Affiliation Mental Health PIHP
Risk-based Capitation
1915(b) Crawford, Grand Traverse, Lake, Leelanau, Mason, Missaukee, Oceana, Roscommon, Wexford
42,819
MI Oakland County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b) Oakland 114,353
MI Omnicare Health Plan Medicaid MCO Risk-based Capitation
1915(b) Oakland, Wayne 51,725
MI Physicians Health Plan of Mid-Michigan Family Care
Medicaid MCO Risk-based Capitation
1915(b) Ingham, Ionia, Montcalm, Shiawassee 18,305
MI Priority Health Government Programs, Inc. Medicaid MCO Risk-based Capitation
1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm, Muskegon, Oceana, Osceola, Ottawa
61,188
MI ProCare Health Plan Medicaid MCO Risk-based Capitation
1915(b) Wayne 1,578
MI Saginaw County CMH Authority Mental Health PIHP
Risk-based Capitation
1915(b) Saginaw 40,597
MI Southwest Michigan Urban & Rural Consortium
Mental Health PIHP
Risk-based Capitation
1915(b) Allegan, Cass, Kalamazoo, St. Joseph 71,992
MI Thumb Alliance PIHP Mental Health PIHP
Risk-based Capitation
1915(b) Lapeer, Sanilac, St. Clair 45,816
MI Total Health Care Medicaid MCO Risk-based Capitation
1915(b) Genesee, Macomb, Oakland, Wayne 52,817
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 42 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MI Upper Peninsula Health Plan Medicaid MCO Risk-based Capitation
1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keewenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft
28,748
MI Venture Behavioral Health Mental Health PIHP
Risk-based Capitation
1915(b) Barry, Berrien, Branch, Calhoun, VanBuren 86,024
MN Blue Plus Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mcleod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Rouseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine
111,508
MN Health Partners Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Anoka, Benton, Carver, Chisago, Dakota, Hennepin, McLeod, Meeker, Ramsey, Scott, Sherburne, Stearns, Washington, Wright
50,312
MN Itasca Medical Care Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Itasca 5,169
MN Medica Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Lake, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Polk, Ramsey, Rice, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright
133,141
MN Metropolitan Health Plan Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Anoka, Carver, Hennepin, Mower, Scott 15,925
MN PrimeWest Health System Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse
19,737
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 43 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MN South Country Health Alliance Medicaid MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena, Waseca
30,376
MN UCARE Commercial MCO Risk-based Capitation
1115, 1932(a), 1915(a),
1915(b)/(c)
Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, LeSueur, Lincoln, Lyon, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Winona, Wright, Yellow Medicine
102,269
MO Alexian Brothers Community Services PACE Risk-based Capitation
PACE St. Louis City, St. Louis County 180
MO Blue Advantage Plus of Kansas City Medicaid MCO Risk-based Capitation
1915(b) Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair
27,413
MO Childrens Mercy Family Health Partners Medicaid MCO Risk-based Capitation
1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon
48,739
MO Harmony Health Plan of Missouri Medicaid MCO Risk-based Capitation
1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington
14,571
MO HealthCare USA Medicaid MCO Risk-based Capitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington
174,092
MO LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 507,160
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 44 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
MO Missouri Care Medicaid MCO Risk-based Capitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington
42,352
MO Molina Healthcare of Missouri Medicaid MCO Risk-based Capitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass, Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Laclede, Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls, Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon, Warren, Washington
69,643
MS LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 533,107
MT Billings Clinic PACE Risk-based Capitation
PACE 59002, 59006, 59015, 59024, 59037, 59044, 59047, 59064, 59079, 59088, 59101, 59102, 59105, 59106
43
MT Health Improvement Program *Enhanced Primary Care
Case Managment
Fee-For-Service 1915(b) Statewide 75,130
MT Passport to Health PCCM Fee-For-Service 1915(b) Statewide 69,610
NC Carolina Access PCCM Fee-For-Service 1932(a) Statewide 74,379
NC Community Care of North Carolina (Access II/III)
PCCM Fee-For-Service 1932(a) Statewide 1,041,665
NC Elderhaus PACE Risk-based Capitation
PACE Brunswick, New Hanover 51
NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-based Capitation
1915(b)/(c) Rowan, Stanly, Davidson, Union and Cabarrus Counties 81,733
NC Piedmont SeniorCare PACE Risk-based Capitation
PACE Caswell, Yancy 63
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 45 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
ND ExperienceHealth ND Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 3,370
ND Northland PACE PACE Risk-based Capitation
PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602, 58652, 58655, 58656
51
ND Primary Care Case Management PCCM Fee-For-Service 1932(a) Statewide 41,987
NE Magellan Behavioral Health *Specialty Physician Case Management
(SPCM) Program
Fee-For-Service 1915(b) Statewide 197,275
NE Primary Care Plus PCCM Fee-For-Service 1915(b), 1932(a) Douglas, Lancaster, Sarpy 50,544
NE Share Advantage Commercial MCO Risk-based Capitation
1915(b), 1932(a) Douglas, Lancaster, Sarpy 40,247
NJ AmeriChoice of New Jersey, Inc. Commercial MCO Risk-based Capitation
1915(b), 1932(a) Statewide 288,539
NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren
115,257
NJ Healthfirst Health Plan of New Jersey, Inc. Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Bergen, Essex, Hudson, Mercer, Middlesex, Morris, Passaic, Somerset, Sussex, Union
15,519
NJ Horizon NJ Health Medicaid MCO Risk-based Capitation
1915(b), 1932(a) Statewide 378,983
NJ Life at Lourdes PACE Risk-based Capitation
PACE 08002, 08003, 08004, 08007, 08009, 08012, 08021, 08026, 08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045, 08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095, 08099, 08101, 08102, 08103, 08104, 08105, 08106, 08107, 08108, 08109, 08110, 08505, 08518, 08554, Mercer County
107
NJ Life St. Francis PACE Risk-based Capitation
PACE 08505, 08518, 08554 86
NJ LogistiCare Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 798,299
NM AMERIGROUP Community Care of New Mexico, Inc.
