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 Effective through December 31, 2017, the Montana Plan First family planning section 1115(a) Medicaid demonstration expands the provision of family planning and family planning-related services to the following populations of women:
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description Effective through December 31, 2017, the Florida Medicaid Family Planning Waiver (“FPW”), section 1115(a) Medicaid demonstration expands the provision of family planning and family planning-related services to women ages 14-55 with family incomes at or below 191 percent of the FPL (post Modified Adjust Gross Income (MAGI) conversion) losing pregnancy coverage after 60 days postpartum and to women ages 14-55 with family incomes at or below 191 percent of the FPL (post MAGI conversion) for a period of two years after losing Medicaid coverage for reasons other than expiration of the 60-day postpartum period.
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description Effective through December 31, 2017, the Alabama Plan First family planning section 1115(a) Medicaid demonstration expands the provision of family planning and family planning-related services to
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. Demonstration Description Effective through December 31, 2017, the Mississippi family planning section 1115(a) Medicaid (FPW) demonstration provides family planning and family planning-related services to women who are losing Medicaid pregnancy coverage at the expiration of the 60- day postpartum period and individuals (men and women), ages 13 through 44, who have family income at or below 194 percent of the federal poverty level (FPL) (post Modified Adjust Gross Income (MAGI) conversion), and who are not otherwise enrolled in Medicaid, Children Health Insurance Plan (CHIP), or has other health insurance coverage that provides family planning services.
PROGRAM DESCRIPTION AND HISTORICAL CONTEXT. In the aftermath of Hurricanes Xxxxxxx and Xxxx, 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. Xxxxxxx and Plaquemines parishes, is one of the largest population centers in ...
