063009 cms summary of state mcos
TRANSCRIPT
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8/8/2019 063009 Cms Summary of State MCOs
1/52
State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
Enrollees
AL Maternity Care Program Medical-onlyPIHP
Risk-basedCapitation
1915(b) Statewide 21,324
AL Partnership Hospital Program Medical-onlyPIHP
Risk-basedCapitation
1915(a) -1902(a)(4)
Statewide 518,769
AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 443,327
AR Connect Care PCCM Fee-For-Service 1115 Statewide 411,351
AR Non-Emergency Transportation Transp PAHP Risk-basedCapitation
1915(b) Statewide 451,863
AR Total Life Healthcare PACE Risk-basedCapitation
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
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AZ AZ Physicians IPA (Family PlanningExtension)
Medicaid MCO Risk-basedCapitation
1115 La Paz, Maricopa, Pima, Yuma 604
AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based
Capitation
1115 LaPaz, Maricopa, Pima, Yuma 220,485
AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-basedCapitation
1115 Yavapai 56
AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-basedCapitation
1115 LaPaz, Maricopa, Yuma 16,182
AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-basedCapitation
1115 Yavapai 2,405
AZ Care 1st Health Plan Medicaid MCO Risk-based
Capitation
1115 Maricopa 49,355
AZ Care 1st Health Plan (Family PlanningExtension)
Medicaid MCO Risk-basedCapitation
1115 Maricopa 208
AZ Cochise Co. Dept. of Health Services (PC) Medicaid MCO Risk-basedCapitation
1115 Cochise, Graham, Greenlee 938
AZ Department of EconomicSecurity/Childrens Medical and DentalProgram (Family Planning Extension)
Medicaid MCO Risk-basedCapitation
1115 Statewide 0
Page 23Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
Enrollees
AZ Department of EconomicSecurity/Childrens Medical and DentalProgram (HP)
Medicaid MCO Risk-basedCapitation
1115 Statewide 9,533
AZ Department of EconomicSecurity/Division of DevelopmentalDisabilities (PC)
Medicaid MCO Risk-basedCapitation
1115 Statewide 21,753
AZ Department of Health Services(Behavioral Health)
MH/SUD PIHP Risk-basedCapitation
1115 Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz,Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz,
Yavapai, Yuma
104,101
AZ Evercare Select (PC) Medicaid MCO Risk-basedCapitation
1115 Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Yuma 3,647
AZ Health Choice Arizona (Family PlanningExtension)
Medicaid MCO Risk-basedCapitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima,Santa Cruz, Yuma
791
AZ Health Choice Arizona (HP) Medicaid MCO Risk-basedCapitation
1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima,Santa Cruz, Yuma
177,142
AZ Maricopa County Health Plan (FamilyPlanning Extension)
Medicaid MCO Risk-basedCapitation
1115 Maricopa 109
AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-basedCapitation
1115 Maricopa 51,234
AZ Mercy Care Plan (Family PlanningExtension)
Medicaid MCO Risk-basedCapitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 994
AZ Mercy Care Plan (HP) Medicaid MCO Risk-basedCapitation
1115 Cochise, Graham, Greenlee, Maricopa, Pima 283,456
AZ Mercy Care Plan (PC) Medicaid MCO Risk-basedCapitation
1115 Maricopa 8,388
AZ Phoenix Health Plan/CommunityConnection (Family Planning Extension)
Medicaid MCO Risk-basedCapitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima,Pinal, Yavapai
710
AZ Phoenix Health Plan/CommunityConnection (HP)
Medicaid MCO Risk-basedCapitation
1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima,Pinal, Yavapai
174,038
AZ Pima Health System (Family PlanningExtension)
Medicaid MCO Risk-basedCapitation
1115 Pima 12
AZ Pima Health System (HP) Medicaid MCO Risk-basedCapitation
1115 Pima 2,153
Page 24Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
Enrollees
AZ Pima Health System (PC) Medicaid MCO Risk-basedCapitation
1115 Pima, Santa Cruz 4,210
AZ Pinal County Long Term Care (PC) Medicaid MCO Risk-basedCapitation
1115 Gila, Pinal 1,433
AZ SCAN Medicaid MCO Risk-basedCapitation
1115 Maricopa 2,591
AZ University Family Care (Family Planning
Extension)
Medicaid MCO Risk-based
Capitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 159
AZ University Family Care (HP) Medicaid MCO Risk-basedCapitation
1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 62,763
AZ Yavapai County Long Term Care (PC) Medicaid MCO Risk-basedCapitation
1115 Yavapai 1,016
CA Access Dental Plan-LA Dental PAHP Risk-basedCapitation
1915(a) Los Angeles 104,353
CA Access Dental Plan-Sacramento Dental PAHP Risk-based
Capitation
1915(a) Sacramento 51,946
CA Alameda Alliance for Health Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Alameda 88,767
CA AltaMed Health Services Corporation PACE Risk-basedCapitation
PACE LA 622
CA American Health Guard-Dental Plan-LA Dental PAHP Risk-basedCapitation
1915(a) Los Angeles 16,938
CA Anthem Blue Cross Partnership Plan -Sacramento
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Sacramento 86,166
CA Anthem Blue Cross Partnership Plan-TPMP
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Alameda, Contra Costa, Fresno, San Francisco, SanJoaquin, Santa Calra, Stanislaus, Tulare
349,162
CA Caloptima-Orange HIO Risk-basedCapitation
1915(b) Orange 327,163
CA Care 1st Health Plan/San Diego Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Diego 9,126
CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-basedCapitation
1915(a) Los Angeles 17,632
Page 25Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
Enrollees
CA Central Coast Alliance For Health HIO Risk-basedCapitation
1915(b) Monterey, Santa Cruz 96,468
CA Coalition of Elders Independence dbaCenter for Elders Independence
PACE Risk-basedCapitation
PACE Alameda 413
CA Community Dental Services/Sacramento Dental PAHP Risk-basedCapitation
1915(b), 1932(a) Sacramento 12,805
CA Community Dental Services-LA Dental PAHP Risk-based
Capitation
1915(a) Los Angeles 4,889
CA Community Eldercare of San Diego dbaSt. Paul's PACE
PACE Risk-basedCapitation
PACE San Diego 77
CA Community Health Group PartnershipPlan-San Diego
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Diego 86,241
CA Contra Costa Health Plan Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Contra Costa 53,869
CA Health Net Community Solutions, Inc. -
Sacramento
Commercial MCO Risk-based
Capitation
1915(b), 1932(a) Sacramento 34,498
CA Health Net Community Solutions, Inc.-San Diego
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Diego 30,586
CA Health Net Community Solutions, Inc.-TPMP
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Fresno, Kern, LA, Stanislaus, Tulare 582,166
CA Health Net of CA-Dental-LA Dental PAHP Risk-basedCapitation
1915(a) Los Angeles 31,247
CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-basedCapitation
1915(a) Sacramento 12,078
CA Health Plan of San Joaquin Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Joaquin 67,793
CA Health Plan of San Mateo *MCO/COHS Risk-basedCapitation
1915(b) San Mateo 52,908
CA Inland Empire Health Plan Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Riverside, San Bernardino 344,595
CA Kern Family Health Care Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Kern 100,487
Page 26Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
Enrollees
CA KP Cal, LLC Commercial MCO Risk-basedCapitation
1915(a) Marin, Sonoma 2,328
CA KP Cal, LLC - Sacramento Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Sacramento 24,405
CA KP Cal, LLC-San Diego Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Diego 13,085
CA LA Care Health Plan Commercial MCO Risk-based
Capitation
1915(b), 1932(a) Los Angeles 763,736
CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-basedCapitation
1915(b), 1932(a) Sacramento 27,192
CA Liberty Dental Plan of CA-LA Dental PAHP Risk-basedCapitation
1915(b), 1932(a) LA 7,095
CA Molina Healthcare of California PartnerPlan, Inc. - Sacramento
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Sacramento 22,791
CA Molina Healthcare of California Partner
Plan, Inc. - San Diego
Commercial MCO Risk-based
Capitation
1915(b), 1932(a) San Diego 53,645
CA Molina Healthcare of California PartnerPlan, Inc.-TPMP
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Riverside, San Bernardino 89,952