Commercial MCO Risk-based Capitation
1915(b)/(c) Statewide 19,422
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 46 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
NM Blue Cross Blue Shield of New Mexico Commercial MCO Risk-based Capitation
1915(b) Statewide 18,901
NM Evercare of New Mexico Commercial MCO Risk-based Capitation
1915(b)/(c) Statewide 18,761
NM Lovelace Community Health Plan Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 90,459
NM Molina Healthcare of New Mexico Medicaid MCO Risk-based Capitation
1115, 1915(b) Statewide 85,144
NM OptumHealth New Mexico Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 366,415
NM Presbyterian Health Plan Commercial MCO Risk-based Capitation
1115, 1915(b) Statewide 166,560
NM Total Community Care (PACE) PACE Risk-based Capitation
PACE Bernalillo County, Sandoval County, Valencia County 388
NV Amerigroup Community Care Medicaid MCO Risk-based Capitation
1932(a) Statewide 67,844
NV Health Plan of Nevada Commercial MCO Risk-based Capitation
1932(a) Clark, Washoe 78,256
NV Logisticare Transp PAHP Risk-based Capitation
1932(a) Statewide 225,459
NY Affinity Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester
236,209
NY Affinity/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 138
NY Amerigroup Medicaid MCO Risk-based Capitation
1115 New York City, Putnam 99,639
NY AmeriGroup Advantage Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 18
NY Amerigroup Community Connections Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 814
NY AmidaCare Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 1,430
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 47
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
NY ArchCare Senior Life PACE Risk-based Capitation
PACE New York City 62
NY Capital District Physicians Health Plan Commercial MCO Risk-based Capitation
1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Washington
61,807
NY Catholic Health - LIFE PACE Risk-based Capitation
PACE Erie 34
NY CCM Select Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 1,748
NY Comprehensive Care Management (CCM) PACE Risk-based Capitation
PACE New York City, Westchester 2,590
NY Eddy Senior Care PACE Risk-based Capitation
PACE Albany, Schenectady 114
NY Elder Plan/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 28
NY Excellus Commercial MCO Risk-based Capitation
1115 Broome, Chemung, Clinton, Essex, Franklin, Herkimer, Livingston, Madison, Monroe, Oneida, Onondaga, Ontario, Orleans, Oswego, Otsego, Seneca, St Lawrence, Wayne, Yates
124,269
NY Fidelis Care at Home Long Term Care PIHP
Risk-based Capitation
1115 Orange, Rockland 345
NY GHI *PPO Risk-based Capitation
1115 Statewide 3,309
NY GHI/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 898
NY Guildnet Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 6,432
NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 249
NY Health Advantage/Elant Choice Long Term Care PIHP
Risk-based Capitation
1915(a) Orange 151
NY Health First Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk 429,385
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 48 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
NY Health Now Commercial MCO Risk-based Capitation
1115 Albany, Allegany, Cattauragus, Chautauqua, Clinton, Columbia, Erie, Essex, Fulton, Genesee, Greene, Montgomery, Niagara, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming
41,317
NY HealthPlus Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens, Richmond 276,185
NY HHH Choices Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 852
NY HIP Combined Commercial MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester
254,483
NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 1,871
NY HomeFirst Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 3,759
NY Hudson Health Plan Medicaid MCO Risk-based Capitation
1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 79,575
NY Independent Care Systems Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 1,550
NY Independent Health/Hudson Valley&WNY Commercial MCO Risk-based Capitation
1115 Erie, Niagara 36,785
NY Independent Living For Seniors PACE Risk-based Capitation
PACE Monroe 279
NY Liberty Health Advantage/Medicaid Advantage
Commercial MCO Risk-based Capitation
1115 Statewide 740
NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 59
NY MetroPlus Health Plan Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens 368,502
NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-based Capitation
1115 Bronx, Brooklyn, Manhattan, Queens 3,386
NY MetroPlus/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 48
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 49
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
NY MVP Health Plan Commercial MCO Risk-based Capitation
1115 Dutchess, Ulster 36,132
NY Neighborhood Health Providers Medicaid MCO Risk-based Capitation
1115 Bronx, Kings, New York, Queens, Richmond 196,532
NY NYPS Select Health Special Needs Medicaid MCO Risk-based Capitation
1115 Statewide 1,445
NY NYS Catholic Health Plan 1199 Commercial MCO Risk-based Capitation
1115 Statewide 3,721
NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-based Capitation
1115 Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton, Columbia, Cortland, Dutchess, Erie, Essex, Greene, Hamilton, Herkimer, Kings, Nassau, New York, Niagara, Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Warren, Washington, Westchester
525,693
NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage
Commercial MCO Risk-based Capitation
1115 Statewide 486
NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 21
NY PACE CNY PACE Risk-based Capitation
PACE Onondaga 397
NY Physician Case Management Program PCCM Risk-based Capitation
1115 Erie 4,804
NY SCHC TotalCare Medicaid MCO Risk-based Capitation
1115 Onondaga, Oswego, Tompkins 37,305
NY Senior Health Partners Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 2,258
NY Senior Network Health Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 400
NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 536
NY Senior Whole Health/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 217
NY Southern Tier Pediatrics PCCM Risk-based Capitation
1115 Chemung, Steuben 4,237
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 50 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
NY Southern Tier Priority PCCM Risk-based Capitation
1115 Chemung, Schuyler, Steuben 6,479
NY Total Aging in Place Long Term Care PIHP
Risk-based Capitation
1915(a) Erie 149
NY Total Senior Care PACE Risk-based Capitation
PACE Cattaraugus 43
NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-based Capitation
1115 Statewide 1,200
