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Managed care Medicaid system starts Dec. 1


CONCORD — The state's new managed care system for Medicaid recipients will begin Dec. 1, state officials said Wednesday.

Health and Human Services Commissioner Nicholas Toumpas said the three managed care management organizations the state hired to run the program have sufficient provider networks in place for the program to begin.
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State lawmakers first approved moving to a managed care system for the Medicaid program from a fee-for-service model in 2011, but the program failed to get off the ground when hospitals, mental health centers and community health centers balked at the low rates the three companies offered.
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The state's largest hospitals sued the state two years ago, claiming the reimbursement rates under the Medicaid program were too low to sustain the health care system for the poor and were set illegally.
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To entice the hospitals to join the managed care networks, Gov. Maggie Hassan, the House and the Senate put additional money into the uncompensated care program.

The Senate used general fund money for the state's share, but said providers would have to join the managed care networks by July 1 to receive the money.
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The nine Community Mental Health Centers signed agreements with the three managed care companies Tuesday and that was the final piece of the puzzle to complete the needed provider networks.

The hospitals and community health centers agreed to join the managed care networks in July.
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"Medicaid care management is a critical part of our state's efforts to strengthen our health care system, helping to reduce costs and improve the quality of care for patients," Hassan said. She thanked the department and health care providers "for coming to the table and working together to move forward with meaningful health care innovations that will benefit thousands of Granite Staters."
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Before the Dec. 1 start up, the agency will contact Medicaid recipients and assist them in selecting a care management plan.

A new website on the managed care system will be put up in a few days and the department will expand its call center to answer questions about the program.
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Enrollment will begin in September.

State budget writers believe moving to a managed care system will save the state millions of dollars a year.

Lawmakers also want the managed care system in place if the state decides to expand Medicaid eligibility under the Affordable Care Act, which could add about 44,000 people to the program.
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grayno@unionleader.com
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