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Tag: Multibilliondollar

Multi-billion-dollar Medicaid contract at stake in legal filing by Aetna Better Health. Insurer asks for review of DHHS selection process. | Local News

September 28, 2020
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| Better Health

“The state also has failed to fulfill its own well-documented commitments to the federal government and the public.”

Moving ahead

The main launch challenge is getting the four statewide PHPs operational by the enrollment date.

Managed care is a system under which people agree to see only certain doctors or go to certain hospitals, as in a health maintenance organization, or HMO, or a preferred provider organization, or PPO, health-insurance plan.

Under the current Medicaid system, providers are paid on a fee-for-service model administered by DHHS.

By contrast, the PHPs will pay health-care providers a set amount per month for each patient’s costs. There will be a limited number of special-needs individuals who will remain with fee-for-service providers.

The next big rollout step for DHHS is formulating the per-patient rates for providers by November and submitting them to CMS.

DHHS will reimburse the PHPs, and people will be able to

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