NY United Healthcare Commercial MCO Risk-based Capitation
1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 240,251
NY Univera Community Health Medicaid MCO Risk-based Capitation
1115 Allegany, Cattaraugus, Chautauqua, Erie 38,605
NY VNS Choice Long Term Care PIHP
Risk-based Capitation
1915(a) New York City 8,502
NY VNS Choice Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 45
NY Wellcare Commercial MCO Risk-based Capitation
1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, New York, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster
77,201
NY WellCare Advantage Plus/Medicaid Advantage Plus
Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 76
NY WellCare Advocate Long Term Care PIHP
Risk-based Capitation
1915(a) Statewide 960
OH Amerigroup Ohio Medicaid MCO Risk-based Capitation
1932(a) Southwest, West Central 57,883
OH Buckeye Community Health Plan Medicaid MCO Risk-based Capitation
1932(a) East Central, Northeast, Northwest, Southwest 158,381
OH CareSource Medicaid MCO Risk-based Capitation
1932(a) Central, East Central, Northeast, Northeast Central, Northwest, Southeast, Southwest, West Central
801,056
OH McGregor PACE PACE Risk-based Capitation
PACE Cuyahoga 192
OH Molina Healthcare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Central, Southeast, Southwest, West Central 233,625
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 51
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
OH Paramount Advantage Medicaid MCO Risk-based Capitation
1932(a) Northwest 87,072
OH TriHealth Senior Link PACE Risk-based Capitation
PACE Butler, Clermont, Hamilton, Warren 540
OH Unison Health Plan of Ohio Medicaid MCO Risk-based Capitation
1932(a) East Central, Northeast Central, Northwest, Southeast 121,891
OH WellCare of Ohio Medicaid MCO Risk-based Capitation
1932(a) Northeast 101,033
OK Cherokee Elder Care PACE Risk-based Capitation
PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434, 74441, 74451, 74452, 74464, 74471
57
OK SoonerCare American Indian PCCM PCCM Fee-For-Service 1115 Statewide 14,247
OK SoonerCare PCCM PCCM Fee-For-Service 1115 Statewide 434,969
OK SoonerRide Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 603,083
OR Accountable Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Benton, Crook, Deschutes, Jefferson, Lincoln 34,237
OR Capitol Dental Care Inc. Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk, Umatilla, Union, Wasco, Washington, Yamhill
153,973
OR Care Oregon Medicaid MCO Risk-based Capitation
1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson, Klamath, Lincoln, Marion, Morrow, Multnomah, Polk, Tillamook, Umatilla, Washington, Yamhill
127,691
OR Cascade Comprehensive Care Medicaid MCO Risk-based Capitation
1115 Klamath 8,265
OR Central Oregon Independent Health Solutions
Medicaid MCO Risk-based Capitation
1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler
15,454
OR Clackamas County Mental Health Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Gilliam, Hood River, Marion, Sherman, Wasco 27,725
OR Doctors of the Oregon Coast South Medicaid MCO Risk-based Capitation
1115 Coos 9,663
OR Douglas County IPA Commercial MCO Risk-based Capitation
1115 Douglas 13,261
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 52 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
OR FamilyCare (Mental Health) Mental Health PIHP
Risk-based Capitation
1115 Clackamas, Multnomah, Washington 26,314
OR FamilyCare Health Plans Commercial MCO Risk-based Capitation
1115 Clackamas, Jackson, Josephine, Morrow, Multnomah, Umatilla, Washington
38,018
OR Greater Oregon Behavioral Health, Inc. Mental Health PIHP
Risk-based Capitation
1115 Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur, Morrow, Umatilla, Union, Wallowa, Wheeler
50,693
OR Inter-Community Health Network Medicaid MCO Risk-based Capitation
1115 Benton, Lincoln, Linn, Tillamook 23,791
OR Jefferson Behavioral Health Mental Health PIHP
Risk-based Capitation
1115 Coos, Curry, Douglas, Jackson, Josephine, Klamath 61,720
OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-based Capitation
1115 Clackamas, Marion, Multnomah, Polk 9,878
OR Lane Care MHO Mental Health PIHP
Risk-based Capitation
1115 Lane 42,122
OR Lane Individual Practice Association Medicaid MCO Risk-based Capitation
1115 Benton, Lane, Linn 35,800
OR Managed Dental Care of Oregon Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill
13,906
OR Marion Polk Community Health Plan Medicaid MCO Risk-based Capitation
1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 51,128
OR Mid Valley Behavioral Care Network Mental Health PIHP
Risk-based Capitation
1115 Linn, Marion, Polk, Tillamook, Yamhill 88,667
OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-based Capitation
1115 Douglas, Jackson, Josephine 16,961
OR Multicare Dental Dental PAHP Risk-based Capitation
1115 Clackamas, Multnomah, Washington 31,357
OR Multnomah County Verity Mental Health PIHP
Risk-based Capitation
1115 Multnomah 76,769
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 53 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
OR Northwest Dental Services Dental PAHP Risk-based Capitation
1115 Baker, Benton, Clackamas, Clatsop, Columbia, Coos, Crook, Curry, Deschutes, Douglas, Gilliam, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Lincoln, Linn, Malheur, Marion, Morrow, Multnomah, Polk, Sherman, Umatilla, Union, Wallowa, Wasco, Washington, Wheeler, Yamhill
140,037
OR ODS Community Health Inc. Medicaid MCO Risk-based Capitation
1115 Baker, Clatsop, Columbia, Deschutes, Jackson, Malheur, Union, Wallowa, Yamhill
8,970
OR Oregon Dental Service Dental PAHP Risk-based Capitation
1115 Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Hood River, Jackson, Jefferson, Josephine, Lane, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Wasco, Washington, Yamhill
57,674
OR Oregon Health Management Service Medicaid MCO Risk-based Capitation
1115 Douglas, Jackson, Josephine 4,552
OR PCCM PCCM Fee-For-Service 1115 Statewide 4,044
OR Providence Elder Place PACE Risk-based Capitation
PACE 97009, 97010, 97014, 97019, 97024, 97030, 97034, 97035, 97056, 97060, 97080, 97124, 97133, 97201, 97202, 97203, 97204, 97205, 97206, 97209, 97210, 97211, 97212, 97213, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97222, 97225, 97227, 97229, 97230, 97231, 97232, 97233, 97236, 97239, 97258, 97266
842
OR Providence Health Assurance Medicaid MCO Risk-based Capitation
1115 Clackamas, Multnomah, Washington, Yamhill 18,176
OR Tuality Health Care Medicaid MCO Risk-based Capitation
1115 Washington 8,829
OR Washington County Health (Mental Health)
Mental Health PIHP
Risk-based Capitation
1115 Washington 38,853