CA On Lok Senior Health Services dba OnLok Lifeways
PACE Risk-basedCapitation
PACE San Francisco 995
CA Partnership Health Plan HIO Risk-basedCapitation
1915(b) Napa, Solano, Yolo 94,280
CA Positive Healthcare/AHF HealthcareCenters
Medicaid MCO Risk-basedCapitation
1915(a) Los Angeles 587
CA Safeguard Dental-LA Dental PAHP Risk-basedCapitation
1915(a) Los Angeles, Riverside, San Bernardino 21,801
CA San Francisco City & CO/Family Mosaic *Emotional andMental HealthSupport PIHP
Risk-basedCapitation
1915(a) San Francisco 157
CA San Francisco Health Plan Commercial MCO Risk-basedCapitation
1915(b), 1932(a) San Francisco 34,567
CA Santa Barbara San luis Obispo Regional
Health Authority
HIO Risk-based
Capitation
1915(b) Santa Barbara 83,751
Page 27Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
EnrolleesCA Santa Clara Family Health Plan Commercial MCO Risk-based
Capitation1915(b), 1932(a) Santa Clara 89,930
CA Senior Care Action Network (SCAN) Medicaid MCO Risk-basedCapitation
1915(a) LA, Riverside, San Barnardino 6,920
CA Sutter Health sacramento Sierra dbaSutter Senior Care
PACE Risk-basedCapitation
PACE Sacramento, Yolo 204
CA Western Dental Services-LA Dental PAHP Risk-based
Capitation
1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 55,845
CA Western Dental Services-Sacramento Dental PAHP Risk-basedCapitation
1915(b), 1932(a) Sacramento 83,840
CA Western Health Advantage CommunityHealth Plan-Sacramento
Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Sacramento 16,070
CO Access Behavioral Care Mental HealthPIHP
Risk-basedCapitation
1915(b) Denver 80,507
CO Behavioral Healthcare, Inc. Mental Health
PIHP
Risk-based
Capitation
1915(b) East Metro Denver 103,730
CO Colorado Access Medicaid MCO Risk-basedCapitation
1915(a) Adams, Arapahoe, Boulder, Broomfield, Denver 2,315
CO Colorado Health Partnerships Mental HealthPIHP
Risk-basedCapitation
1915(b) Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos, Costilla,Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont,Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson,Kiowa, La Plata, Lake, Las Animas, Mesa, Mineral, Moffat,Montezuma, Montrose, Otero, Ouray, Park, Pitkin, Prowers,Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan,San Miguel, Summit, Teller
157,160
CO Denver Health and Hospital Authority Medicaid MCO Risk-basedCapitation
1915(a) Adams, Arapahoe, Denver, Jefferson 41,932
CO Foothills Behavioral Health Partners Mental HealthPIHP
Risk-basedCapitation
1915(b) Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 50,500
CO Northeast Behavioral Health Partnership Mental HealthPIHP
Risk-basedCapitation
1915(b) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan,Morgan, Phillips, Sedgwick, Washington, Weld, Yuma
56,410
CO Primary Care Physician Program PCCM Fee-For-Service 1932(a) Statewide 22,426
CO Rocky Mountain Health Plan Authority Medical-onlyPIHP
Non-riskCapitation
1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 15,157
Page 28Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
EnrolleesCO Rocky Mountain PACE PACE Risk-based
CapitationPACE El Paso 37
CO Total Long Term Care PACE Risk-basedCapitation
PACE Adams, Arapahoe, Denver, Jefferson 1,263
CO VOANS PACE, Inc PACE Risk-basedCapitation
PACE Delta, Montrose 121
CT Aetna Better Health Commercial MCO Risk-based
Capitation
1915(b) Statewide 83,069
CT Americhoice by United HealthCare Medicaid MCO Risk-basedCapitation
1915(b) Statewide 39,163
CT Community Health Network of Connecticut Medicaid MCO Risk-basedCapitation
1915(b) Statewide 220,384
CT HUSKY Primary Care PCCM Fee-For-Service 1915(b) Greater Waterbury, Greater Windham 168
DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-basedCapitation
1932(a) Statewide 63,915
DC Health Right Incorporated Medicaid MCO Risk-basedCapitation
1932(a) Statewide 20,356
DC Health Services For Children with SpecialNeeds
Medical-onlyPIHP
Risk-basedCapitation
1915(a) Statewide 3,593
DC Medical Transportation Management Transp PAHP Non-riskCapitation
1902(a)(70) Statewide 50,174
DC Unison Health Plan of the Capital Area Medicaid MCO Risk-basedCapitation
1932(a) Statewide 12,368
DE Delaware Physicians Care, Inc Medicaid MCO Risk-basedCapitation
1115 Statewide 78,603
DE Diamond State Partners *Fee for ServiceModel
Fee-For-Service 1115 Statewide 8,487
DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-basedCapitation
1115 Statewide 38,999
FL Access Health Solutions Medical-onlyPAHP
Non-riskCapitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee,Indian River, Manatee, Martin, Nassau, Okeechobee,Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St.
Lucie, Volusia
57,539
Page 29Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
EnrolleesFL Access Health Solutions (Reform) Medical-only
PIHPFFS/Some Risk
Capitation1115 Baker, Broward, Clay, Duval, Nassau 51,260
FL Adult Day Health Care *Adult DayHealth Care
Facility
Fee-For-Service 1915(b)/(c) Lee, Palm Beach 37
FL AIDS Healthcare Foundation, Inc. DiseaseManagement
PAHP
Non-riskCapitation
1915(b) Statewide 6,015
FL Alternative Medicine Integration DiseaseManagement
PAHP
Non-riskCapitation
1915(b) Hillsborough, Pasco, Pinellas 428
FL Alzheimer's Waiver Service Provider *CommunityCare for the
Elderly Agencies
Fee-For-Service 1915(b)/(c) Broward, Dade, Palm Beach, Pinellas 310
FL American Eldercare Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Clay, Dade, Duval,Flagler, Hernando, Highlands, Hillsborough, Indian River,Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, PalmBeach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns,St. Lucie, Volusia
3,821
FL Amerigroup Commercial MCO Risk-basedCapitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lake, Lee,Manatee, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota,Seminole, Volusia
155,880
FL Amerigroup (NHD) Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval,Hernando, Hillsborough, Indian River, Lake, Lee, Manatee,Marion, Martin, Orange, Osceola, Palm Beach, Pasco,Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie,Volusia
2,301
FL Amerigroup (Reform) Commercial MCO Risk-basedCapitation
1115 Broward 22,262
FL Atlantic Dental, Inc. Dental PAHP Risk-basedCapitation
1915(b) Dade 175,971
FL Better Health (Reform) Medical-onlyPIHP
FFS w/Some RiskCapitation
1115 Broward County 4,410
FL Buena Vista Commercial MCO Risk-basedCapitation
1915(b) Broward, Dade, Gadsden, Hendry, Jefferson, Leon, Liberty,Madison, Wakulla
20,981
FL Caremark Disease
ManagementPAHP
Non-risk
Capitation
1915(b) Statewide 85
Page 30Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
EnrolleesFL Children's Medical Services (Reform) Medical-only
PIHPFFS/Some Risk
Capitation1115 Broward, Duval 5,484
FL Citrus (NHD) Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Alachua, Brevard, Broward, Citrus, Dade, Duval, Hernando,Hillsborough, Lake, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole,Volusia
1,226
FL Citrus Health Care Commercial MCO Risk-basedCapitation
1915(b) Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk,Seminole
27,039
FL Commission for the Transportation of theDisadvantaged
Transp PAHP Flat Rate per Ride 1915(b) Statewide 70,965
FL First Coast Advantage (Reform) Medical-onlyPIHP
FFS/Some RiskCapitation
1115 Duval 29,032
FL Florida Health Partners, Inc. Mental HealthPIHP
Risk-basedCapitation
1915(b) Hillsborough, Lee, Osceola, Pasco 188,934
FL Florida PACE Centers PACE Risk-basedCapitation
PACE 33125, 33127, 33128, 33129, 33130, 33131, 33132, 33135,33136, 33137, 33138, 33139, 33140, 33141, 33142, 33147,33150, 33154, 33161, 33167, 33168, 33181
231
FL Freedom Health Plan Commercial MCO Risk-basedCapitation
1915(b) Dade, Palm Beach 2,191
FL Freedom Health Plan (Reform) Commercial MCO Risk-basedCapitation
1115 Broward 1,022
FL HealthEase Medicaid MCO Risk-basedCapitation
1915(b) Brevard, Broward, Calhoun, Citrus, Dade, Duval, Escambia,Gadsden, Highlands, Hillsborough, Jefferson, Lake, Leon,Liberty, Madison, Manatee, Marion, Martin, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa,Sarasota, Seminole, Volusia, Wakulla
179,142
FL HealthEase (Reform) Commercial MCO Risk-basedCapitation
1115 Duval 23,508
FL HealthierFlorida (Pfizer Health Solutions,Inc.)
