Nearly 900,000 Medicaid recipients will be steered into private managed-care plans
Twelve companies have applied to participate in the state's new "coordinated care networks" initiative, which will steer nearly 900,000 Medicaid recipients into private managed-care plans starting early next year.
View full sizeA flu vaccination is prepared.The applications were due June 24 to the state Department of Health and Hospitals, which plans to spend a month evaluating the different proposals before announcing the winners by July 25. A maximum of six winners can be chosen in each of the three geographic regions where the program will be launched next year, starting with a planned rollout in the New Orleans area and the north shore.
"This competitive process will ensure that our evaluation teams can select those networks that have the best competencies to meaningfully impact our residents and transform our health system," Health and Hospitals Secretary Bruce Greenstein said.
The care networks are the centerpiece of Gov. Bobby Jindal's health care strategy, with supporters saying the private plans will produce better health outcomes by reducing unnecessary tests and hospitalizations through improved coordination between primary-care doctors, specialists, hospitals and other care providers.
Opponents of the new model say it will result in fewer state dollars going to pay for health care as the private companies divert money for marketing costs, overhead and profits.
Medicaid in Louisiana currently operates on a fee-for-service model, where the 1.2 million people who qualify for the program by their age, income or disability can go to any provider who will accept them. The providers then bill the state for any services and get reimbursed at rates set by the government.
In the new system, most Medicaid recipients will have a choice of several private plans that would oversee their care and pre-approve visits to specialists, hospital admissions and diagnostic tests.
Some of the plans will be paid a monthly fee for each enrollee, which will vary based on the enrollee's health, and be responsible for the cost of that person's care. Other plans will continue to be based on the fee-for-service model, except the networks would get paid an added monthly fee to provide better care coordination.
The Medicaid recipients who cost the state the most money, such as nursing-home residents or people with severe disabilities, will stay in the old, fee-for-service system.
A bill approved by the Legislature during the recently concluded session would require the health department to provide detailed information each year about how the plans are performing, including the number of people enrolled, how quickly claims are being paid and how many claims are being denied. Senate Bill 207, which awaits a signature or veto from the governor, also requires the program to sunset by the end of 2014 unless it's renewed by the Legislature.
Jan Moller can be reached at jmoller@timespicayune.com or 225.342.5207.