In January 2020, the District of Columbia issued an RFP for the D.C. Healthy Families Program, the District of Columbia Healthcare Alliance Program, and the Immigrant Children’s Program. These small-scale RFPs — which are expected to cover just under 200,000 subscribers — are part of the early steps Washington D.C. is taking in their five-year transition from Medicaid services to managed care. Health plans that are currently available to Medicaid subscribers in Washington D.C. include AmeriHealth Caritas, Anthem, and Trusted Health Plan.
Similar changes are occurring in Kentucky starting in January 2021, as they issued an RFP to cover 1.2 million subscribers who are currently part of their Medicaid program. This comes after Kentucky’s 2019 announcement informing the public that they will cancel and renegotiate their existing Medicaid managed care contract. This newly-issued RFP will cover all SSI and foster care children as well as former-foster care children who are covered under the Affordable Care Act (ACA).
Kentucky is also seeking incumbents to provide coverage for patients who receive SSI coverage without Medicare, that are dually eligible for both Medicare and Medicaid, as well as adults who fall under the Modified Adjusted Gross Income (MAGI) section of ACA. Aetna, Anthem, Humana, Passport, and WellCare are among the health care plans presently being used by the 1.2 million Medicaid subscribers in Kentucky.
In traditional (or fee-for-service) Medicaid, subscribers are encouraged to seek care from any provider whose practice accepts Medicaid. This may seem beneficial due to its apparent ability to shield subscribers from the effects of sparse provider networks. However, a transition to managed Medicaid is actually in the best interest of the subscribers and those who provide insurance. Managed Medicaid is easier to use due to flat monthly rates. This option also addresses a subscriber’s medical needs while keeping their services in one place.
When subscribers receive care in one facility (or sister facilities in close contact), this prevents fragmentation in the continuity of care. Fragmented care can result from improper or absent communication between health care providers, a lack of follow-up by community agencies, and repeat or unnecessary services that do not efficiently or effectively meet the needs of the individual. Fragmented care has a negative impact on service provision, outcomes rendered, quality care, and cost utilization.
Managed Medicaid not only avoids care fragmentation and all the adverse effects that can result, but this plan also focuses on preventive care to further prioritize the present and future needs of each individual. RFPs help insurance companies find qualified MCOs to provide
coverage for their subscribers while lowering costs and making insurance more accessible for all.
If you need support responding to a state managed care RFP or building your provider network during these trying times, consider TOG Network Solutions a resource. Schedule a free consultation today.