DiseaseManagement
PAHP
Non-riskCapitation
1915(b) Statewide 10,171
FL Healthy Palm Beaches Medicaid MCO Risk-basedCapitation
1915(b) Palm Beach 7,833
FL Hemophilia of the Sunshine State Disease
ManagementPAHP
Non-risk
Capitation
1915(b) Statewide 130
Page 31Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area Served
Number of
EnrolleesFL Hope Life Care Long Term Care
PIHPRisk-basedCapitation
1915(a)/(c) Charlotte, Collier, Hendry, Lee 203
FL Hope Select Care PACE Risk-basedCapitation
PACE Lee 98
FL Humana Family Commercial MCO Risk-basedCapitation
1915(b) Broward, Dade, Palm Beach 36,703
FL Humana Family (Reform) Commercial MCO Risk-based
Capitation
1115 Broward 15,063
FL Humana Medical Plan Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Broward, Dade, Duval, Flagler, Hillsborough, Manatee,Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas,Polk, Sarasota, Seminole, St. Johns, Volusia
605
FL Humana Senior's Choice Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard, Broward, Dade, Indian River, Martin, Okeechobee,Palm Beach, St. Lucie
303
FL JMH Health Plan Commercial MCO Risk-basedCapitation
1915(b) Dade 15,200
FL Lakeview Center, Inc. Mental HealthPIHP
Risk-basedCapitation
1915(b) Escambia 31,116
FL Little Havana Activities and NutritionCenters
Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Broward, Dade, Palm Beach 847
FL Magellan Behavioral Health of Florida Mental HealthPIHP
Risk-basedCapitation
1915(b) Dade, Leon, Palm Beach, Volusia 213,091
FL Managed Care of North America Dental PAHP Risk-basedCapitation
1915(b) Dade 6,228
FL MediPass PCCM Fee-For-Service 1915(b) Statewide 455,877
FL Molina Health Care of Florida Medicaid MCO Risk-basedCapitation
1915(b) Broward (Reform), Dade, Hillsborough, Palm Beach, Pasco,Pinellas, Polk
23,731
FL Molina Health Care of Florida (Reform) Commercial MCO Risk-basedCapitation
1115 Broward County 5,023
FL Neighborly Care Network Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard, Broward, Citrus, Dade, Hernando, Hillsborough,Indian River, Manatee, Martin, Orange, Osceola, PalmBeach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie
522
Page 32Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
AuthorityGeographic Area Served
Number of
EnrolleesFL NetPass Medical-only
PAHPRisk-basedCapitation
1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee,Indian River, Manatee, Martin, Nassau, Okeechobee,Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St.Lucia, Volusia
13,568
FL NetPass (Reform) Medical-onlyPIHP
FFS/Some RiskCapitation
1115 Broward 8,002
FL North Florida Behavioral HealthPartnership
Mental HealthPIHP
Risk-basedCapitation
1915(b) Alachua 88,856
FL Preferred Medical Plan Commercial MCO Risk-basedCapitation
1915(b) Broward, Dade 14,512
FL Preferred Medical Plan (Reform) Commercial MCO Risk-basedCapitation
1115 Broward 2,735
FL Prestige Health Choice Medicaid MCO Risk-basedCapitation
1915(b) Dade, Hillsborough, Lee, Pinellas 16,327
FL Project Independence at Home Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Dade 105
FL Provider Service Network *Shared SavingsModel
FFS/Some RiskCapitation
1915(b) Dade 9,045
FL Public Health Trust of Dade County Mental HealthPIHP
Risk-basedCapitation
1915(b) Dade 47,332
FL South Florida Community Care Network(Reform)
Medical-onlyPIHP
FFS/Some RiskCapitation
1115 Broward 17,792
FL StayWell Commercial MCO Risk-basedCapitation
1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee,Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas,Polk, Sarasota, Seminole, St. Lucie, Sumter
178,605
FL Sunshine State Health Plan Medicaid MCO Risk-basedCapitation
1915(b) Dade, Hillbourough, Pasco, Pinellas 22,298
FL Total Health Choice Commercial MCO Risk-basedCapitation
1915(b) Broward, Dade 2,753
FL Total Health Choice (Reform) Commercial MCO Risk-basedCapitation
1115 Broward 18,819
FL United Evercare Commercial MCO Risk-basedCapitation
1915(b) Broward, Dade 2,126
Page 33Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
AuthorityGeographic Area Served
Number of
EnrolleesFL United Health Care Commercial MCO Risk-based
Capitation1915(b) Brevard, Broward, Citrus, Dade, Duval, Hernando, Highlands,
Hillsborough, Lake, Manatee, Marion, Osceola, Palm Beach,Pasco, Pinellas, Polk, Seminole, Volusia
80,591
FL United Health Care (NHD) Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Dade, Duval, Hernando,Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St.Johns, Volusia
2,198
FL United Health Care (Reform) Commercial MCO Risk-based
Capitation
1115 Baker, Clay, Duval, Nassau 10,815
FL United Home Care Services Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Dade 918
FL Universal Health Care Commercial MCO Risk-basedCapitation
1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon,Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota,Wakulla
23,127
FL Universal Health Care (NHD) Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard, Charlotte, Citrus, Clay, Collier, Dade, Hernando,Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole
682
FL Universal Health Care (Reform) Commercial MCO Risk-basedCapitation
1115 Broward, Duval 7,003
FL Urban Jacksonville Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Clay, Duval, St. Johns 96
FL Vista Health Plan of South Florida Commercial MCO Risk-basedCapitation
1915(b) Dade 18,945
FL Vista Independence Plan Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Broward, Dade, Palm Beach 1,233
FL YourCare Brevard Long Term CarePIHP
Risk-basedCapitation
1915(a)/(c) Brevard 62
GA Amerigroup Community Care Medicaid MCO Risk-basedCapitation
1932(a) Atlanta Region, East Region, North Region, Southeast Region 177,441
GA Georgia Better Health Care PCCM Fee-For-Service 1932(a) Statewide 108,619
GA Non-Emergency TransportationBrokerage Program
Transp PAHP Risk-basedCapitation
1902(a)(70) Statewide 1,274,823
GA Peach State Health Plan Medicaid MCO Risk-based
Capitation
1932(a) Atlanta Region, Central Region, Southwest Region 239,247
Page 34Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
AuthorityGeographic Area Served
Number of
EnrolleesGA WellCare Medicaid MCO Risk-based
Capitation1932(a) Atlanta Region, Central Region, East Region, North Region,
Southeast Region, Southwest Region421,656
HI Aloha Care Medicaid MCO Risk-basedCapitation
1115 Statewide 68,037
HI Evercare Commercial MCO Risk-basedCapitation
1115 Statewide 18,494
HI HMSA-Medical Commercial MCO Risk-based
Capitation
1115 Big Island, Kauai, Oahu 97,164
HI Kaiser Permanente Commercial MCO Risk-basedCapitation
1115 Maui, Oahu 22,223
HI Maui PACE PACE Risk-basedCapitation
PACE Maui 17
HI Ohana Commercial MCO Risk-basedCapitation
1115 Maui 22,239
IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-basedCapitation
1915(b) Statewide 329,897
IA Medipass PCCM Fee-For-Service 1932(a) Adair, Adams, Allamakee, Appanoose, Audubon, Benton,Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler,Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee,Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas,Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet,Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie,Hamilton, Hancock, Hardin, Harrison, Henry, Howard,Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones,Keokuk, Kossuth, Lee, Linn, Lucas, Lyon, Madison,Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe,
Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto,Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott,Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren,Warren, Wayne, Webster, Winnebago, Winneshiek,Woodbury, Worth, Wright
170,659
IA Siouxland PACE PACE Risk-basedCapitation
PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 55
ID Blue Cross of Idaho Dental PAHP Risk-basedCapitation
1937 Statewide 129,308
ID Healthy Connections PCCM Fee-for-Service 1937 Statewide 166,524
Page 35Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
ID Medicare-Medicaid Coordinated Plan Medical-onlyPAHP
Risk-basedCapitation
1937 Ada, Bannock, Benewah, Boise, Bonner, Bonneville,Boundary, Canyon, Caribou, Cassia, Gem, Jefferson,Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida,Owyhee, Payette, Power, Shoshone, Twin Falls, Washington
1,030
IL Family Health Network Medicaid MCO Risk-basedCapitation
1915(a) Cook 44,500
IL Harmony Health Plan Commercial MCO Risk-basedCapitation
1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair,Washington, Williamson
133,200
IL Illinois Health Connect PCCM Fee-For-Service 1932(a) Statewide 1,100,300
IL Meridian Health Plan Medicaid MCO Risk-basedCapitation
1915(a) Adams, Brown, Henry, Mercer, Pike, Rock Island, Scott 200
IN Advantage Health Solutions-Care Select PCCM Fee-For-Service 1915(b) Statewide 28,691
IN Anthem-Healthy Indiana Plan Commercial MCO Risk-basedCapitation
1115 Statewide 29,232
IN Anthem-Hoosier Healthwise Commercial MCO Risk-based
Capitation
1115, 1915(b) Statewide 148,426
IN Enhanced Services Plan (ESP)-HealthyIndiana Plan
*High Risk Plan Fee-For-Service 1115 Statewide 469
IN Managed Health Services (MHS)-HoosierHealthwise
Medicaid MCO Risk-basedCapitation
1115, 1915(b) Statewide 191,413
IN MDwise-Care Select PCCM Fee-For-Service 1915(b) Statewide 35,498
IN MDwise-Healthy Indiana Plan Commercial MCO Risk-basedCapitation
1115 Statewide 15,127
IN MDwise-Hoosier Healthwise Commercial MCO Risk-basedCapitation
1115, 1915(b) Statewide 262,780
KS Children's Mercy's Family Health Partners Medicaid MCO Risk-basedCapitation
1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 93,316
KS HealthConnect Kansas PCCM Fee-For-Service 1932(a) Statewide 24,050
KS Kansas Health Solutions Mental HealthPAHP
Non-riskCapitation
1915(b)/(c) Statewide 243,352
KS Midland Care Services PACE Risk-based
Capitation
PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie,
Shawnee, Wabaunsee
54
Page 36Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-basedCapitation
1932(a) Statewide 47,684
KS ValueOptions-Kansas Substance UseDisorders PIHP
Risk-basedCapitation
1915(b)/(c) Statewide 243,352
KS Via Christi Healthcare OutreachPrograms for Elders
PACE Risk-basedCapitation
PACE Sedgwick 173
KY Human Service Transportation Transp PAHP Risk-based
Capitation
1902(a)(70) Statewide 638,083
KY Kentucky Patient Access and Care(KenPAC)
PCCM Fee-For-Service 1932(a) Statewide 304,973
KY Passport Health Plan Medicaid MCO Risk-basedCapitation
1115 Jefferson County (Louisville) Kentucky and 15 surroundingcounties
159,005
LA Community Care PCCM Fee-For-Service 1932(a) Statewide 729,219
LA Greater New Orleans PACE Risk-basedCapitation
PACE 70001, 70002, 70003, 70005, 70006, 70032, 70043, 70053,70112, 70113, 70114, 70115, 70116, 70117, 70118, 70119,70121, 70122, 70124, 70125, 70126, 70127, 70128, 70129,
70130, 70131
119
MA Boston Medical Center HealthNet Plan Medicaid MCO Risk-basedCapitation
1115 Boston/Greater Boston Region, Central Region, SouthernRegion, Western Region
181,342
MA Elder Service Plan of Cambridge HealthAlliance
PACE Risk-basedCapitation
PACE Allston, Cambridge, Somerville 194
MA Elder Service Plan of East Boston PACE Risk-basedCapitation
PACE East Boston 297
MA Elder Service Plan of Harbor Health
Services, Inc.
PACE Risk-based
Capitation
PACE Greater Boston 293
MA Elder Service Plan of the North Shore, Inc. PACE Risk-basedCapitation
PACE Northeastern MA 652
MA Fallon Community Health Plan Commercial MCO Risk-basedCapitation
1115 Central Region 12,259
MA MA Behavioral Health Partnership MH/SUD PIHP Risk-basedCapitation
1115 Statewide 304,821
MA Neighborhood Health Plan Commercial MCO Risk-based
Capitation
1115 Boston/Greater Region, Central/Western Region,
Northeast/Southeast Region
135,287
Page 37Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
MA Network Health Medicaid MCO Risk-basedCapitation
1115 Boston/Greater Boston Region, Central/Western Region,Northeast/Southeast Region
107,286
MA Primary Care Clinician Plan PCCM Fee-For-Service 1115 Statewide 284,404
MA Summit Elder Care PACE Risk-basedCapitation
PACE Worchester 592
MA Uphams Elder Service Plan PACE Risk-basedCapitation
PACE Boston 150
MD AMERIGROUP - PAC Medical-onlyPAHP
Risk-basedCapitation
1115 Statewide except for Allegany and Washington Count 624
MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-basedCapitation
1115 Statewide except Allegany and Wahington Counties 182,360
MD Hopkins Elder Plus PACE Risk-basedCapitation
PACE 21052, 21202, 21205, 21206, 21213, 21214, 21218, 21219,21220, 21221, 21222, 21224, 21227, 21231, 21237
138
MD JAI Medical System Medicaid MCO Risk-basedCapitation
1115 Baltimore City, Baltimore County 11,012
MD JAI Medical Systems - PAC Medical-onlyPAHP
Risk-basedCapitation
1115 Baltimore City, Baltimore County 6,136
MD Maryland Physicians Care Medicaid MCO Risk-basedCapitation
1115 Statewide except Cecil County 100,608
MD Maryland Physicians Care - PAC Medical-onlyPAHP
Risk-basedCapitation
1115 Statewide 11,128
MD Medstar Family Choice Medicaid MCO Risk-basedCapitation
1115 Anne Arundel North, Baltimore City, Baltimore County,Harford
24,795
MD Priority Partners - PAC Medical-onlyPAHP
Risk-basedCapitation
1115 Statewide 3,640
MD Priority Partners MCO Medicaid MCO Risk-basedCapitation
1115 Statewide except North and East Baltimore County and CecilCounty
143,839
MD The Diamond Plan Medicaid MCO Risk-basedCapitation
1115 Baltimore City, Baltimore County, Cecil, Harford 7,870
MD United Health Care Medicaid MCO Risk-basedCapitation
1115 Statewide 119,056
Page 38Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
MD United HealthCare - PAC Medical-onlyPAHP
Risk-basedCapitation
1115 Statewide 8,818
ME MaineCare Primary Care CaseManagement
PCCM Fee-For-Service 1932(a) Statewide 178,353
MI Access Alliance of Michigan Mental HealthPIHP
Risk-basedCapitation
1915(b) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 54,216
MI BlueCaid of Michigan Medicaid MCO Risk-basedCapitation
1915(b) Livingston, Washtenaw, Wayne 20,128
MI Care Resources PACE Capitation PACE Kent 154
MI CareSource of Michigan Medicaid MCO Risk-basedCapitation
1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Benzie, Berrien,Calhoun, Cass, Charlevoix, Cheboygan, Crawford, Genesee,Gladwin, Grand Traverse, Ionia, Iosco, Kalamazoo, Kalkaska,Kent, Lake, Leelanau, Manistee, Mason, Mecosta,Missaukee, Montmorency, Newaygo, Oceana, Ogemaw,Osceola, Oscoda, Ottawa, Presque Isle, Roscommon,Saginaw, St. Joseph, Van Buren
