DMAS Update on Managed Care for LTSS Services

May 21, 2015

Transitioning Remaining Medicaid FFS Populations into Mandatory Managed Care

Proposed Phase I:
Enroll Individuals Who Are Eligible for the CCC Program but Choose Not to Participate in CCC Into Mandatory Managed Care

Timeframe: Summer 2016

Proposed Phase II:
Enroll Remaining Duals and LTSS Populations into a Mandatory Managed Care Program

Timeframe: Mid 2017
· Transition approximately 37,000 CCC eligible individuals who have chosen not to participate in CCC into a mandatory managed care program for Medicaid services.

· Includes primary and acute, LTSS, and behavioral services coordinated by a CCC health plan (Anthem, Humana and Virginia Premier).

· Provides care coordination with the goal of improving health outcomes.

· Individuals will continue to have the option to enroll in CCC.

· This program will be phased-in regionally.

· Develop and implement a new managed care program for the remaining LTC populations and services.

· Includes primary and acute, LTSS, and behavioral services. The health plans will be selected through a competitive procurement process.

· There are two general populations to transition into a new Medicaid managed care program coordinated by a health plan.

· Approximately 50,000 dual eligibles that are currently not in the CCC demonstration regions or are currently excluded from CCC (such as children and individuals in select home and community based waivers).

Approximately 20,000 non-dual eligibles who receive LTSS either in an institution or through one of DMAS’ six home and community based care waivers.
At this time the expansion of Medicaid managed care for individuals enrolled in the DS, ID, and, DD Waivers is being considered for their acute and primary care services, only.

While DMAS is exploring the feasibility of managed care models for the ID, DD, and DS Waivers, these individuals will continue to receive their HCBS through Medicaid fee-for-service until DBHDS completes the redesign of these waivers. This program will be phased-in regionally.