Managed Medicaid

Indiana Picks Two Medicaid MCOs For Care Management of ABDs

Reprinted from the July 19, 2007, issue of MEDICARE ADVANTAGE NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

Indiana's Family and Social Services Administration (FSSA) recently chose two managed care organizations (MCOs) to manage the care of its aged, blind and disabled (ABD) population. The selection came two years after Indiana revamped its Hoosier Healthwise Medicaid program to make managed care mandatory in the whole state.

There are about 200,000 ABD beneficiaries in the state, says Dennis Rosebrough, spokesman for FSSA, and the annual medical costs for this population alone are about $1 billion. "About 69% of all [of Indiana's] Medicaid expenditures go to this roughly 25% of Medi-caid recipients, so there is a real disproportionate share of costs," he tells AIS.

MDwise and provider-owned Advantage Health Solutions, Inc. were picked for the job, and the state now is in contract talks with the two companies, Rosebrough says. MDwise also serves the Hoosier Healthwise beneficiaries. Coverage for the ABD population is scheduled to start on Oct. 1.

The two plans will take on the care management and coordination of treatment for those beneficiaries. "With this population, a lot of time [goes into] care..It tends not to be coordinated and is therefore less effective," Rosebrough says. "This is care coordination, case management, disease management, etc. It is more than just having a network of physicians like in traditional managed care. It is more hands-on total care management," he tells AIS.

Vicki Perry, president and CEO of Advantage Health Solutions, says the company cannot comment on the program until contract negotiations with the state are complete. A spokeswoman for MDwise could not be reached for comment.

The state put out a request for proposals in January, and a total of five companies applied, Rosebrough says. The other three were UnitedHealth Group's AmeriChoice unit, APS Healthcare Inc. and WellPoint, Inc.'s Anthem Blue Cross and Blue Shield. AmeriChoice has filed a protest with the state after it did not receive a contract. FSSA is reviewing the protest now, but is continuing talks with the two chosen companies, and plans to be on track for implementation in October, Rosebrough says. He explains that he cannot comment on the reason why AmeriChoice did not get a contract while the matter is under review. A spokesman for AmeriChoice also declined to comment.

Enrollment in Medicaid managed care has been mandatory in all Indiana counties since Nov. 1, 2005. There are more than 500,000 beneficiaries in the program. The state then revamped the system in 2006 by letting beneficiaries pick a plan rather than be forced into the only plan that their providers were allowed to contract with

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