48,143
MI CMH Affiliation of Mid-Michigan Mental HealthPIHP
Risk-basedCapitation
1915(b) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee,Newago
84,957
MI CMH for Central Michigan Mental HealthPIHP
Risk-basedCapitation
1915(b) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 39,138
MI CMHSA Network of West Michigan Mental HealthPIHP
Risk-basedCapitation
1915(b) Kent 88,718
MI Comprehensive Senior Care Corporation PACE Risk-basedCapitation
PACE Calhoun 18
MI Detroit-Wayne County CMH Agency Mental Health
PIHP
Risk-based
Capitation
1915(b) Wayne 400,370
MI Genesee County CMH Services Mental HealthPIHP
Risk-basedCapitation
1915(b) Genesee 84,805
MI Great Lakes Health Plan Medicaid MCO Risk-basedCapitation
1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron,Jackson, Kalamazoo, Lenawee, Livingston, Macomb,Oakland, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola,Van Buren, Wayne
193,811
Page 39Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
MI Molina Healthcare of Michigan Medicaid MCO Risk-basedCapitation
1915(b) Alcona, Allegan, Arenac, Bay, Benzie, Clare, Crawford,Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Isabella,Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland,Missaukee, Monroe, Montcalm, Montmorency, Muskegon,Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda,Otsego, Ottawa, Presque Isle, Roscommon, Saginaw,Sanilac, St. Clair, Tuscola, Wayne, Wexford
205,469
MI Northcare Mental HealthPIHP
Risk-basedCapitation
1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic,Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette,
Menominee, Ontonagon, Schoolcraft
41,636
MI Northern Affiliation Mental HealthPIHP
Risk-basedCapitation
1915(b) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet,Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego,Presque Isle
43,437
MI Northern Lakes CMH Authority Mental HealthPIHP
Risk-basedCapitation
1915(b) Crawford, Grand Traverse, Lake, Leelanau, Mason,Missaukee, Oceana, Roscommon, Wexford
40,434
MI Oakland County CMH Authority Mental HealthPIHP
Risk-basedCapitation
1915(b) Oakland 95,564
MI Omnicare Health Plan Medicaid MCO Risk-basedCapitation
1915(b) Oakland, Wayne 54,184
MI Physicians Health Plan of Mid-Michigan -Family Care
Medicaid MCO Risk-basedCapitation
1915(b) Ingham, Ionia, Montcalm, Shiawassee 17,843
MI Priority Health Government Programs, Inc. Medicaid MCO Risk-basedCapitation
1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm,Muskegon, Oceana, Osceola, Ottawa
59,560
MI ProCare Health Plan Medicaid MCO Risk-basedCapitation
1915(b) Wayne 1,113
MI Saginaw County CMH Authority Mental Health
PIHP
Risk-based
Capitation
1915(b) Saginaw 38,276
MI Southeast Partnership Mental HealthPIHP
Risk-basedCapitation
1915(b) Lenawee, Livingston, Monroe, Washtenaw 67,544
MI Southwest Alliance Mental HealthPIHP
Risk-basedCapitation
1915(b) Allegan, Cass, Kalamazoo, St. Joseph 67,132
MI Thumb Mental Health Alliance Mental HealthPIHP
Risk-basedCapitation
1915(b) Lapeer, Sanilac, St. Clair 41,820
MI Total Health Care Medicaid MCO Risk-based
Capitation
1915(b) Genesee, Macomb, Oakland, Wayne 53,576
Page 41Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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Medicaid Managed Care Program Summary
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
MO Missouri Care Medicaid MCO Risk-basedCapitation
1915(b) Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole,Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries,Marion, Miller, Moniteau, Monroe, Montgomery, Morgan,Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline,Shelby
40,763
MO Molina Healthcare of Missouri Medicaid MCO Risk-basedCapitation
1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass,Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade,Henry, Howard, Jackson, Jefferson, Johnson, Laclede,Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion,
Miller, Moniteau, Monroe, Montgomery, Morgan, Osage,Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls,Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St.Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon,Warren, Washington
77,507
MS LogistiCare Soultions, LLC Transp PAHP Risk-basedCapitation
1902(a)(70) Statewide 512,796
MT Billings Clinic PACE Risk-basedCapitation
PACE 59002, 59006, 59015, 59024, 59037, 59044, 59047, 59064,59079, 59088, 59101, 59102, 59105, 59106
24
MT McKesson Health Solutions DiseaseManagement
PAHP
Risk-basedCapitation
1915(b) Statewide 368
MT Passport to Health PCCM Fee-For-Service 1915(b) Statewide 371
NC Carolina Access PCCM Fee-For-Service 1932(a) Statewide 77,803
NC Community Care of North Carolina(Access II/III)
PCCM Fee-For-Service 1932(a) Statewide 921,106
NC Elderhaus PACE Risk-basedCapitation
PACE Brunswick, New Hanover 26
NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-basedCapitation
1915(b)/(c) Rowan, Stanly, Davidson, Union and Cabarrus Counties 72,734
NC Piedmont SeniorCare PACE Risk-basedCapitation
PACE Caswell, Yancy 24
ND ExperienceHealth ND DiseaseManagement
PAHP
Risk-basedCapitation
1915(b) Statewide 2,427
ND Northland PACE PACE Risk-basedCapitation
PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602,58652, 58655, 58656
25
Page 44Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
ND Primary Care Case Management PCCM Fee-For-Service 1932(a) Statewide 29,339
NE Magellan Behavioral Health *SpecialtyPhysician CaseManagement
(SPCM) Program
Fee-For-Service 1915(b) Statewide 179,512
NE Primary Care Plus PCCM Fee-For-Service 1915(b), 1932(a) Douglas, Lancaster, Sarpy 38,623
NE Share Advantage Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Douglas, Lancaster, Sarpy 36,119
NH McKesson Health Solutions DiseaseManagement
PAHP
Risk-basedCapitation
1915(b) Statewide 96,553
NJ AmeriChoice of New Jersey, Inc. Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Statewide 222,083
NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-basedCapitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May,Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer,Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset,Sussex, Union, Warren
90,055
NJ Health Net of New Jersey, Inc. Medicaid MCO Risk-basedCapitation
1915(b), 1932(a) Bergen, Burlington, Camden, Cumberland, Essex,Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris,Ocean, Passaic, Salem, Somerset, Union
41,914
NJ Horizon NJ Health Medicaid MCO Risk-basedCapitation
1915(b), 1932(a) Statewide 324,911
NJ Life at Loudes PACE Risk-basedCapitation
PACE 08002, 08003, 08004, 08007, 08009, 08012, 08021, 08026,08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045,08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095,08099, 08101, 08102, 08103, 08104, 08105, 08106, 08107,
08108, 08109, 08110
14
NJ Life St. Francis PACE Risk-basedCapitation
PACE 08505, 08518, 08554 17
NJ University Health Plans, Inc. Commercial MCO Risk-basedCapitation
1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cumberland, Essex,Gloucester, Hudson, Hunterdon, Mercer, Middlesex,Monmouth, Morris, Ocean, Passaic, Salem, Somerset,Sussex, Union, Warren
46,651
NM AMERIGROUP Community Care of NewMexico, Inc.