OR Willamette Dental Dental PAHP Risk-based Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Deschutes, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill
63,843
PA Access Plus Program PCCM Fee-For-Service 1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
290,807
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 54 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PA Aetna Better Health Commercial MCO Risk-based Capitation
1915(b) Adams, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, Lancaster, Lebanon, Lehigh, Montgomery, Northampton, Perry, Philadelphia, York
14,649
PA Albright LIFE Medical-only PIHP
Risk-based Capitation
1915(a) Clinton, Lancaster, Lycoming 76
PA AmeriChoice of Pennsylvania Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 67,946
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan
Commercial MCO Risk-based Capitation
1915(b) Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, York
94,083
PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL
Commercial MCO Risk-based Capitation
1915(a) Carbon, Lackawanna, Luzerne, Monroe, Pike 2,698
PA APS Healthcare Disease Management
PAHP
Risk-based Capitation
1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntington, Jefferson, Juniata, Lackwanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming
53,048
PA Community Care Behavioral Health North Central
MH/SUD PIHP Risk-based Capitation
1915(b) Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniat
133,254
PA Community Care Behavioral Health Northeast
MH/SUD PIHP Risk-based Capitation
1915(b) Lackawanna, Luzerne, Susquehanna, Wyoming 83,088
PA Community LIFE PACE Risk-based Capitation
PACE 14145, 15014, 15018, 15020, 15024, 15025, 15028, 15030, 15032, 15034, 15035, 15037, 15045, 15047, 15049, 15051, 15065, 15075, 15076, 15084, 15088, 15102, 15104, 15110, 15112, 15120, 15122, 15129, 15131, 15132, 15133, 15135, 15137, 15139, 15140, 15144, 15146, 15147, 15148, 15206, 15207, 15208, 15215, 15217, 15218, 15221, 15227, 15232, 15234, 15235, 15236, 15238, 15239
328
PA Counties of Armstrong/Indiana - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Armstrong, Indiana 19,371
PA Counties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania
MH/SUD PIHP Risk-based Capitation
1915(b) Bedford 14,807
PA Counties of Carbon/Monroe/Pike - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Carbon, Monroe, Pike 32,815
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 55 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PA Counties of Crawford/Mercer/Venango - MH/SUD PIHP Risk-based 1915(b) Crawford, Mercer, Venango Value Behavioral Health Capitation
PA Counties of Franklin/Fulton - Community MH/SUD PIHP Risk-based 1915(b) Franklin, Fulton Behavorial Healthcare Network of Capitation Pennsylvania
PA Counties of Lycoming/Clinton - MH/SUD PIHP Risk-based 1915(b) Clinton, Lycoming Community Behavioral Healthcare Capitation Network of Pennsylvania
PA County of Adams - Community Care MH/SUD PIHP Risk-based 1915(b) Adams Behavioral Health Capitation
PA County of Allegheny - Community Care MH/SUD PIHP Risk-based 1915(b), Allegheny Behavioral Health Capitation 1932(a)/1915(c)
PA County of Beaver - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Beaver Health of PA Capitation
PA County of Berks - Community Care MH/SUD PIHP Risk-based 1915(b) Berks Behavioral Health Capitation
PA County of Blair County - Community MH/SUD PIHP Risk-based 1915(b) Blair Behavioral Healthcare Network of PA Capitation
PA County of Bucks - Magellan Behavioral MH/SUD PIHP Risk-based 1915(b) Bucks Health Capitation
PA County of Butler - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Butler Health of PA Capitation
PA County of Cambria - Value Behavioral MH/SUD PIHP Risk-based 1915(b) Cambria Health Capitation
PA County of Chester - Community Care MH/SUD PIHP Risk-based 1915(b) Chester Behavioral Health Capitation
PA County of Cumberland - Community MH/SUD PIHP Risk-based 1915(b) Cumberland Behavioral Healthcare Network of PA, Inc. Capitation
PA County of Dauphin - Community MH/SUD PIHP Risk-based 1915(b) Dauphin Behavioral Healthcare Network of PA, Inc. Capitation
PA County of Delaware - Magellan MH/SUD PIHP Risk-based 1915(b) Delaware Behavioral Health Capitation
39,431
15,377
20,116
7,523
153,075
22,092
55,455
19,472
40,958
15,073
19,373
27,816
14,605
33,495
62,336
PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-based Capitation
1915(b) Erie 45,680
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 56
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PA County of Fayette - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Fayette 27,673
PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lancaster 51,180
PA County of Lawrence - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Lawrence 13,740
PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Lebanon 13,801
PA County of Lehigh - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Lehigh 46,752
PA County of Montgomery - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Montgomery 53,364
PA County of Northampton - Magellan Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Northampton 28,478
PA County of Perry - Community Behavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-based Capitation
1915(b) Perry 3,888
PA County of Philadelphia - Community Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) Philadelphia 405,093
PA County of Washington - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Washington 23,190
PA County of Westmoreland - Value Behavioral Health of PA
MH/SUD PIHP Risk-based Capitation
1915(b) Westmoreland 38,855
PA County of York - Community Care Behavioral Health
MH/SUD PIHP Risk-based Capitation
1915(b) York 40,931
PA Coventry Care Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 4,607
PA Everyday LIFE PACE Risk-based Capitation
PACE Lehigh, Northampton 16
PA Gateway Health Plan, Inc. Commercial MCO Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York
214,708
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 57
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PA Gateway Health Plan, Inc. -VOL Commercial MCO Risk-based Capitation
1915(a) Blair, Erie 21,925
PA Health Partners of Philadelphia Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 143,660
PA Keystone Mercy Health Plan Commercial MCO Risk-based Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 281,848
PA LIFE at Home PACE Risk-based Capitation
PACE Chester, Delaware 90
PA LIFE Geisinger PACE Risk-based Capitation
PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill, Snyder, Union, Wyoming
141
PA LIFE Lutheran Services PACE Risk-based Capitation
PACE Franklin 33
PA LIFE Northwestern PA Medical-only PIHP
Risk-based Capitation
1915(a) Erie 37
