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