Commercial MCO Risk-basedCapitation
1915(b)/(c) Statewide 19,080
Page 45Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
Medicaid Managed Care Program Summary
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State Plan
June 30, 2009
Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
NM Blue Cross Blue Shield of New Mexico Commercial MCO Risk-basedCapitation
1915(b) Statewide 9,560
NM Evercare of New Mexico Commercial MCO Risk-basedCapitation
1915(b)/(c) Statewide 17,891
NM Lovelace Community Health Plan Commercial MCO Risk-basedCapitation
1915(b) Statewide 80,679
NM Molina Healthcare of New Mexico Medicaid MCO Risk-basedCapitation
1915(b) Statewide 69,035
NM Presbyterian Health Plan Commercial MCO Risk-basedCapitation
1915(b) Statewide 148,732
NM Total Community Care (PACE) PACE Risk-basedCapitation
PACE Bernalillo County, Sandoval County, Valencia County 376
NM ValueOptions of New Mexico Mental HealthPIHP
Risk-basedCapitation
1915(b) Statewide 312,498
NV Amerigroup Community Care Medicaid MCO Risk-basedCapitation
1932(a) Statewide 46,921
NV Health Plan of Nevada Commercial MCO Risk-basedCapitation
1932(a) Clark, Washoe 59,381
NV Logisticare Transp PAHP Risk-basedCapitation
1932(a) Statewide 178,711
NY Affinity Health Plan Medicaid MCO Risk-basedCapitation
1115 Bronx, Kings, Nassau, New York, Orange, Queens,Richmond, Rockland, Suffolk, Westchester
204,166
NY Affinity/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 81
NY Amerigroup Medicaid MCO Risk-basedCapitation
1115 New York City, Putnam 98,618
NY Amerigroup Community Connections Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 585
NY Broome County MC PCCM Fee-For-Service 1115 Broome 3,366
NY Capital District Physicians Health Plan Commercial MCO Risk-basedCapitation
1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery,Rensselaer, Saratoga, Schenectady, Schoharie, Tioga,Washington
53,410
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
NY CCM Select Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 1,254
NY Comprehensive Care Management (CCM) PACE Risk-basedCapitation
PACE New York City, Westchester 2,488
NY Eddy Senior Care PACE Risk-basedCapitation
PACE Albany, Schenectady 113
NY Excellus Commercial MCO Risk-basedCapitation
1115 Broome, Chemung, Clinton, Essex, Franklin, Herkimer,Livingston, Madison, Monroe, Oneida, Onondaga, Ontario,
Orleans, Oswego, Otsego, Seneca, St Lawrence, Wayne,Yates
105,454
NY GHI *PPO Risk-basedCapitation
1115 Statewide 6,148
NY GHI HMO Select Commercial MCO Risk-basedCapitation
1115 Albany, Bronx, Broome, Columbia, Delaware, Dutchess,Greene, Kings, Manhattan, Montgomery, Orange, Otsego,Putnam, Rensselaer, Richmond, Rockland, Saratoga,Schenectady, Sullivan, Ulster, Warren, Washington,Westchester
36,547
NY GHI/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 940
NY Guildnet Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 6,522
NY GuildNet/Medicaid Advantage Plus Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 162
NY Health Advantage/Elant Choice Long Term CarePIHP
Risk-basedCapitation
1915(a) Orange 136
NY Health First Medicaid MCO Risk-basedCapitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk 381,548
NY Health Now Commercial MCO Risk-basedCapitation
1115 Albany, Allegany, Cattauragus, Chautauqua, Clinton,Columbia, Erie, Essex, Fulton, Genesee, Greene,Montgomery, Niagara, Orleans, Rensselaer, Saratoga,Schenectady, Warren, Washington, Wyoming
39,462
NY Health Now/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 166
NY HealthPlus Medicaid MCO Risk-based
Capitation
1115 Bronx, Kings, New York, Queens, Richmond 258,988
Page 47Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Medicaid Managed Care Program Summary
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
NY HHH Choices Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 754
NY HIP Combined Commercial MCO Risk-basedCapitation
1115 Bronx, Kings, Nassau, New York, Queens, Richmond,Suffolk, Westchester
255,511
NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 1,950
NY HomeFirst Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 3,236
NY Hudson Health Plan Medicaid MCO Risk-basedCapitation
1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 64,812
NY Independent Care Systems Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 1,369
NY Independent Health/Hudson Valley&WNY Commercial MCO Risk-basedCapitation
1115 Erie, Niagara 31,030
NY Independent Living For Seniors PACE Risk-basedCapitation
PACE Monroe 253
NY Liberty Health Advantage/MedicaidAdvantage
Commercial MCO Risk-basedCapitation
1115 Statewide 703
NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 51
NY MetroPlus Health Plan Medicaid MCO Risk-basedCapitation
1115 Bronx, Kings, New York, Queens 339,331
NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-basedCapitation
1115 Bronx, Brooklyn, Manhattan, Queens 2,962
NY MetroPlus/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 8
NY MVP Health Plan Commercial MCO Risk-basedCapitation
1115 Dutchess, Ulster 32,276
NY Neighborhood Health Provider/MedicaidAdvantage
Commercial MCO Risk-basedCapitation
1115 Statewide 195
NY Neighborhood Health Providers Medicaid MCO Risk-basedCapitation
1115 Bronx, Kings, New York, Queens, Richmond 199,517
Page 48Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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June 30, 2009
g g y
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
NY NYPS Select Health Special Needs Medicaid MCO Risk-basedCapitation
1115 Statewide 1,334
NY NYS Catholic Health Plan 1199 Commercial MCO Risk-basedCapitation
1115 Statewide 4,219
NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-basedCapitation
1115 Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton,Columbia, Cortland, Dutchess, Erie, Essex, Greene,Hamilton, Herkimer, Kings, Nassau, New York, Niagara,Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer,Richmond, Rockland, Saratoga, Schenectady, Suffolk,Warren, Washington, Westchester
393,919
NY NYS Catholic HealthPlan/Fidelis/Medicaid Advantage
Commercial MCO Risk-basedCapitation
1115 Statewide 240
NY PACE CNY PACE Risk-basedCapitation
PACE Onondaga 340
NY Partners In Community Care Long Term CarePIHP
Risk-basedCapitation
1915(a) Orange, Rockland 270
NY Physician Case Management Program PCCM Risk-based
Capitation
1115 Erie 4,947
NY SCHC TotalCare Medicaid MCO Risk-basedCapitation
1115 Onondaga, Oswego, Tompkins 31,284
NY Senior Health Partners Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 1,599
NY Senior Network Health Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 378
NY Senior Whole Health Medicaid Advantage
Plus
Long Term Care
PIHP
Risk-based
Capitation
1915(a) Statewide 135
NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 599
NY Southern Tier Pediatrics PCCM Risk-basedCapitation
1115 Chemung, Steuben 4,050
NY Southern Tier Priority PCCM Risk-basedCapitation
1115 Chemung, Schuyler, Steuben 4,276
NY Total Aging in Place Long Term Care
PIHP
Risk-based
Capitation
1915(a) Erie 147
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
NY Total Senior Care PACE Risk-basedCapitation
PACE Cattaraugus 16
NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-basedCapitation
1115 Statewide 551
NY United Healthcare Commercial MCO Risk-basedCapitation
1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 209,812
NY Univera Community Health Medicaid MCO Risk-basedCapitation
1115 Allegany, Cattaraugus, Chautauqua, Erie 36,123
NY VidaCare Inc. Special Needs Medicaid MCO Risk-basedCapitation