PA LIFE Pittsburgh PACE Risk-based Capitation
PACE 15006, 15007, 15015, 15017, 15031, 15044, 15046, 15056, 15064, 15071, 15082, 15086, 15090, 15091, 15101, 15106, 15108, 15116, 15126, 15127, 15136, 15142, 15143, 15201, 15202, 15203, 15204, 15205, 15209, 15210, 15211, 15212, 15213, 15214, 15216, 15219, 15220, 15222, 15223, 15224, 15225, 15226, 15228, 15229, 15233, 15237, 15241, 15243
364
PA LIFE St Mary PACE Risk-based Capitation
PACE Bucks 25
PA LIFE University of Pennsylvania PACE Risk-based Capitation
PACE 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153
368
PA Logisticare Solutions, LLC Transp PAHP Risk-based Capitation
1902(a)(70) Philadelphia 426,548
PA Mercy LIFE PACE Risk-based Capitation
PACE 19106, 19107, 19111, 19114, 19115, 19116, 19123, 19124, 19125, 19134, 19135, 19136, 19137, 19145, 19146, 19147, 19148, 19149, 19152, 19154
318
PA New Courtland LIFE PACE Risk-based Capitation
PACE Philadelphia County zip codes 19118, 19119, 19120, 19126, 19127, 19128, 19129, 19132, 19138, 19141,
180
PA Senior LIFE York Medical-only PIHP
Risk-based Capitation
1915(a) York 6
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 58 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PA Senior LIFE Johnstown PACE Risk-based Capitation
PACE Blair, Cambria, Dauphin, Somerset County zip codes 15531, 15928, 15935, 15953 and 15963, Westmoreland County zip codes 15944 and 15954, York
176
PA Senior LIFE Washingtown Medical-only PIHP
Risk-based Capitation
1915(a) Fayette, Greene and Washington 76
PA Unison Health Plan / MedPLUS Commercial MCO Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York
96,487
PA Unison Health Plan/MedPlus - VOL Commercial MCO Risk-based Capitation
1915(a) Blair, Bradford, Cambria, Carbon, Clarion, Columbia, Crawford, Erie, Forest, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Pike, Schuylkill, Somerset, Sullivan, Susquehanna, Warren, Wyoming
33,734
PA UPMC Health Plan, Inc./UPMC for You Commercial MCO Risk-based Capitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York
111,844
PA UPMC Health Plan, Inc./UPMC for You - VOL
Commercial MCO Risk-based Capitation
1915(a) Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango
6,379
PA Value Behavioral Health of PA (Greene County)
MH/SUD PIHP Risk-based Capitation
1915(b) Greene 6,756
PA Viecare Beaver PACE Risk-based Capitation
PACE Beaver 159
PA Viecare Butler Medical-only PIHP
Risk-based Capitation
1915(a) Butler 44
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 59 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PR American Health Medicare Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 17,256 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
PR APS Healthcare MH/SUD PIHP Risk-based Capitation
1915(a) Aguas Buenas, Arecibo, Barceloneta, Caguas, Camuy, Canovanas, Carolina, Cayey, Ceiba, Ciales, Cidra, Culebra,
328,090
Fajardo, Florida, Gurabo, Hatillo, Humacao, Juncos, Lares, Las Piedras, Loiza, Luquillo, Manati, Morovis, Naguabo, Quebradillas, Rio Grande, San Lorenzo, Trujillo Alto, Utuado, Vega Baja, Vieques, Yabucoa
PR FHC Healthcare MH/SUD PIHP Risk-based 1915(a) Adjuntas, Aibonito, Arroyo, Barranquitas, Coamo, Guanica, 186,565 Capitation Guayama, Guayanilla, Jayuya, Juana Diaz, Maunabo,
Orocovis, Patillas, Penuelas, Ponce, Salinas, Santa Isabel, Villalba, Yauco
PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO Risk-based 1915(a) Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, 213,624 Capitation Cayey, Cidra, Coamo, Guayama, Gurabo, Humacao, Juana
Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 60 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PR Humana Puerto Rico Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 10,202 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
Bayamón, Cabo Rojo, Caguas, Camuy, Canóvanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerío, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Loíza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
PR MCS Advantage Commercial MCO Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
51,368
Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Loiza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
PR MCS Health Management Options, Inc. Commercial MCO Risk-based 1915(a) Aguada, Aguadilla, Añasco, Cabo Rojo, Canovanas, 265,946 Capitation Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela,
Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez, Moca, Rincon, Rio Grande, Sabana Grande, San German, San Juan, San Sebastian, Trujillo Alto, Vieques
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 61 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
PR MMM Healthcare Inc. Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 48,529 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
PR PMC Medicare Choice Commercial MCO Risk-based Capitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
29,223
Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
PR Triple S Commercial MCO Risk-based 1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, 11,921 Capitation Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas,
Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 62 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority
1915(a)
1115
Geographic Area Served
Adjuntas, Arecibo, Barceloneta, Bayamón, Camuy, Cataño, Ciales, Comerío, Corozal, Dorado, Florida, Guanica, Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati, Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta, Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco
Statewide
Number of Enrollees
329,117
14,698
1115
1115
Statewide
Statewide
2,404
78,331
PACE Statewide except for Zip Codes Block Island 02807 194
1115 Statewide 48,626
1115 Statewide 34,353
1932(a)
1932(a)
Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkely, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Fairfield, Florence, Greenville, Hampton, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
91,163
27,230
PR Triple-S, Inc. Commercial MCO Risk-based Capitation
RI Blue Cross & Blue Shield of Rhode Island Commercial MCO Risk-based Capitation
RI Connect Care Choice PCCM Fee-For-Service
RI Neighborhood Health Plan of Rhode Island
Medicaid MCO Risk-based Capitation
RI PACE Organization of Rhode Island PACE Risk-based Capitation
RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-based Capitation
RI United HealthCare of New England Commercial MCO Risk-based Capitation
SC Absolute Total Care Medicaid MCO Risk-based Capitation
SC BlueChoice Health Plan Medicaid MCO Risk-based Capitation
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 63 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
SC First Choice by Select Health of South Carolina, Inc.
Medicaid MCO Risk-based Capitation
1932(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Sumter, Union, Williamsburg, York
204,001
SC Logisticare Transp PAHP Risk-based Capitation
1902(a)(70) Region 3, Region 4, Region 5, Region 6 605,693
SC Medical Transportation Management (MTM)
Transp PAHP Risk-based Capitation
1902(a)(70) Region 1, Region 2 201,898
SC Palmetto SeniorCare (PACE) PACE Risk-based Capitation
PACE Lexington, Richland 387
SC South Carolina Solutions PCCM Fee-For-Service 1932(a) Statewide 111,486
SC The Oaks PACE PACE Risk-based Capitation
PACE Orangeburg County 70
SC Unison Health Plan of SC Medicaid MCO Risk-based Capitation
1932(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Marion, Marlboro, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Sumter, Union, Williamsburg, York
70,295
SD PRIME PCCM Fee-For-Service 1932(a) Statewide 90,953
TN Alexian Brothers Community Services PACE Risk-based Capitation
PACE Hamilton 328
TN AmeriChoice - East TN Medicaid MCO Risk-based Capitation
1115 East Tennessee 181,429
TN AmeriChoice - Middle TN Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 198,193
TN AmeriChoice - West TN Medicaid MCO Risk-based Capitation
1115 West Tennessee 165,791
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 64 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
TN AmeriGroup Community Care Medicaid MCO Risk-based Capitation
1115 Middle Tennessee 195,582
TN DentaQuest *Dental Benefit Manager PAHP
Non-risk Capitation
1115 Statewide 744,086
TN SXC Health Solutions Corporation *Pharmacy Benefits
Manager PAHP
Non-risk Capitation
1115 Statewide 1,069,182
TN Volunteer State Health Plan (Bluecare) - East
Medicaid MCO Risk-based Capitation
1115 East Tennessee 233,782
TN Volunteer State Health Plan (Bluecare) - West
Medicaid MCO Risk-based Capitation
1115 West Tennessee 185,851
TN Volunteer State Health Plan (TennCare Select)
*Prepaid Inpatient Health
Plan (PIHP), partial risk,
partial capitation
Partial Capitation 1115 Statewide 43,611
TX Aetna Commercial MCO Risk-based Capitation
1915(b) Atascosa, Bexar, Comal, Denton, Guadalupe, Hood, Johnson, Kendall, Medina, Parker, Tarrant, Wilson, Wise
47,924
TX Amerigroup (STAR) Medicaid MCO Risk-based Capitation
1915(b) Bastrop, Brazoria, Burnet, Caldwell, Collin, Dallas, Denton, Ellis, Fort Bend, Galveston, Harris, Hays, Hood, Hunt, Johnson, Kaufman, Lee, Montgomery, Navarro, Parker, Rockwell, Tarrant, Travis, Waller, Williamson, Wise
407,236
TX Amerigroup (STAR+PLUS) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Atascosa, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Comal, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Lee, Medina, Montgomery, Travis, Waller, Williamson, Wilson
57,192
TX Bienvivir Senior Health Service PACE Risk-based Capitation
PACE 79901, 79902, 79903, 79904, 79905, 79907, 79915, 79924, 79925, 79930, 79935, 79936
808
TX Community First Commercial MCO Risk-based Capitation
1915(b) Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson 83,486
TX Community Health Choice Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 123,955
TX Cook Children's Medicaid MCO Risk-based Capitation
1915(b) Denton, Hood, Johnson, Parker, Tarrant, Wise 59,216
TX Driscoll Medicaid MCO Risk-based Capitation
1915(b) Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Victoria
43,188
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 65 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
TX El Paso First Premier Commercial MCO Risk-based Capitation
1915(b) El Paso 47,163
TX Evercare Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Bastrop, Blanco, Brazoria, Burnet, Caldwell, Crosby, Floyd, Fort Bend, Galveston, Garza, Hale, Harris, Hays, Hockley, Lamb, Lee, Lubbock, Lynn, Montgomery, Terry, Travis, Waller, Williamson
56,196
TX First Care Commercial MCO Risk-based Capitation
1915(b) Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry
28,426
TX Jan Werner Adult Day Care Center PACE Risk-based Capitation
PACE 79015, 79101, 79102, 79103, 79104, 79106, 79107, 79108, 79109, 79110, 79111, 79118, 79119, 79121, 79124
136
TX La Paloma PACE Risk-based Capitation
PACE 79403, 79404, 79407, 79408, 79414, 79415, 79416, 79423, 79424, 79452, 79453, 79464, 79490, 79493, 79499
4
TX McKesson Health Solutions Disease Management
PAHP
Risk-based Capitation
1915(b) Statewide 62,980
TX Molina (STAR) Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,978
TX Molina (STAR+Plus) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Atascosa, Bexar, Brazoria, Comal, Fort Bend, Galveston, Guadalupe, Harris, Kendall, Medinal, Montgomery, Waller, Wilson
18,688
TX Parkland Community Health Plan Medicaid MCO Risk-based Capitation
1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 152,852
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 66 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
TX PCCM PCCM Fee-For-Service 1932(a) Anderson, Andrews, Angelina, Archer, Armstrong, Austin, Bailey, Bandera, Baylor, Bell, Bordon, Bosque, Bowie, Brazos, Brewster, Briscoe, Brooks, Brown, Burleson, Callahan, Cameron, Camp, Carson, Cass, Castro, Chambers, Cherokee, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Colorado, Comanche, Concho, Cooke, Coryell, Cottle, Crane, Crockett, Dallam, Dawson, Deaf Smith, Delta, DeWitt, Dickens, Dimmit, Donley, Duval, Eastland, Ector, Edwards, Erath, Falls, Fannin, Fayette, Fisher, Foard, Franklin, Freestone, Frio, Gaines, Gillespie, Glasscock, Goliad, Gonzales, Gray, Grayson, Gregg, Grimes, Hall, Hamilton, Hansford, Hardeman, Hardin, Harrison, Hartley, Haskell, Hemphill, Henderson, Hildalgo, Hill, Hopkins, Houston, Howard, Hutchinson, Irion, Jack, Jackson, Jasper, Jeff Davis, Jefferson, Jim Hogg, Jones, Karnes, Kenedy, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lamar, Lampasas, Lavaca, Leon, Liberty, Limestone, Lipscomb, Live Oak, Llano, Loving, Madison, Marion, Martin, Mason, Matagorda, Maverick, McCulloch, McLennan, McMullen, Menard, Midland, Milam, Mills, Mitchell, Montague, Moore, Morris, Motley, Nacogdoches, Newton, Nolan, Ochiltree, Oldham, Orange, Palo Pinto, Panola, Parmer, Pecos, Polk, Potter, Presidio, Rains, Randall, Reagan, Real, Red River, Reeves, Roberts, Robertson, Runnels, Sabine, San Augustine, San Jacinto, San Saba, Schleicher, Scurry, Shackelford, Shelby, Sherman, Smith, Somervell, Starr, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Throckmorton, Titus, Tom Green, Trinity, Tyler, Upshur, Upton, Uvalde, Val Verde, Van Zandt, Walker, Ward, Washington, Webb, Wharton, Wheeler, Wichita, Wilbarger, Willacy, Winkler, Wood, Yoakum, Young, Zapata, Zavala
848,808
TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-based Capitation
1915(a) Statewide 30,703
TX Superior HealthPlan (STAR) Medicaid MCO Risk-based Capitation
1915(b) Atascosa, Bastrop, Bexar, Burnet, Caldwell, Comal, Crosby, El Paso, Floyd, Garza, Guadalupe, Hale, Hays, Hockley, Hudspeth, Kendall, Lamb, Lee, Lubbock, Lynn, Medina, Terry, Travis, Williamson, Wilson
237,342
TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-based Capitation
1915(b), 1915(b)/(c)
Aransas, Atascosa, Bee, Bexar, Calhoun, Comal, Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces, Refugio, San Patricio, Victoria, Wilson
36,999
TX Texas Children's Health Plan Medicaid MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 195,890
