Managed Care

Oklahoma to transition to Medicaid managed care

This week, our In Focus section reviews a new Oklahoma law to implement Medicaid managed care by October 1, 2023. The law, signed by Governor Kevin Stitt on May 26, 2022, requires the state to issue a request for proposals and to award at least three Medicaid managed care contracts to health plans or provider-led entities like accountable care organizations.

Provider-led entities would receive preferential treatment, with at least one targeted to receive a contract. However, if no provider-led entity submits a response, the state will not be required to contract with one.

Goals of the legislation include:

  • Improve health outcomes for Medicaid members and the state as a whole;
  • Ensure budget predictability through shared risk and accountability;
  • Ensure access to care, quality measures, and member satisfaction;
  • Ensure efficient and cost-effective administrative systems and structures; and
  • Ensure a sustainable delivery system that is a provider-led effort and that is operated and managed by providers to the maximum extent possible.

Plans would provide physical health, behavioral health, and prescription drug services. Covered beneficiaries would include traditional Medicaid members and the state’s voter-approved expansion population, but not the aged, blind, and disabled population eligible for SoonerCare.

Plans will need to contract with at least one local Oklahoma provider organization for a model of care containing care coordination, care management, utilization management, disease management, network management, or another model of care as approved by OHCA.

Oklahoma will also issue separate RFPs for a Medicaid dental benefit manager plan and a Children’s Specialty plan.

Background

Oklahoma currently does not have a fully capitated, risk-based Medicaid managed care program. The majority of the state’s more than 1.2 million Medicaid members are in SoonerCare Choice, a Primary Care Case Management (PCCM) program in which each member has a medical home. Other programs include SoonerCare Traditional (Medicaid fee-for-service), SoonerPlan (a limited benefit family planning program), and Insure Oklahoma (a premium assistance program for low-income people whose employers offer health insurance). Prior efforts to transition to Medicaid managed care have encountered roadblocks, starting in 2017 with a failed attempt to move aged, blind, and disabled members to managed care.

More recently, in June 2021, the Oklahoma Supreme Court struck down a planned transition of the state’s traditional Medicaid program to managed care, ruling that the Oklahoma Health Care Authority does not have the authority to implement the program without legislative approval.

Contracts had been awarded to Blue Cross Blue Shield of Oklahoma, Humana, Centene/Oklahoma Complete Health, and UnitedHealthcare. Centene/Oklahoma Complete Health also won an award for the SoonerSelect Specialty Children’s Health Plan program, covering foster children, juvenile justice-involved individuals, and children either in foster care or receiving adoption assistance.

Link to Senate Bill 1337

HMA conference on “The New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs” to feature insights from health plan leaders, state Medicaid directors, and providers

Pre-Conference Workshop: October 9, 2022
Conference: October 10-11, 2022
Location: Fairmont Chicago, Millennium Park

HMA Conference on the New Normal for Medicaid, Medicare, and Other Publicly Sponsored Programs to Feature Insights from Health Plan Leaders, State Medicaid Directors, Providers

Early Bird registration is now open for HMA’s fifth national conference on trends in publicly sponsored healthcare. Early Bird Registration Ends July 11th.

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Nebraska releases Medicaid managed care RFP

This week, our In Focus section reviews the Nebraska Heritage Health request for proposals (RFP), released by the Nebraska Department of Health and Human Services (DHHS) on April 15, 2022. DHHS will award statewide contracts to two or three Medicaid managed care organizations (MCOs) to serve approximately 342,000 individuals. Implementation is set to begin July 1, 2023. Contracts are currently worth $1.8 billion annually.

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Texas Releases STAR+PLUS RFP

This week, our In Focus section reviews the Texas STAR+PLUS managed care services request for proposals (RFP) released on March 31, 2022, by the Texas Health and Human Services Commission (HHSC). The STAR+PLUS program, including the STAR+PLUS Home and Community-based Services (HCBS) program, provides acute care services and Long-Term Services and Supports (LTSS) to the aged and disabled.

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Iowa releases Health Link Medicaid managed care RFP

This week, our In Focus section reviews the Iowa Health Link request for proposals (RFP) for Medicaid managed care organizations (MCOs) to serve the state’s traditional Medicaid program, the Children’s Health Insurance Program (CHIP) known as Healthy and Well Kids in Iowa (Hawki), and the Iowa Health and Wellness Plan (IHAWP). The RFP was released by the Iowa Department of Human Services on February 17, 2022. Contracts are set to begin July 1, 2023, and are worth approximately $6.5 billion annually.

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California releases Medi-Cal managed care RFP for three plan models in 21 counties

This week, our In Focus section reviews the California Medicaid (Medi-Cal) managed care request for proposals (RFP) released by the California Department of Health Care Services (DHCS) on February 9, 2022. DHCS is procuring contracts for commercial plans for three of the Medi-Cal managed care plan models in 21 counties, serving approximately 3 million beneficiaries. Contracts will be awarded to one managed care organization (MCO) in each of the Two-Plan model counties, two MCOs in each of the geographic managed care (GMC) model counties, and two MCOs in each of the Regional model counties. This procurement is the largest released by California, rebidding contracts for commercial plans statewide.

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Delaware Releases Medicaid Managed Care RFP

This week our In Focus section reviews the Delaware request for proposals (RFP) for Diamond State Health Plan (DSHP) and Diamond State Health Plan Plus (DSHP Plus), the state’s Medicaid managed care programs. The RFP was released by the Delaware Department of Health and Social Services (DHSS), Division of Medicaid and Medical Assistance (DMMA) on December 15, 2021.

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Minnesota releases Medicaid RFP for 80 counties outside Twin Cities

This week our In Focus section reviews the Minnesota request for proposals (RFP) for Families and Children Medical Assistance (MA), the state’s traditional Medicaid managed care program, and MinnesotaCare, the state’s Basic Health Program (BHP), in 80 counties outside of the Twin Cities seven-county region. The RFP was released by Minnesota Department of Human Services, Purchasing and Service Delivery Division on January 18, 2022. Contracts will begin January 1, 2023, covering approximately 470,000 members.

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Medicaid managed care: opportunities to address social determinants of health and equity

This week, our In Focus highlights a new report prepared by Health Management Associates (HMA) on the potential for Medicaid Managed Care to enable states to address social determinants of health (SDOH) and health equity above and beyond what’s possible with traditional fee-for-service models. The report was released by Together for Better Medicaid, a coalition committed to building a better Medicaid system across the country.

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District of Columbia releases Medicaid Managed Care RFP

This week, our In Focus section reviews the District of Columbia (DC) Medicaid managed care request for proposals (RFP), released on November 19, 2021, by the District of Columbia Department of Health Care Finance. The procurement will cover DC Healthy Families Program (DCHFP), including adults with special health care needs; District of Columbia Healthcare Alliance Program (Alliance); and Immigrant Children’s Program (ICP). DC expects to award contracts to up to three managed care organizations (MCOs), covering physical, behavioral health, and pharmacy services. Contract approval is expected by June 2022 and implementation in October 2022.

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