1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 1,374
NY VNS Choice Long Term CarePIHP
Risk-basedCapitation
1915(a) New York City 7,375
NY VNS Choice Plus/Medicaid AdvantagePlus
Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 21
NY Wellcare Commercial MCO Risk-basedCapitation
1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, NewYork, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster
89,419
NY WellCare Advantage Plus/MedicaidAdvantage Plus
Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 127
NY WellCare Advocate Long Term CarePIHP
Risk-basedCapitation
1915(a) Statewide 283
OH Amerigroup Ohio Medicaid MCO Risk-basedCapitation
1932(a) Southwest, West Central 59,762
OH Buckeye Community Health Plan Medicaid MCO Risk-basedCapitation
1932(a) East Central, Northeast, Northwest, Southwest 140,296
OH CareSource Medicaid MCO Risk-basedCapitation
1932(a) Central, East Central, Northeast, Northeast Central,Northwest, Southeast, Southwest, West Central
689,818
OH Concordia Care PACE Risk-basedCapitation
PACE Cuyahoga 238
OH Molina Healthcare of Ohio Medicaid MCO Risk-basedCapitation
1932(a) Central, Southeast, Southwest, West Central 201,551
OH Paramount Advantage Medicaid MCO Risk-basedCapitation
1932(a) Northwest 76,841
Page 50Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
OH TriHealth Senior Link PACE Risk-basedCapitation
PACE Butler, Clermont, Hamilton, Warren 454
OH Unison Health Plan of Ohio Medicaid MCO Risk-basedCapitation
1932(a) East Central, Northeast Central, Southeast 108,213
OH WellCare of Ohio Medicaid MCO Risk-basedCapitation
1932(a) Northeast 97,347
OK Cherokee Elder Care PACE Risk-basedCapitation
PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434,74441, 74451, 74452, 74464, 74471
49
OK SoonerCare American Indian PCCM PCCM Fee-For-Service 1115 Statewide 11,831
OK SoonerCare PCCM PCCM Fee-For-Service 1115 Statewide 400,642
OK SoonerRide Transp PAHP Risk-basedCapitation
1902(a)(70) Statewide 553,385
OR Accountable Behavioral Health Mental HealthPIHP
Risk-basedCapitation
1115 Benton, Crook, Deschutes, Jefferson, Lincoln 30,076
OR Capitol Dental Care Inc. Dental PAHP Risk-based
Capitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River,
Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion,Morrow, Multnomah, Polk, Umatilla, Union, Wasco,Washington, Yamhill
131,921
OR Care Oregon Medicaid MCO Risk-basedCapitation
1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson,Klamath, Marion, Morrow, Multnomah, Polk, Umatilla,Washington, Yamhill
114,606
OR Cascade Comprehensive Care Medicaid MCO Risk-basedCapitation
1115 Klamath 6,678
OR Central Oregon Independent Health
Solutions
Medicaid MCO Risk-based
Capitation
1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson,
Klamath, Lake, Sherman, Wasco, Wheeler
22,859
OR Clackamas County Mental Health Mental HealthPIHP
Risk-basedCapitation
1115 Clackamas, Gilliam, Hood River, Marion, Sherman, Wasco 27,427
OR Deschutes County CDO Substance UseDisorders PAHP
Risk-basedCapitation
1115 Deschutes 15,615
OR Doctors of the Oregon Coast South Medicaid MCO Risk-basedCapitation
1115 Coos 8,444
OR Douglas County IPA Commercial MCO Risk-based
Capitation
1115 Douglas 12,369
Page 51Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
OR FamilyCare (Mental Health) Mental HealthPIHP
Risk-basedCapitation
1115 Clackamas, Multnomah, Washington 12,727
OR FamilyCare Health Plans Commercial MCO Risk-basedCapitation
1115 Clackamas, Jackson, Josephine, Morrow, Multnomah,Umatilla, Washington
23,132
OR Greater Oregon Behavioral Health, Inc. Mental HealthPIHP
Risk-basedCapitation
1115 Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur,Morrow, Umatilla, Union, Wallowa, Wheeler
46,127
OR Hayden Family Dentistry Dental PAHP Risk-basedCapitation
1115 Benton, Clackamas, Coos, Crook, Deschutes, Douglas,Gilliam, Grant, Harney, Jackson, Jefferson, Klamath, Lake,
Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk,Sherman, Umatilla, Wasco, Wheeler
60,900
OR Inter-Community Health Network Medicaid MCO Risk-basedCapitation
1115 Benton, Linn 17,999
OR Jefferson Behavioral Health Mental HealthPIHP
Risk-basedCapitation
1115 Coos, Curry, Douglas, Jackson, Josephine, Klamath 55,904
OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-basedCapitation
1115 Clackamas, Marion, Multnomah, Polk 6,355
OR Lane Care MHO Mental HealthPIHP
Risk-basedCapitation
1115 Lane 38,210
OR Lane Individual Practice Association Medicaid MCO Risk-basedCapitation
1115 Benton, Lane, Linn 31,541
OR Managed Dental Care of Oregon Dental PAHP Risk-basedCapitation
1115 Benton, Clackamas, Clatsop, Columbia, Hood River,Jackson, Josephine, Linn, Marion, Multnomah, Polk,Tillamook, Washington, Yamhill
10,509
OR Marion Polk Community Health Plan Medicaid MCO Risk-basedCapitation
1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 45,642
OR Mid Valley Behavioral Care Network Mental HealthPIHP
Risk-basedCapitation
1115 Linn, Marion, Polk, Tillamook, Yamhill 79,755
OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-basedCapitation
1115 Douglas, Jackson, Josephine 12,880
OR Multicare Dental Dental PAHP Risk-basedCapitation
1115 Clackamas, Multnomah, Washington 28,057
OR Multnomah County Verity Mental HealthPIHP
Risk-basedCapitation
1115 Multnomah 74,430
Page 52Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
PA County of Beaver - Value BehavioralHealth of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Beaver 19,792
PA County of Berks - Community CareBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Berks 48,242
PA County of Blair County - CommunityBehavioral Healthcare Network of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Blair 17,435
PA County of Bucks - Magellan BehavioralHealth
MH/SUD PIHP Risk-basedCapitation
1915(b) Bucks 35,983
PA County of Butler - Value BehavioralHealth of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Butler 13,462
PA County of Cambria - Value BehavioralHealth
MH/SUD PIHP Risk-basedCapitation
1915(b) Cambria 17,308
PA County of Chester - Community CareBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Chester 24,311
PA County of Cumberland - CommunityBehavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-basedCapitation
1915(b) Cumberland 13,100
PA County of Dauphin - CommunityBehavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-basedCapitation
1915(b) Dauphin 30,360
PA County of Delaware - MagellanBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Delaware 56,058
PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-basedCapitation
1915(b) Erie 39,483
PA County of Fayette - Value BehavioralHealth of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Fayette 24,132
PA County of Lancaster - CommunityBehavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-basedCapitation
1915(b) Lancaster 44,157
PA County of Lawrence - Value BehavioralHealth of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Lawrence 12,361
PA County of Lebanon - CommunityBehavioral Healthcare Network of PA, Inc.
MH/SUD PIHP Risk-basedCapitation
1915(b) Lebanon 12,248
PA County of Lehigh - Magellan BehavioralHealth
MH/SUD PIHP Risk-basedCapitation
1915(b) Lehigh 41,315
Page 55Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
PA County of Montgomery - MagellanBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Montgomery 47,007
PA County of Northampton - MagellanBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Northampton 25,482
PA County of Perry - Community BehavioralHealthcare Network of PA, Inc.