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 67 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
TX Unicare Commercial MCO Risk-based Capitation
1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 20,932
TX United Commercial MCO Risk-based Capitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 12,188
TX ValueOptions MH/SUD PIHP FFS/Some Risk Based Capitation
1915(b) Collin County, Dallas County, Ellis County, Hunt County, Kaufman County, Navarro County, Rockwall County
365,127
UT Bear River Mental Health Mental Health PIHP
Risk-based Capitation
1915(b) Box Elder, Cache, Rich 13,107
UT Central Utah Counseling Center Mental Health PIHP
Risk-based Capitation
1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,705
UT Davis Behavioral Health Mental Health PIHP
Risk-based Capitation
1915(b) Davis 18,052
UT Four Corners Community Behavioral Health
Mental Health PIHP
Risk-based Capitation
1915(b) Carbon, Emery, Grand 4,608
UT Healthy Outcomes Medical Excellence (HOME)
*PIHP Covering both Medical and
Mental Health
Non-risk Capitation
1915(a) Statewide 793
UT Healthy U Medical-only PAHP
Non-risk Capitation
1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 33,258
UT Molina Healthcare of Utah (Molina) Medicaid MCO Risk-based Capitation
1115, 1915(b) Davis, Salt Lake, Utah, Weber 46,148
UT Non-Emergency Medical Transportation Transp PAHP Risk-based Capitation
1915(b) Statewide 173,189
UT Northeastern Counseling Center Mental Health PIHP
Risk-based Capitation
1915(b) Daggett, Duchesne, Uintah 4,467
UT Select Access PCCM Fee-For-Service 1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 65,431
UT Southwest Behavioral Health Services Mental Health PIHP
Risk-based Capitation
1915(b) Beaver, Garfield, Iron, Kane, Washington 20,317
UT Valley Mental Health Mental Health PIHP
Risk-based Capitation
1915(b) Salt Lake, Summit, Tooele 93,183
UT Wasatch Mental Health Mental Health PIHP
Risk-based Capitation
1915(b) Utah County 38,255
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Page 68
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
UT Weber Human Services Mental Health PIHP
Risk-based Capitation
1915(b) Morgan, Weber 21,715
VA AllCare for Seniors PACE Risk-based Capitation
PACE Buchanan, Dickerson, Russell, Tazewell 33
VA Amerigroup Community Care Medicaid MCO Risk-based Capitation
1915(b) Alexandria City, Arlington County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Loudoun County, Manassas City, Manassas Park City, Prince William County
35,322
VA Anthem Healthkeepers Plus Commercial MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Alexandria City, Amelia County, Arlington County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Franklin City, Frederick County, Fredericksburg City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas City, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Richmond City, Richmond County, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Westmoreland County, Williamsburg City, Winchester City, York County
190,853
VA Centra Health PACE Risk-based Capitation
PACE Amherst, Bedford, Campbell, Forest, Lynchburg 59
VA LogistiCare Solutions Transp PAHP Risk-based Capitation
1902(a)(70) Statewide 523,654
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 69 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
VA MEDALLION PCCM Fee-For-Service 1915(b) Alleghany County, Bath County, Bland County, Bristol City, 55,837 Buchanan County, Carroll County, Covington City, Craig County, Dickenson County, Galax, Grayson County, Highland County, Lee County, Norton, Russell, Scott County, Smyth County, Tazewell County, Washington County, Wise County
VA Mountain Empire PACE Risk-based PACE Lee, Norton, Scott, Wise 65 Capitation
VA Optima Family Care Commercial MCO Risk-based 1915(b) Accomack County, Albemarle County, Amelia County, 136,755 Capitation Amherst County, Appomattox County, Augusta County,
Brunswick County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Danville City, Dinwiddie County, Emporia City, Essex County, Fluvanna County, Franklin City, Frederick County, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Rappahannock County, Richmond City, Richmond County, Rockingham County, Shenandoah County, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Williamsburg City, Winchester City, York County
VA Riverside Peninsula PACE Risk-based PACE Hampton, Newport News, Poquoson, Southeastern portion of 270 Capitation York County
VA Sentara Senior Community Care PACE Risk-based Capitation
PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 142
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 70 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
VA Southern Health CareNet Commercial MCO Risk-based 1915(b) Albemarle County, Amelia County, Amherst County, 22,533 Capitation Appomattox County, Augusta County, Buckingham County,
Campbell County, Caroline County, Charles City County, Charlottesville, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Fluvanna County, Goochland County, Greene County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Lynchburg, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Northumberland County, Nottoway County, Orange County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Staunton, Surry County, Sussex County, Waynesboro, Westmoreland County
VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation
1915(b) Accomack County, Albemarle County, Amelia County, Appomattox County, Augusta County, Bedford City, Bedford
138,191
County, Botetourt County, Brunswick County, Buckingham County, Buena Vista City, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Culpeper County, Cumberland County, Danville, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Nottoway County, Orange County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Rappahannock County, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Shenandoah County, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Winchester City, Wythe County
VT Global Committment to Health Medicaid MCO Risk-based 1115 Statewide 100,251 Capitation
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 71 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
VT Vermont PACE PACE Risk-based Capitation
PACE Chittenden County, Lower Grand Isle County, Rutland County 108
WA Asuris Northwest Health Commercial MCO Risk-based Capitation
1932(a) Spokane County 2,321
WA City of Seattle Human Services Disease Management
PAHP
Risk-based Capitation
1932(a) King 8,342
WA Columbia United Providers Commercial MCO Risk-based Capitation
1932(a) Clark 43,254
WA Community Health Plan Commercial MCO Risk-based Capitation
1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oriellle, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima
212,298
WA Group Health Cooperative Commercial MCO Risk-based Capitation
1932(a) King, Kitsap, Pierce, Snohomish, Spokane, Thurston 22,823
WA Kaiser Foundation Health Plan Commercial MCO Risk-based Capitation
1932(a) Clark, Cowlitz 715
WA Molina Healthcare Commercial MCO Risk-based Capitation
1932(a) Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima
329,866
WA Molina Healthcare (WMIP) Commercial MCO Risk-based Capitation
1932(a) Snohomish 3,924
WA OptumHealth MH/SUD PIHP Risk-based Capitation
1915(b) Pierce County 32,021
WA PCCM Tribal Clinics PCCM Fee-For-Service 1932(a) Statewide 6,381
WA Providence ElderPlace - Seattle PACE Risk-based Capitation
PACE King 364
WA Regence Blue Shield Commercial MCO Risk-based Capitation
1932(a) Clallam, Grays Harbor, Island, Pacific, Pierce, San Juan, Skagit, Snohomish, Yakima
38,958
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 72 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
WA Regional Support Network Mental Health PIHP
Risk-based Capitation
1915(b) Statewide 940,232
WI Abri Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Brown, Dodge, Green Lake, Jefferson, Kenosha, Kewaunee, Lincoln, Marathon, Marquette, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Shawano, Vilas, Washington, Waukesha, Waupaca, Waushara, Winnebago
16,388
WI Abri Health Plan -- SSI Commercial MCO Risk-based Capitation
1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago
1,714
WI Care Wisconsin First, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Columbia, Dodge, Green Lake, Jefferson, Marquette, Washington, Waukesha, Waushara
3,074
WI Care Wisconsin Health Plan, Inc. (Partnership)
Medicaid MCO Risk-based Capitation
1932(a)/1915(c) Dane County 1,165
WI Children's Community Health Plan - Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha
24,425
WI CHP-LTS, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Chippewa, Dunn, Eau Claire, Pierce, St. Croix 1,136
WI Community Care Health Plan, Inc. Commercial MCO Risk-based Capitation
1932(a)/1915(c) Milwaukee 362
WI Community Care of Central Wisconsin Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Marathon, Portage, Wood 2,694
WI Community Care Organization (PACE) PACE Risk-based Capitation
PACE Milwaukee 880
WI Community Care, Inc. Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha
6,385
WI Compcare -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Jackson, Juneau, La Crosse, Marquette, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn
31,106
WI Dane County Human Services Department -- CCF
MH/SUD PIHP Risk-based Capitation
1915(a) Dane 131
WI Dean Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Grant, Green, Iowa, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Sauk, Walworth, Waukesha
51,206
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 73 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
WI Group Health Cooperative Of Eau Claire -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, Lafayette, Lincoln, Marathon, Pepin, Pierce, Polk, Price, Rusk, Sauk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn
42,529
WI Group Health Cooperative of Eau Claire County SSI
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Jackson, La Crosse, Monroe, Trempealeau, Vernon 1,876
WI Group Health Cooperative Of South Central WI -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane, Monroe, Vernon 4,306
WI Gundersen Lutheran Health Plan Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Trempealeau, Vernon
17,281
WI Health Tradition Health Plan -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Buffalo, Crawford, Grant, La Crosse, Monroe, Trempealeau, Vernon
9,499
WI Independent Care (iCare) - Medicaid HMO Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha
4,409
WI Independent Care Health Plan -- SSI Medicaid MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha
8,907
WI Independent Care Health Plan (SNP) Medicaid MCO Risk-based Capitation
1932(a)/1915(c) Milwaukee 61
WI Lakeland Care District Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Fond du Lac 2,511
WI Managed Health Services -- Medicaid HMO
Medicaid MCO Risk-based Capitation
1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Green Lake, Jefferson, Kenosha, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
75,262
WI Managed Health Services -- SSI Medicaid MCO Risk-based Capitation
1932(a) Kensosha, Milwaukee, Racine, Waukesha 5,376
WI MercyCare Insurance Company -- Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane, Green, Jefferson, Rock, Walworth 15,946
WI Milwaukee County Department of Family Care
Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Milwaukee 7,484
WI Milwaukee County Human Services Department -- Wraparound Milwaukee
MH/SUD PIHP Risk-based Capitation
1915(a) Milwaukee 869
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 74 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
WI Network Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Forest, Green Lake, Jefferson, Kenosha, Langlade, Lincoln, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
49,677
WI Network Health Plan - SSI Commercial MCO Risk-based Capitation
1932(a) Kenosha, Milwaukee, Racine, Waukesha 2,670
WI Northern Bridges Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Ashland, Barron, Bayfield, Burnett, Douglas, Iron, Polk, Price, Rusk, Sawyer, Washburn
1,880
WI Partnership Health Plan, Inc. Commercial MCO Risk-based Capitation
1932(a)/1915(c) Chippewa, Dunn, Eau Claire 1,885
WI Physicians Plus Health Plan - Medicaid HMO
Commercial MCO Risk-based Capitation
1932(a) Dane 7,776
WI Security Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Polk, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Vilas, Washburn, Waupaca, Wood
54,766
WI Southwest Family Care Alliance Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Crawford, Green, Juneau, Lafayette, Richland, Sauk 1,732
WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Sawyer, Shawano, Sheboygan, St. Croix, Taylor, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood
230,591
WI UnitedHealthcare of WI -- SSI Commercial MCO Risk-based Capitation
1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Walworth, Washburn, Washington, Waukesha, Waupace, Waushara, Winnebago, Wood
9,870
WI Unity Health Insurance -- Medicaid HMO Commercial MCO Risk-based Capitation
1932(a) Columbia, Dane, Dodge, Green, Jefferson, Sauk 12,837
WI Western Wisconsin Cares Long Term Care PIHP
Risk-based Capitation
1915(b)/(c) Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, Vernon
3,293
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 75 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary July 1, 2010
State Plan Managed
Care Entity Reimbursement
Arrangement Operating Authority Geographic Area Served
Number of Enrollees
WV Carelink Health Plan Commercial MCO Risk-based Capitation
1915(b), 1937 Barbour, Boone, Braxton, Brooke, Cabell, Calhoun, Clay, Doddridge, Fayette, Gilmer, Hancock, Harrison, Jackson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, Mason, McDowell, Mercer, Mingo, Monongalia, Monroe, Nicholas, Ohio, Pleasants, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tyler, Wayne, Webster, Wetzel, Wirt, Wood, Wyoming
53,667
WV Health Plan of the Upper Ohio Valley Commercial MCO Risk-based Capitation
1915(b), 1937 Barbour, Brooke, calhoun, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler, Upshur, webster, Wetzel, Wirt, Wood
28,234
WV Physician Assured Access System PCCM Fee-For-Service 1915(b) Statewide 9,345
WV Unicare Health Plan of WV Commercial MCO Risk-based Capitation
1915(b), 1937 Barbour, Berkeley, Boone, Braxton, brooke, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hampshire, Hancock, Hardy, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pendleton, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming
81,230
TOTAL NUMBER OF ENROLLEES: 56,267,341
Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 07/01/2010 Page 76 * Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Recommended