At Friday’s Medicaid Managed Care Council meeting, DSS described plans to transition 337,181 HUSKY members from the current non-capitated, fee-for-service structure back into potentially three capitated HMOs starting July 1st, to begin Charter Oak enrollment also on July 1st, the planned dental carve out also set to begin July 1st, and their plan to provide HUSKY members with the new PCCM option beginning October 1st.
In the fall, HUSKY families will be able to choose Primary Care Case Management (PCCM) rather than one of the new HMOs. In PCCM, members will choose a primary care provider (PCP) to serve as their medical home. Their PCP will be responsible for providing all their primary care needs, as well as coordinating their care – making arrangements for needed specialty care, collecting results from tests and other visits, providing follow up care and encouraging healthy behaviors. PCPs will receive a monthly fee per member for care coordination in addition to fee-for-service reimbursement for medical services. A working group of advocates, including this one, and DSS staff has been meeting regularly. A concept paper describing the plan’s details is awaiting the Commissioner’s approval. The RFQ and provider agreement are almost complete and DSS expects to release the RFQ next month. A provider advisory group will be convened in August.
The transition for HUSKY families from the current managed care organizations – CHN and Anthem – and fee-for-service to the three new managed care organizations, assuming they are all approved by DSS – CHN, Aetna Better Health and AmeriChoice (United Health Group) – will be gradual from July thru December. Counties will transition as the new plans build enough provider panel capacity to meet the needs of HUSKY members in that region. Members who do not choose among the new plans will be defaulted, based on network capacity. The dept. will provide both separate Charter Oak applications and one combined with HUSKY. ACS, the current enrollment broker, will collect premiums and monitor out-of-pocket costs for Charter Oak members. DSS is now choosing a company to run the dental carve out among the four applicants – Benecare, HealthPlex, Doral and Liberty. There is also $4.5 million for safety net grants to expand dental capacity and DSS is working to recruit providers to the new program.