MH/SUD PIHP Risk-basedCapitation
1915(b) Perry 3,517
PA County of Philadelphia - C ommunityBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) Philadelphia 353,115
PA County of Washington - Value BehavioralHealth of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Washington 20,798
PA County of Westmoreland - ValueBehavioral Health of PA
MH/SUD PIHP Risk-basedCapitation
1915(b) Westmoreland 35,123
PA County of York - Community CareBehavioral Health
MH/SUD PIHP Risk-basedCapitation
1915(b) York 37,574
PA Everyday LIFE PACE Risk-basedCapitation
PACE Lehigh, Northampton 5
PA Gateway Health Plan, Inc. Commercial MCO Risk-basedCapitation
1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler,Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster,Lawrence, Lebanon, Lehigh, Northampton, Perry,Washington, Westmoreland, York
192,419
PA Gateway Health Plan, Inc. -VOL Commercial MCO Risk-basedCapitation
1915(a) Blair, Cambria, Carbon, Clarion, Columbia, Erie, Franklin,Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour,Northumberland, Pike, Schuylkill, Somerset, Susquehanna,Wyoming
19,681
PA Health Partners of Philadelphia Commercial MCO Risk-based
Capitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 124,518
PA Keystone Mercy Health Plan Commercial MCO Risk-basedCapitation
1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 263,884
PA LIFE - Beaver County PACE Risk-basedCapitation
PACE Beaver 122
PA LIFE - Geisinger PACE Risk-basedCapitation
PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill,Snyder, Union, Wyoming
98
Page 56Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
PR Humana Puerto Rico Commercial MCO Risk-basedCapitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canvanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comero, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Marias, Las Piedras, Loza,Luquillo, Manat, Maricao, Maunabo, Mayaguz, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincon, Ro Grande, Sabana Grande,
Salinas, San German, San Juan, San Lorenzo, SanSebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco
8,338
PR MCS Advantage Commercial MCO Risk-basedCapitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canovanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comerio, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Maras, Las Piedras, Loiza,Luquillo, Manat, Maricao, Maunabo, Mayagez, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincn, Ro Grande, Sabana Grande,Salinas, San German, San Juan, San Lorenzo, SanSebastin, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco
40,124
PR MCS Health Management Options, Inc. Commercial MCO Risk-basedCapitation
1915(a) Aguada, Aguadilla, Aasco, Cabo Rojo, Canovanas,Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela,
Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez,Moca, Rincon, Rio Grande, Sabana Grande, San German,San Juan, San Sebastian, Trujillo Alto, Vieques
260,470
Page 59Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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J ,
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
PR Triple S Commercial MCO Risk-basedCapitation
1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canovanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comerio, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Maras, Las Piedras, Lioza,Luquillo, Manat, Maricao, Maunabo, Mayaguz, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincn, Ro Grande, Sabana Grande,
Salinas, San German, San Juan, San Lorenzo, SanSebastin, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco
18,405
PR Triple-S, Inc. Commercial MCO Risk-basedCapitation
1915(a) Adjuntas, Arecibo, Barceloneta, Bayamn, Camuy, Catao,Ciales, Comero, Corozal, Dorado, Florida, Guanica,Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati,Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta,Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco
323,026
RI Blue Cross & Blue Shield of Rhode Island Commercial MCO Risk-based
Capitation
1115 Statewide 13,638
RI Neighborhood Health Plan of RhodeIsland
Medicaid MCO Risk-basedCapitation
1115 Statewide 74,027
RI PACE Organization of Rhode Island PACE Risk-basedCapitation
PACE Statewide except for Zip Codes Block Island 02807 164
RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-basedCapitation
1115 Statewide 41,717
RI United HealthCare of New England Commercial MCO Risk-based
Capitation
1115 Statewide 32,578
SC Absolute Total Care Medicaid MCO Risk-basedCapitation
1915(a) Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort,Berkely, Calhoun, Charleston, Cherokee, Chester,Chesterfield, Clarendon, Colleton, Darlington, Dillon,Dorchester, Edgefield, Fairfield, Florence, Greenville,Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee,Lexington, Marion, Marlboro, Newberry, Oconee,Orangeburg, Pickens, Richland, Saluda, Spartanburg,Sumter, Union, Williamsburg, York
46,270
Page 61Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
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State Plan
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
SC The Oaks PACE PACE Risk-basedCapitation
PACE Orangeburg County 32
SC Unison Health Plan of SC Medicaid MCO Risk-basedCapitation
1915(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell,Beaufort, Berkeley, Calhoun, Chester, Chesterfield,Clarendon, Colleton, Darlington, Dillon, Dorchester,Edgefield, Fairfield, Florence, Georgetown, Greenville,Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee,Lexington, Marion, Marlboro, Newberry, Oconee,Orangeburg, Pickens, Richland, Saluda, Sumter, Union,Williamsburg, York
53,868
SD PRIME PCCM Fee-For-Service 1932(a) Statewide 85,476
TN Alexian Brothers Community Services PACE Risk-basedCapitation
PACE Hamilton 309
TN AmeriChoice - East TN Medicaid MCO Risk-basedCapitation
1115 East Tennessee 172,670
TN AmeriChoice - Middle TN Medicaid MCO Risk-basedCapitation
1115 Middle Tennessee 189,868
TN AmeriChoice - West TN Medicaid MCO Risk-basedCapitation
1115 West Tennessee 162,647
TN AmeriGroup Community Care Medicaid MCO Risk-basedCapitation
1115 Middle Tennessee 189,937
TN Doral Dental of Tennessee, LLC *Dental BenefitManager
AdministrativeServices Fee
1115 Statewide 678,776
TN Premier Behavioral Systems of TN MH/SUD PIHP Risk-basedCapitation
1115 Statewide 71,661
TN SXC Health Solution Corperation *PharmacyBenefit Manager AdministrativeServices Fee 1115 Statewide 1,230,750
TN Volunteer State Health Plan (Bluecare) -East
Medicaid MCO Risk-basedCapitation
1115 East Tennessee 249,726
TN Volunteer State Health Plan (Bluecare) -West
Medicaid MCO Risk-basedCapitation
1115 West Tennessee 194,241
Page 63Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-basedCapitation
1915(a) Statewide 29,508
TX Superior HealthPlan (STAR) Medicaid MCO Risk-basedCapitation
1915(b) Atascosa, Bastrop, Bexar, Burnet, Caldwell, Comal, Crosby,El Paso, Floyd, Garza, Guadalupe, Hale, Hays, Hockley,Hudspeth, Kendall, Lamb, Lee, Lubbock, Lynn, Medina,Terry, Travis, Williamson, Wilson
211,806
TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-basedCapitation
1915(b),1915(b)/(c)
Aransas, Atascosa, Bee, Bexar, Calhoun, Comal,Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces,Refugio, San Patricio, Victoria, Wilson
35,680
TX Texas Children's Health Plan Medicaid MCO Risk-basedCapitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 153,468
TX Unicare Commercial MCO Risk-basedCapitation
1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 23,699
TX United Commercial MCO Risk-basedCapitation
1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,587
TX ValueOptions MH/SUD PIHP FFS/Some RiskBased Capitation
1915(b) Collin County, Dallas County, Ellis County, Hunt County,Kaufman County, Navarro County, Rockwall County
306,513
UT Bear River Mental Health Mental HealthPIHP
Risk-basedCapitation
1115, 1915(b) Box Elder, Cache, Rich 12,284
UT Central Utah Counseling Center Mental HealthPIHP
Risk-basedCapitation
1115, 1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,115
UT Davis Behavioral Health Mental HealthPIHP
Risk-basedCapitation
1115, 1915(b) Davis 16,430
UT Four Corners Community BehavioralHealth
Mental HealthPIHP
Risk-basedCapitation
1115, 1915(b) Carbon, Emery, Grand 4,544
UT Healthy U Medical-onlyPIHP
Non-riskCapitation
1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 29,338
UT Molina Healthcare of Utah (Molina) Medical-onlyPIHP
Non-riskCapitation
1115, 1915(b) Davis, Salt Lake, Utah, Weber 42,116
UT Non-Emergency Medical Transportation Transp PAHP Risk-basedCapitation
1915(b) Statewide 176,036
UT Northeastern Counseling Center Mental HealthPIHP
Risk-basedCapitation
1115, 1915(b) Daggett, Duchesne, Uintah 4,207
Page 66Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009
* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE
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State Plan
Managed
Care Entity
Reimbursement
Arrangement
Operating
Authority Geographic Area ServedNumber of
Enrollees
VT Vermont PACE PACE Risk-basedCapitation
PACE Chittereden, Dorset, Grand Isle, Manchester, Rupert, SouthHero
76
WA Asuris Northwest Health Commercial MCO Risk-basedCapitation
1932(a) Spokane County 2,003
WA City of Seattle Human Services DiseaseManagement
PAHP
Risk-basedCapitation
1932(a) King 8,386
WA Columbia United Providers Commercial MCO Risk-basedCapitation
1932(a) Clark 37,848
WA Community Health Plan Commercial MCO Risk-basedCapitation
1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry,Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap,K