New Hampshire's move to Medicaid managed care kicks in on SundayBy GARRY RAYNO
State House Bureau
November 27. 2013 5:47PM
CONCORD — The state's long-awaited Medicaid managed care system program is about to begin for the approximately 130,000 program recipients.
The Department of Health and Human Services will transition from a fee-for-service to managed-care system Sunday.
"The transition to (Medicaid Care Management) has been a significant undertaking, and in fact one of the biggest public policy initiatives in our state's history," said Health and Human Services Commissioner Nick Toumpas. "Our goal in implementing MCM has been to improve quality of care and overall health status of those we serve, while at the same time reducing healthcare costs."
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 offered by the three companies hired to administer the program.
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. That case is still pending in federal court.
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 and increased some provider rates.
The nine Community Mental Health Centers signed agreements with the three companies in August and that was the final piece of the puzzle to complete the needed provider networks.
Recipients could choose which of the three private managed care companies — Meridian Health Plan of New Hampshire, New Hampshire Healthy Families and WellSense — best suited the client's medical needs, but those who did not make a decision were assigned a company by the department.
Recipients could change those assignments until Friday, but any changes made from now on will not be effective until Jan. 1, according to the department.
After Dec. 1, recipients will be working with the three managed care companies and not the state for their medical needs.
Benefits remain the same with the transition and providers will continue treating clients and receiving reimbursements without interruption. Any Medicaid recipient not currently enrolled in the managed care program will continue to receive services as they have in the past.
Additional information is available on the DHHS website: www.dhhs.nh.gov.