Medicaid transition plan draws limited sign-up participation; DHHS extends deadline to Friday | Govt-and-politics

“There’s nothing more fundamental to getting this right than to having that kind of commitment,” Richard told legislators. “This is Job One when we go live.

“If we implement this transformation this way, we will be the best in the country.”

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. DHHS will reimburse the PHPs.

There will be a limited number of special-needs individuals who will remain with fee-for-service providers.

All health plans are required to have the same Medicaid services, such as office visits, blood tests and X-rays. Health plans each have their own network of qualified doctors and health care professionals.

According to DHHS, “a small number (of beneficiaries) will stay in the current Medicaid system because of the type of services they need, such as those only in the family planning program.”