063009 Cms Summary of State MCOs

8/8/2019 063009 Cms Summary of State MCOs

1/52

State Plan

June 30, 2009

Medicaid Managed Care Program Summary

Managed

Care Entity

Reimbursement

Arrangement

Operating

Authority Geographic Area Served

Number of

Enrollees

AL Maternity Care Program Medical-onlyPIHP

Risk-basedCapitation

1915(b) Statewide 21,324

AL Partnership Hospital Program Medical-onlyPIHP


1915(a) -1902(a)(4)

Statewide 518,769

AL Patient 1st PCCM Fee-For-Service 1915(b) Statewide 443,327

AR Connect Care PCCM Fee-For-Service 1115 Statewide 411,351

AR Non-Emergency Transportation Transp PAHP Risk-basedCapitation


AR Total Life Healthcare PACE Risk-basedCapitation

PACE 72315, 72319, 72324, 72354, 72365, 72373, 72387, 72396,72401, 72404, 72411, 72414, 72416, 72417, 72419, 72421,72427, 72432, 72433, 72437, 72438, 72442, 72447, 72450,72455, 72465, 72467, 72472, 72476

21

AZ AZ Physicians IPA (Family PlanningExtension)

Medicaid MCO Risk-basedCapitation

1115 La Paz, Maricopa, Pima, Yuma 604

AZ AZ Physicians IPA (HP) Medicaid MCO Risk-based

Capitation

1115 LaPaz, Maricopa, Pima, Yuma 220,485

AZ Bridgeway (Family Planning Extension) Medicaid MCO Risk-basedCapitation

1115 Yavapai 56

AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-basedCapitation

1115 LaPaz, Maricopa, Yuma 16,182

AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-basedCapitation

1115 Yavapai 2,405

AZ Care 1st Health Plan Medicaid MCO Risk-based

Capitation

1115 Maricopa 49,355

AZ Care 1st Health Plan (Family PlanningExtension)


1115 Maricopa 208

AZ Cochise Co. Dept. of Health Services (PC) Medicaid MCO Risk-basedCapitation

1115 Cochise, Graham, Greenlee 938

AZ Department of EconomicSecurity/Childrens Medical and DentalProgram (Family Planning Extension)


1115 Statewide 0

Page 23Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2009

* Indicates the structure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP or PACE


2/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

Enrollees

AZ Department of EconomicSecurity/Childrens Medical and DentalProgram (HP)


1115 Statewide 9,533

AZ Department of EconomicSecurity/Division of DevelopmentalDisabilities (PC)



AZ Department of Health Services(Behavioral Health)

MH/SUD PIHP Risk-basedCapitation

1115 Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz,Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz,

Yavapai, Yuma

104,101

AZ Evercare Select (PC) Medicaid MCO Risk-basedCapitation

1115 Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Yuma 3,647

AZ Health Choice Arizona (Family PlanningExtension)


1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima,Santa Cruz, Yuma

791

AZ Health Choice Arizona (HP) Medicaid MCO Risk-basedCapitation

1115 Apache, Coconino, LaPaz, Maricopa, Mohave, Navajo, Pima,Santa Cruz, Yuma

177,142

AZ Maricopa County Health Plan (FamilyPlanning Extension)


1115 Maricopa 109

AZ Maricopa County Health Plan (HP) Medicaid MCO Risk-basedCapitation

1115 Maricopa 51,234

AZ Mercy Care Plan (Family PlanningExtension)


1115 Cochise, Graham, Greenlee, Maricopa, Pima 994

AZ Mercy Care Plan (HP) Medicaid MCO Risk-basedCapitation

1115 Cochise, Graham, Greenlee, Maricopa, Pima 283,456

AZ Mercy Care Plan (PC) Medicaid MCO Risk-basedCapitation

1115 Maricopa 8,388

AZ Phoenix Health Plan/CommunityConnection (Family Planning Extension)


1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima,Pinal, Yavapai

710

AZ Phoenix Health Plan/CommunityConnection (HP)


1115 Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima,Pinal, Yavapai

174,038

AZ Pima Health System (Family PlanningExtension)


1115 Pima 12

AZ Pima Health System (HP) Medicaid MCO Risk-basedCapitation

1115 Pima 2,153




3/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

Enrollees

AZ Pima Health System (PC) Medicaid MCO Risk-basedCapitation

1115 Pima, Santa Cruz 4,210

AZ Pinal County Long Term Care (PC) Medicaid MCO Risk-basedCapitation

1115 Gila, Pinal 1,433

AZ SCAN Medicaid MCO Risk-basedCapitation

1115 Maricopa 2,591

AZ University Family Care (Family Planning

Extension)

Medicaid MCO Risk-based

Capitation

1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 159

AZ University Family Care (HP) Medicaid MCO Risk-basedCapitation

1115 Cochise, Gila, Graham, Greenlee, Pima, Pinal, Santa Cruz 62,763

AZ Yavapai County Long Term Care (PC) Medicaid MCO Risk-basedCapitation

1115 Yavapai 1,016

CA Access Dental Plan-LA Dental PAHP Risk-basedCapitation

1915(a) Los Angeles 104,353

CA Access Dental Plan-Sacramento Dental PAHP Risk-based

Capitation

1915(a) Sacramento 51,946

CA Alameda Alliance for Health Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Alameda 88,767

CA AltaMed Health Services Corporation PACE Risk-basedCapitation

PACE LA 622

CA American Health Guard-Dental Plan-LA Dental PAHP Risk-basedCapitation


CA Anthem Blue Cross Partnership Plan -Sacramento

Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Sacramento 86,166

CA Anthem Blue Cross Partnership Plan-TPMP


1915(b), 1932(a) Alameda, Contra Costa, Fresno, San Francisco, SanJoaquin, Santa Calra, Stanislaus, Tulare

349,162

CA Caloptima-Orange HIO Risk-basedCapitation

1915(b) Orange 327,163

CA Care 1st Health Plan/San Diego Commercial MCO Risk-basedCapitation

1915(b), 1932(a) San Diego 9,126

CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-basedCapitation





4/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

Enrollees

CA Central Coast Alliance For Health HIO Risk-basedCapitation

1915(b) Monterey, Santa Cruz 96,468

CA Coalition of Elders Independence dbaCenter for Elders Independence

PACE Risk-basedCapitation

PACE Alameda 413

CA Community Dental Services/Sacramento Dental PAHP Risk-basedCapitation

1915(b), 1932(a) Sacramento 12,805

CA Community Dental Services-LA Dental PAHP Risk-based

Capitation


CA Community Eldercare of San Diego dbaSt. Paul's PACE


PACE San Diego 77

CA Community Health Group PartnershipPlan-San Diego


1915(b), 1932(a) San Diego 86,241

CA Contra Costa Health Plan Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Contra Costa 53,869

CA Health Net Community Solutions, Inc. -

Sacramento

Commercial MCO Risk-based

Capitation

1915(b), 1932(a) Sacramento 34,498

CA Health Net Community Solutions, Inc.-San Diego


1915(b), 1932(a) San Diego 30,586

CA Health Net Community Solutions, Inc.-TPMP


1915(b), 1932(a) Fresno, Kern, LA, Stanislaus, Tulare 582,166

CA Health Net of CA-Dental-LA Dental PAHP Risk-basedCapitation


CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-basedCapitation

1915(a) Sacramento 12,078

CA Health Plan of San Joaquin Commercial MCO Risk-basedCapitation

1915(b), 1932(a) San Joaquin 67,793

CA Health Plan of San Mateo *MCO/COHS Risk-basedCapitation

1915(b) San Mateo 52,908

CA Inland Empire Health Plan Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Riverside, San Bernardino 344,595

CA Kern Family Health Care Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Kern 100,487




5/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

Enrollees

CA KP Cal, LLC Commercial MCO Risk-basedCapitation

1915(a) Marin, Sonoma 2,328

CA KP Cal, LLC - Sacramento Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Sacramento 24,405

CA KP Cal, LLC-San Diego Commercial MCO Risk-basedCapitation

1915(b), 1932(a) San Diego 13,085

CA LA Care Health Plan Commercial MCO Risk-based

Capitation

1915(b), 1932(a) Los Angeles 763,736

CA Liberty Dental Plan of CA/Sacramento Dental PAHP Risk-basedCapitation

1915(b), 1932(a) Sacramento 27,192

CA Liberty Dental Plan of CA-LA Dental PAHP Risk-basedCapitation

1915(b), 1932(a) LA 7,095

CA Molina Healthcare of California PartnerPlan, Inc. - Sacramento


1915(b), 1932(a) Sacramento 22,791

CA Molina Healthcare of California Partner

Plan, Inc. - San Diego

Commercial MCO Risk-based

Capitation

1915(b), 1932(a) San Diego 53,645

CA Molina Healthcare of California PartnerPlan, Inc.-TPMP


1915(b), 1932(a) Riverside, San Bernardino 89,952

CA On Lok Senior Health Services dba OnLok Lifeways


PACE San Francisco 995

CA Partnership Health Plan HIO Risk-basedCapitation

1915(b) Napa, Solano, Yolo 94,280

CA Positive Healthcare/AHF HealthcareCenters


1915(a) Los Angeles 587

CA Safeguard Dental-LA Dental PAHP Risk-basedCapitation

1915(a) Los Angeles, Riverside, San Bernardino 21,801

CA San Francisco City & CO/Family Mosaic *Emotional andMental HealthSupport PIHP


1915(a) San Francisco 157

CA San Francisco Health Plan Commercial MCO Risk-basedCapitation

1915(b), 1932(a) San Francisco 34,567

CA Santa Barbara San luis Obispo Regional

Health Authority

HIO Risk-based

Capitation

1915(b) Santa Barbara 83,751




6/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesCA Santa Clara Family Health Plan Commercial MCO Risk-based

Capitation1915(b), 1932(a) Santa Clara 89,930

CA Senior Care Action Network (SCAN) Medicaid MCO Risk-basedCapitation

1915(a) LA, Riverside, San Barnardino 6,920

CA Sutter Health sacramento Sierra dbaSutter Senior Care


PACE Sacramento, Yolo 204

CA Western Dental Services-LA Dental PAHP Risk-based

Capitation

1915(a) Los Angeles, Riverside, Sacramento, San Bernardino 55,845

CA Western Dental Services-Sacramento Dental PAHP Risk-basedCapitation

1915(b), 1932(a) Sacramento 83,840

CA Western Health Advantage CommunityHealth Plan-Sacramento


1915(b), 1932(a) Sacramento 16,070

CO Access Behavioral Care Mental HealthPIHP


1915(b) Denver 80,507

CO Behavioral Healthcare, Inc. Mental Health

PIHP

Risk-based

Capitation

1915(b) East Metro Denver 103,730

CO Colorado Access Medicaid MCO Risk-basedCapitation

1915(a) Adams, Arapahoe, Boulder, Broomfield, Denver 2,315

CO Colorado Health Partnerships Mental HealthPIHP


1915(b) Alamosa, Archuleta, Baca, Bent, Chaffee, Conejos, Costilla,Crowley, Custer, Delta, Dolores, Eagle, El Paso, Fremont,Garfield, Grand, Gunnison, Hinsdale, Huerfano, Jackson,Kiowa, La Plata, Lake, Las Animas, Mesa, Mineral, Moffat,Montezuma, Montrose, Otero, Ouray, Park, Pitkin, Prowers,Pueblo, Rio Blanco, Rio Grande, Routt, Saguache, San Juan,San Miguel, Summit, Teller

157,160

CO Denver Health and Hospital Authority Medicaid MCO Risk-basedCapitation

1915(a) Adams, Arapahoe, Denver, Jefferson 41,932

CO Foothills Behavioral Health Partners Mental HealthPIHP


1915(b) Boulder, Broomfield, Clear Creek, Gilpin, Jefferson 50,500

CO Northeast Behavioral Health Partnership Mental HealthPIHP


1915(b) Cheyenne, Elbert, Kit Carson, Larimer, Lincoln, Logan,Morgan, Phillips, Sedgwick, Washington, Weld, Yuma

56,410

CO Primary Care Physician Program PCCM Fee-For-Service 1932(a) Statewide 22,426

CO Rocky Mountain Health Plan Authority Medical-onlyPIHP

Non-riskCapitation

1915(a) Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel 15,157




7/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesCO Rocky Mountain PACE PACE Risk-based

CapitationPACE El Paso 37

CO Total Long Term Care PACE Risk-basedCapitation

PACE Adams, Arapahoe, Denver, Jefferson 1,263

CO VOANS PACE, Inc PACE Risk-basedCapitation

PACE Delta, Montrose 121

CT Aetna Better Health Commercial MCO Risk-based

Capitation


CT Americhoice by United HealthCare Medicaid MCO Risk-basedCapitation


CT Community Health Network of Connecticut Medicaid MCO Risk-basedCapitation


CT HUSKY Primary Care PCCM Fee-For-Service 1915(b) Greater Waterbury, Greater Windham 168

DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-basedCapitation

1932(a) Statewide 63,915

DC Health Right Incorporated Medicaid MCO Risk-basedCapitation


DC Health Services For Children with SpecialNeeds

Medical-onlyPIHP



DC Medical Transportation Management Transp PAHP Non-riskCapitation

1902(a)(70) Statewide 50,174

DC Unison Health Plan of the Capital Area Medicaid MCO Risk-basedCapitation


DE Delaware Physicians Care, Inc Medicaid MCO Risk-basedCapitation


DE Diamond State Partners *Fee for ServiceModel

Fee-For-Service 1115 Statewide 8,487

DE Unison Health Plan of Delaware, Inc. Medicaid MCO Risk-basedCapitation


FL Access Health Solutions Medical-onlyPAHP

Non-riskCapitation

1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee,Indian River, Manatee, Martin, Nassau, Okeechobee,Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St.

Lucie, Volusia

57,539




8/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesFL Access Health Solutions (Reform) Medical-only

PIHPFFS/Some Risk

Capitation1115 Baker, Broward, Clay, Duval, Nassau 51,260

FL Adult Day Health Care *Adult DayHealth Care

Facility

Fee-For-Service 1915(b)/(c) Lee, Palm Beach 37

FL AIDS Healthcare Foundation, Inc. DiseaseManagement

PAHP

Non-riskCapitation


FL Alternative Medicine Integration DiseaseManagement

PAHP

Non-riskCapitation

1915(b) Hillsborough, Pasco, Pinellas 428

FL Alzheimer's Waiver Service Provider *CommunityCare for the

Elderly Agencies

Fee-For-Service 1915(b)/(c) Broward, Dade, Palm Beach, Pinellas 310

FL American Eldercare Long Term CarePIHP


1915(a)/(c) Alachua, Brevard, Broward, Charlotte, Clay, Dade, Duval,Flagler, Hernando, Highlands, Hillsborough, Indian River,Lake, Lee, Manatee, Marion, Martin, Orange, Osceola, PalmBeach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns,St. Lucie, Volusia

3,821

FL Amerigroup Commercial MCO Risk-basedCapitation

1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lake, Lee,Manatee, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota,Seminole, Volusia

155,880

FL Amerigroup (NHD) Long Term CarePIHP


1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Collier, Dade, Duval,Hernando, Hillsborough, Indian River, Lake, Lee, Manatee,Marion, Martin, Orange, Osceola, Palm Beach, Pasco,Pinellas, Polk, Sarasota, Seminole, St. Johns, St. Lucie,Volusia

2,301

FL Amerigroup (Reform) Commercial MCO Risk-basedCapitation

1115 Broward 22,262

FL Atlantic Dental, Inc. Dental PAHP Risk-basedCapitation

1915(b) Dade 175,971

FL Better Health (Reform) Medical-onlyPIHP

FFS w/Some RiskCapitation

1115 Broward County 4,410

FL Buena Vista Commercial MCO Risk-basedCapitation

1915(b) Broward, Dade, Gadsden, Hendry, Jefferson, Leon, Liberty,Madison, Wakulla

20,981

FL Caremark Disease

ManagementPAHP

Non-risk

Capitation

1915(b) Statewide 85




9/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesFL Children's Medical Services (Reform) Medical-only

PIHPFFS/Some Risk

Capitation1115 Broward, Duval 5,484

FL Citrus (NHD) Long Term CarePIHP


1915(a)/(c) Alachua, Brevard, Broward, Citrus, Dade, Duval, Hernando,Hillsborough, Lake, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole,Volusia

1,226

FL Citrus Health Care Commercial MCO Risk-basedCapitation

1915(b) Hillsborough, Lake, Orange, Osceola, Pasco, Pinellas, Polk,Seminole

27,039

FL Commission for the Transportation of theDisadvantaged

Transp PAHP Flat Rate per Ride 1915(b) Statewide 70,965

FL First Coast Advantage (Reform) Medical-onlyPIHP

FFS/Some RiskCapitation

1115 Duval 29,032

FL Florida Health Partners, Inc. Mental HealthPIHP


1915(b) Hillsborough, Lee, Osceola, Pasco 188,934

FL Florida PACE Centers PACE Risk-basedCapitation

PACE 33125, 33127, 33128, 33129, 33130, 33131, 33132, 33135,33136, 33137, 33138, 33139, 33140, 33141, 33142, 33147,33150, 33154, 33161, 33167, 33168, 33181

231

FL Freedom Health Plan Commercial MCO Risk-basedCapitation

1915(b) Dade, Palm Beach 2,191

FL Freedom Health Plan (Reform) Commercial MCO Risk-basedCapitation

1115 Broward 1,022

FL HealthEase Medicaid MCO Risk-basedCapitation

1915(b) Brevard, Broward, Calhoun, Citrus, Dade, Duval, Escambia,Gadsden, Highlands, Hillsborough, Jefferson, Lake, Leon,Liberty, Madison, Manatee, Marion, Martin, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa,Sarasota, Seminole, Volusia, Wakulla

179,142

FL HealthEase (Reform) Commercial MCO Risk-basedCapitation

1115 Duval 23,508

FL HealthierFlorida (Pfizer Health Solutions,Inc.)

DiseaseManagement

PAHP

Non-riskCapitation


FL Healthy Palm Beaches Medicaid MCO Risk-basedCapitation

1915(b) Palm Beach 7,833

FL Hemophilia of the Sunshine State Disease

ManagementPAHP

Non-risk

Capitation





10/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesFL Hope Life Care Long Term Care

PIHPRisk-basedCapitation

1915(a)/(c) Charlotte, Collier, Hendry, Lee 203

FL Hope Select Care PACE Risk-basedCapitation

PACE Lee 98

FL Humana Family Commercial MCO Risk-basedCapitation

1915(b) Broward, Dade, Palm Beach 36,703

FL Humana Family (Reform) Commercial MCO Risk-based

Capitation

1115 Broward 15,063

FL Humana Medical Plan Long Term CarePIHP


1915(a)/(c) Broward, Dade, Duval, Flagler, Hillsborough, Manatee,Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas,Polk, Sarasota, Seminole, St. Johns, Volusia

605

FL Humana Senior's Choice Long Term CarePIHP


1915(a)/(c) Brevard, Broward, Dade, Indian River, Martin, Okeechobee,Palm Beach, St. Lucie

303

FL JMH Health Plan Commercial MCO Risk-basedCapitation

1915(b) Dade 15,200

FL Lakeview Center, Inc. Mental HealthPIHP


1915(b) Escambia 31,116

FL Little Havana Activities and NutritionCenters

Long Term CarePIHP


1915(a)/(c) Broward, Dade, Palm Beach 847

FL Magellan Behavioral Health of Florida Mental HealthPIHP


1915(b) Dade, Leon, Palm Beach, Volusia 213,091

FL Managed Care of North America Dental PAHP Risk-basedCapitation

1915(b) Dade 6,228

FL MediPass PCCM Fee-For-Service 1915(b) Statewide 455,877

FL Molina Health Care of Florida Medicaid MCO Risk-basedCapitation

1915(b) Broward (Reform), Dade, Hillsborough, Palm Beach, Pasco,Pinellas, Polk

23,731

FL Molina Health Care of Florida (Reform) Commercial MCO Risk-basedCapitation

1115 Broward County 5,023

FL Neighborly Care Network Long Term CarePIHP


1915(a)/(c) Brevard, Broward, Citrus, Dade, Hernando, Hillsborough,Indian River, Manatee, Martin, Orange, Osceola, PalmBeach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie

522




11/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating

AuthorityGeographic Area Served

Number of

EnrolleesFL NetPass Medical-only

PAHPRisk-basedCapitation

1915(b) Baker, Brevard, Broward, Clay, Duval, Flagler, Hardee,Indian River, Manatee, Martin, Nassau, Okeechobee,Orange, Osceola, Palm Beach, Polk, Seminole, St. Johns, St.Lucia, Volusia

13,568

FL NetPass (Reform) Medical-onlyPIHP


1115 Broward 8,002

FL North Florida Behavioral HealthPartnership

Mental HealthPIHP


1915(b) Alachua 88,856

FL Preferred Medical Plan Commercial MCO Risk-basedCapitation

1915(b) Broward, Dade 14,512

FL Preferred Medical Plan (Reform) Commercial MCO Risk-basedCapitation

1115 Broward 2,735

FL Prestige Health Choice Medicaid MCO Risk-basedCapitation

1915(b) Dade, Hillsborough, Lee, Pinellas 16,327

FL Project Independence at Home Long Term CarePIHP


1915(a)/(c) Dade 105

FL Provider Service Network *Shared SavingsModel


1915(b) Dade 9,045

FL Public Health Trust of Dade County Mental HealthPIHP


1915(b) Dade 47,332

FL South Florida Community Care Network(Reform)

Medical-onlyPIHP


1115 Broward 17,792

FL StayWell Commercial MCO Risk-basedCapitation

1915(b) Brevard, Broward, Dade, Hernando, Hillsborough, Lee,Manatee, Orange, Osceola, Palm Beach, Pasco, Pinellas,Polk, Sarasota, Seminole, St. Lucie, Sumter

178,605

FL Sunshine State Health Plan Medicaid MCO Risk-basedCapitation

1915(b) Dade, Hillbourough, Pasco, Pinellas 22,298

FL Total Health Choice Commercial MCO Risk-basedCapitation


FL Total Health Choice (Reform) Commercial MCO Risk-basedCapitation

1115 Broward 18,819

FL United Evercare Commercial MCO Risk-basedCapitation





12/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesFL United Health Care Commercial MCO Risk-based

Capitation1915(b) Brevard, Broward, Citrus, Dade, Duval, Hernando, Highlands,

Hillsborough, Lake, Manatee, Marion, Osceola, Palm Beach,Pasco, Pinellas, Polk, Seminole, Volusia

80,591

FL United Health Care (NHD) Long Term CarePIHP


1915(a)/(c) Brevard, Broward, Charlotte, Citrus, Dade, Duval, Hernando,Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St.Johns, Volusia

2,198

FL United Health Care (Reform) Commercial MCO Risk-based

Capitation

1115 Baker, Clay, Duval, Nassau 10,815

FL United Home Care Services Long Term CarePIHP


1915(a)/(c) Dade 918

FL Universal Health Care Commercial MCO Risk-basedCapitation

1915(b) Dade, Gadsden, Hernando, Hillsborough, Jefferson, Leon,Manatee, Palm Beach, Pasco, Pinellas, Polk, Sarasota,Wakulla

23,127

FL Universal Health Care (NHD) Long Term CarePIHP


1915(a)/(c) Brevard, Charlotte, Citrus, Clay, Collier, Dade, Hernando,Hillsborough, Lake, Lee, Manatee, Marion, Orange, Osceola,Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole

682

FL Universal Health Care (Reform) Commercial MCO Risk-basedCapitation

1115 Broward, Duval 7,003

FL Urban Jacksonville Long Term CarePIHP


1915(a)/(c) Clay, Duval, St. Johns 96

FL Vista Health Plan of South Florida Commercial MCO Risk-basedCapitation

1915(b) Dade 18,945

FL Vista Independence Plan Long Term CarePIHP


1915(a)/(c) Broward, Dade, Palm Beach 1,233

FL YourCare Brevard Long Term CarePIHP


1915(a)/(c) Brevard 62

GA Amerigroup Community Care Medicaid MCO Risk-basedCapitation

1932(a) Atlanta Region, East Region, North Region, Southeast Region 177,441

GA Georgia Better Health Care PCCM Fee-For-Service 1932(a) Statewide 108,619

GA Non-Emergency TransportationBrokerage Program

Transp PAHP Risk-basedCapitation

1902(a)(70) Statewide 1,274,823

GA Peach State Health Plan Medicaid MCO Risk-based

Capitation

1932(a) Atlanta Region, Central Region, Southwest Region 239,247




13/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Number of

EnrolleesGA WellCare Medicaid MCO Risk-based

Capitation1932(a) Atlanta Region, Central Region, East Region, North Region,

Southeast Region, Southwest Region421,656

HI Aloha Care Medicaid MCO Risk-basedCapitation


HI Evercare Commercial MCO Risk-basedCapitation


HI HMSA-Medical Commercial MCO Risk-based

Capitation

1115 Big Island, Kauai, Oahu 97,164

HI Kaiser Permanente Commercial MCO Risk-basedCapitation

1115 Maui, Oahu 22,223

HI Maui PACE PACE Risk-basedCapitation

PACE Maui 17

HI Ohana Commercial MCO Risk-basedCapitation

1115 Maui 22,239

IA Iowa Plan For Behavioral Health MH/SUD PIHP Risk-basedCapitation


IA Medipass PCCM Fee-For-Service 1932(a) Adair, Adams, Allamakee, Appanoose, Audubon, Benton,Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler,Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee,Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas,Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet,Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie,Hamilton, Hancock, Hardin, Harrison, Henry, Howard,Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones,Keokuk, Kossuth, Lee, Linn, Lucas, Lyon, Madison,Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe,

Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto,Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott,Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren,Warren, Wayne, Webster, Winnebago, Winneshiek,Woodbury, Worth, Wright

170,659

IA Siouxland PACE PACE Risk-basedCapitation

PACE Cherokee, Ida, Monona, Plymouth, Sioux, Woodbury 55

ID Blue Cross of Idaho Dental PAHP Risk-basedCapitation


ID Healthy Connections PCCM Fee-for-Service 1937 Statewide 166,524




14/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating

Authority Geographic Area ServedNumber of

Enrollees

ID Medicare-Medicaid Coordinated Plan Medical-onlyPAHP


1937 Ada, Bannock, Benewah, Boise, Bonner, Bonneville,Boundary, Canyon, Caribou, Cassia, Gem, Jefferson,Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida,Owyhee, Payette, Power, Shoshone, Twin Falls, Washington

1,030

IL Family Health Network Medicaid MCO Risk-basedCapitation

1915(a) Cook 44,500

IL Harmony Health Plan Commercial MCO Risk-basedCapitation

1915(a) Cook, Jackson, Kane, Madison, Perry, Randolph, St. Clair,Washington, Williamson

133,200

IL Illinois Health Connect PCCM Fee-For-Service 1932(a) Statewide 1,100,300

IL Meridian Health Plan Medicaid MCO Risk-basedCapitation

1915(a) Adams, Brown, Henry, Mercer, Pike, Rock Island, Scott 200

IN Advantage Health Solutions-Care Select PCCM Fee-For-Service 1915(b) Statewide 28,691

IN Anthem-Healthy Indiana Plan Commercial MCO Risk-basedCapitation


IN Anthem-Hoosier Healthwise Commercial MCO Risk-based

Capitation

1115, 1915(b) Statewide 148,426

IN Enhanced Services Plan (ESP)-HealthyIndiana Plan

*High Risk Plan Fee-For-Service 1115 Statewide 469

IN Managed Health Services (MHS)-HoosierHealthwise


1115, 1915(b) Statewide 191,413

IN MDwise-Care Select PCCM Fee-For-Service 1915(b) Statewide 35,498

IN MDwise-Healthy Indiana Plan Commercial MCO Risk-basedCapitation


IN MDwise-Hoosier Healthwise Commercial MCO Risk-basedCapitation

1115, 1915(b) Statewide 262,780

KS Children's Mercy's Family Health Partners Medicaid MCO Risk-basedCapitation

1932(a) Region 1 (NE/NCentral KS), Region 2 (SE/SCentral KS) 93,316

KS HealthConnect Kansas PCCM Fee-For-Service 1932(a) Statewide 24,050

KS Kansas Health Solutions Mental HealthPAHP

Non-riskCapitation

1915(b)/(c) Statewide 243,352

KS Midland Care Services PACE Risk-based

Capitation

PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie,

Shawnee, Wabaunsee

54




15/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

KS UniCare Health Plan of Kansas, Inc. Medicaid MCO Risk-basedCapitation


KS ValueOptions-Kansas Substance UseDisorders PIHP


1915(b)/(c) Statewide 243,352

KS Via Christi Healthcare OutreachPrograms for Elders


PACE Sedgwick 173

KY Human Service Transportation Transp PAHP Risk-based

Capitation

1902(a)(70) Statewide 638,083

KY Kentucky Patient Access and Care(KenPAC)

PCCM Fee-For-Service 1932(a) Statewide 304,973

KY Passport Health Plan Medicaid MCO Risk-basedCapitation

1115 Jefferson County (Louisville) Kentucky and 15 surroundingcounties

159,005

LA Community Care PCCM Fee-For-Service 1932(a) Statewide 729,219

LA Greater New Orleans PACE Risk-basedCapitation

PACE 70001, 70002, 70003, 70005, 70006, 70032, 70043, 70053,70112, 70113, 70114, 70115, 70116, 70117, 70118, 70119,70121, 70122, 70124, 70125, 70126, 70127, 70128, 70129,

70130, 70131

119

MA Boston Medical Center HealthNet Plan Medicaid MCO Risk-basedCapitation

1115 Boston/Greater Boston Region, Central Region, SouthernRegion, Western Region

181,342

MA Elder Service Plan of Cambridge HealthAlliance


PACE Allston, Cambridge, Somerville 194

MA Elder Service Plan of East Boston PACE Risk-basedCapitation

PACE East Boston 297

MA Elder Service Plan of Harbor Health

Services, Inc.

PACE Risk-based

Capitation

PACE Greater Boston 293

MA Elder Service Plan of the North Shore, Inc. PACE Risk-basedCapitation

PACE Northeastern MA 652

MA Fallon Community Health Plan Commercial MCO Risk-basedCapitation

1115 Central Region 12,259

MA MA Behavioral Health Partnership MH/SUD PIHP Risk-basedCapitation


MA Neighborhood Health Plan Commercial MCO Risk-based

Capitation

1115 Boston/Greater Region, Central/Western Region,

Northeast/Southeast Region

135,287




16/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

MA Network Health Medicaid MCO Risk-basedCapitation

1115 Boston/Greater Boston Region, Central/Western Region,Northeast/Southeast Region

107,286

MA Primary Care Clinician Plan PCCM Fee-For-Service 1115 Statewide 284,404

MA Summit Elder Care PACE Risk-basedCapitation

PACE Worchester 592

MA Uphams Elder Service Plan PACE Risk-basedCapitation

PACE Boston 150

MD AMERIGROUP - PAC Medical-onlyPAHP


1115 Statewide except for Allegany and Washington Count 624

MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-basedCapitation

1115 Statewide except Allegany and Wahington Counties 182,360

MD Hopkins Elder Plus PACE Risk-basedCapitation

PACE 21052, 21202, 21205, 21206, 21213, 21214, 21218, 21219,21220, 21221, 21222, 21224, 21227, 21231, 21237

138

MD JAI Medical System Medicaid MCO Risk-basedCapitation

1115 Baltimore City, Baltimore County 11,012

MD JAI Medical Systems - PAC Medical-onlyPAHP


1115 Baltimore City, Baltimore County 6,136

MD Maryland Physicians Care Medicaid MCO Risk-basedCapitation

1115 Statewide except Cecil County 100,608

MD Maryland Physicians Care - PAC Medical-onlyPAHP



MD Medstar Family Choice Medicaid MCO Risk-basedCapitation

1115 Anne Arundel North, Baltimore City, Baltimore County,Harford

24,795

MD Priority Partners - PAC Medical-onlyPAHP



MD Priority Partners MCO Medicaid MCO Risk-basedCapitation

1115 Statewide except North and East Baltimore County and CecilCounty

143,839

MD The Diamond Plan Medicaid MCO Risk-basedCapitation

1115 Baltimore City, Baltimore County, Cecil, Harford 7,870

MD United Health Care Medicaid MCO Risk-basedCapitation





17/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

MD United HealthCare - PAC Medical-onlyPAHP



ME MaineCare Primary Care CaseManagement


MI Access Alliance of Michigan Mental HealthPIHP


1915(b) Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola 54,216

MI BlueCaid of Michigan Medicaid MCO Risk-basedCapitation

1915(b) Livingston, Washtenaw, Wayne 20,128

MI Care Resources PACE Capitation PACE Kent 154

MI CareSource of Michigan Medicaid MCO Risk-basedCapitation

1915(b) Alcona, Allegan, Alpena, Antrim, Arenac, Benzie, Berrien,Calhoun, Cass, Charlevoix, Cheboygan, Crawford, Genesee,Gladwin, Grand Traverse, Ionia, Iosco, Kalamazoo, Kalkaska,Kent, Lake, Leelanau, Manistee, Mason, Mecosta,Missaukee, Montmorency, Newaygo, Oceana, Ogemaw,Osceola, Oscoda, Ottawa, Presque Isle, Roscommon,Saginaw, St. Joseph, Van Buren

48,143

MI CMH Affiliation of Mid-Michigan Mental HealthPIHP


1915(b) Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee,Newago

84,957

MI CMH for Central Michigan Mental HealthPIHP


1915(b) Clare, Gladwin, Isabella, Mecosta, Midland, Osceola 39,138

MI CMHSA Network of West Michigan Mental HealthPIHP


1915(b) Kent 88,718

MI Comprehensive Senior Care Corporation PACE Risk-basedCapitation

PACE Calhoun 18

MI Detroit-Wayne County CMH Agency Mental Health

PIHP

Risk-based

Capitation

1915(b) Wayne 400,370

MI Genesee County CMH Services Mental HealthPIHP


1915(b) Genesee 84,805

MI Great Lakes Health Plan Medicaid MCO Risk-basedCapitation

1915(b) Allegan, Berrien, Branch, Calhoun, Cass, Hillsdale, Huron,Jackson, Kalamazoo, Lenawee, Livingston, Macomb,Oakland, Saginaw, Sanilac, St. Clair, St. Joseph, Tuscola,Van Buren, Wayne

193,811




18/52

M di id M d C P S


19/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

MI Molina Healthcare of Michigan Medicaid MCO Risk-basedCapitation

1915(b) Alcona, Allegan, Arenac, Bay, Benzie, Clare, Crawford,Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Isabella,Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland,Missaukee, Monroe, Montcalm, Montmorency, Muskegon,Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda,Otsego, Ottawa, Presque Isle, Roscommon, Saginaw,Sanilac, St. Clair, Tuscola, Wayne, Wexford

205,469

MI Northcare Mental HealthPIHP


1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic,Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette,

Menominee, Ontonagon, Schoolcraft

41,636

MI Northern Affiliation Mental HealthPIHP


1915(b) Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet,Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego,Presque Isle

43,437

MI Northern Lakes CMH Authority Mental HealthPIHP


1915(b) Crawford, Grand Traverse, Lake, Leelanau, Mason,Missaukee, Oceana, Roscommon, Wexford

40,434

MI Oakland County CMH Authority Mental HealthPIHP


1915(b) Oakland 95,564

MI Omnicare Health Plan Medicaid MCO Risk-basedCapitation

1915(b) Oakland, Wayne 54,184

MI Physicians Health Plan of Mid-Michigan -Family Care


1915(b) Ingham, Ionia, Montcalm, Shiawassee 17,843

MI Priority Health Government Programs, Inc. Medicaid MCO Risk-basedCapitation

1915(b) Allegan, Kent, Lake, Manistee, Mecosta, Montcalm,Muskegon, Oceana, Osceola, Ottawa

59,560

MI ProCare Health Plan Medicaid MCO Risk-basedCapitation

1915(b) Wayne 1,113

MI Saginaw County CMH Authority Mental Health

PIHP

Risk-based

Capitation

1915(b) Saginaw 38,276

MI Southeast Partnership Mental HealthPIHP


1915(b) Lenawee, Livingston, