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Scott Brunner Senior Analyst Kansas Health Institute

Medicaid Managed Care: KanCare Request for Proposals House Social Services Budget Committee Topeka, Kansas • January 11, 2012. Scott Brunner Senior Analyst Kansas Health Institute. What is Managed Care?. Different than fee for service. A Medicaid beneficiary seeks a health care service

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Scott Brunner Senior Analyst Kansas Health Institute

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  1. Medicaid Managed Care: KanCare Request for Proposals House Social Services Budget CommitteeTopeka, Kansas • January 11, 2012 Scott Brunner Senior Analyst Kansas Health Institute

  2. What is Managed Care? • Different than fee for service. • A Medicaid beneficiary seeks a health care service • A health care provider provides that service • The provider sends a bill to the state • The state pays the bill based on coverage rules and predetermined rates for each service.

  3. What is Managed Care?(continued) • State leases a network of providers from a health plan or managed care organization (MCO) • Health plan negotiates/contracts with providers • Providers agree to accept patients from the health plan • Health plans pay providers for services delivered

  4. What is Managed Care?(continued) • Providers must meet access standards, case management requirements, treatment guidelines from the health plan. • Health plans have performance standards in the contract from the state • Adequate network • Timely access to care • Clinical utilization standards • Quality of care • Payment timeliness

  5. Medicaid/CHIP Population and Spending

  6. Medicaid and CHIPManaged Care 163,882 people are currently in comprehensive managed care

  7. Who’s included in KanCare? • All Medicaid eligible people • Infants and children (Medicaid and CHIP) • Pregnant women • Low income adults • Persons with disabilities • Dual eligible Medicare and Medicaid elderly, foster children and children with special health care needs included through a “waiver”

  8. What services are covered? • All medically necessary services available through the Medicaid State Plan or HCBS waivers. • Must be in an “amount, duration and scope” no less than required by Medicaid

  9. What services are covered? (continued) • MCOs can offer “valued added” services • Gift cards or vouchers • Specialized medical equipment • Additional transportation • Health Opportunity Accounts • Health Literacy Training • Health Risk Assessments

  10. What services are covered? (continued) • MCOs must provide “Health Homes” • Develop a person-centered care plan • Integrate clinical and non-clinical needs and services • Coordinate all services and care management across service settings • Required for people with chronic conditions • Mental illness, substance abuse, asthma, diabetes, heart disease and obesity

  11. Key Takeaways • Managed care shifts responsibility for public programs to the private companies. • KanCare shifts 100% of the Medicaid population into comprehensive managed care. • KanCare shifts 75% of Medicaid spending into managed care.

  12. Kansas Health Institute Information for policy makers. Health for Kansans.

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