PROGRAM DESCRIPTION AND HISTORICAL CONTEXT Sample Clauses
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. The HealthChoice section 1115(a) demonstration is designed to use a managed care delivery system to create efficiencies in the Medicaid program and enable the extension of coverage and/or targeted benefits to certain individuals who would otherwise be without health insurance or without access to benefits tailored to the beneficiary’s specific medical needs. The initial HealthChoice demonstration was approved in 1996 to enroll most Medicaid beneficiaries into managed care organizations (MCOs) beginning July 1, 1997. The state’s goal in implementing and continuing the demonstration is to improve the health status of low-income Marylanders by: • Improving access to health care for the Medicaid population; • Improving the quality of health services delivered; • Expanding coverage to additional low-income Marylanders with resources generated through managed care efficiencies; • Providing patient-focused, comprehensive, and coordinated care designed to meet health care needs by providing each member a single “medical home” through a primary care provider (PCP); and, • Emphasizing health promotion and disease prevention by providing access to immunizations and other wellness services, such as regular prenatal care. Under the statewide health care reform program, the state enrolls individuals affected by or eligible through the demonstration into a managed care organization for comprehensive primary and acute care, and/or one of the demonstration’s authorized health care programs. The benefits received may include or be limited to targeted programs authorized solely by the demonstration: the Rare and Expensive Case Management (REM) program, the Family Planning program, and the Increasing Community Services (ICS) program. The Primary Adult Care (PAC) program expired on December 31, 2013. Behavioral health services are provided under the demonstration in a separate fee-for-service (FFS) delivery system managed by an Administrative Services Organization (ASO), and dental services are managed by a dental ASO. The HealthChoice demonstration continued to evolve during the 2008 to 2011 extension period by providing both eligibility and a benefit expansion, which were approved by the Maryland General Assembly in state fiscal year (SFY) 2008. The eligibility expansion allowed coverage through the Medicaid State plan to categorically eligible parent and caretaker adults with income above 30 percent of the Federal poverty level (FPL) to 116 percent of the FPL. The benefit e...
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description
a. Women aged 19 through 44, with incomes up to 211 percent of the Federal Poverty Level (FPL) (post Modified Adjusted Gross Income (MAGI) conversion) who are losing Medicaid pregnancy coverage at the conclusion of 60 days postpartum; and
b. Uninsured women aged 19 through 44, with incomes from 47 percent of the FPL up to 211 percent of the FPL (post MAGI conversion) who are not otherwise eligible for Medicaid. Enrollment in this demonstration is capped at 4,000 individuals. The initial Montana Plan First demonstration was approved on May 30, 2012 through December 31, 2013. The demonstration was temporarily extended through December 31, 2014. Under this demonstration, Montana expects to promote the objectives of Title XIX by: • Improve access to and use of family planning services; • Reducing the number of unintended pregnancies in Montana; and • Improve birth outcomes and women’s health by increasing child spacing intervals.
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description
1. Women ages 19 through 55 losing Medicaid 60 days postpartum with incomes up to 141 percent of the Federal Poverty Level (FPL)(post Modified Adjust Gross Income (MAGI) conversion);
2. Women 19 -55 with incomes up to 141percent of the FPL who are not otherwise eligible for Medicaid; and
3. Men age of 21 with incomes up to 133 percent of the FPL (post MAGI conversion) for vasectomies.
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. In the aftermath of Hurricanes ▇▇▇▇▇▇▇ and ▇▇▇▇, the State of Louisiana Department of Health and Hospitals (DHH) was awarded a $100 million Primary Care Access Stabilization Grant (PCASG) program for the period July 2007 through September 30. 2010. This 3-year program was designed to restore and expand access to primary care services, including mental health care services and dental care services, without regard to a patient’s ability to pay, by providing short- term financial relief to outpatient provider organizations. The PCASG program was also intended to decrease costly reliance on emergency room usage for primary care services for patients who are uninsured, underinsured, or receiving Medicaid. To be eligible to receive PCASG funding, provider organizations (Federally Qualified Health Centers, Mental Health Clinics, and Physician Groups) were required to meet several requirements, including creating referral relationships with local specialists and hospitals, establishing a quality assurance or improvement program, and providing a long-term sustainability plan. The other eligibility requirements were to be operational and serving patients at one or more health care sites; be a public or private nonprofit organization; have a formal policy to serve all people regardless of the patient’s ability to pay for services; establish a system to collect and organize patient and encounter data, and report the data to DHH through the Louisiana Public Health Institute (LPHI); and provide plans if the organization intends to relocate or renovate health care sites. On August 6, 2010, the State of Louisiana submitted a proposal to CMS for a Medicaid section 1115 Demonstration for the continued funding of the PCASG provider organizations. -. The State proposed to reduce discretionary Disproportionate Share Hospital (DSH) funding and increase support for primary care medical homes (PCMH). The Demonstration’s funding approach would permit the State to use up to $30 million (total computable) in Demonstration years (DY) 1, 2, & 3 and $7.5 million (total computable) in DY 4 for specified PCMH providers. To maintain budget neutrality, the State would ensure that these amounts, when added to payments to DSH payments would not exceed the DSH allotment calculated in accordance with section 1923 of the Social Security Act (the Act). The Greater New Orleans area, comprised of Orleans, Jefferson, St. ▇▇▇▇▇▇▇ and Plaquemines parishes, is one of the largest population centers in ...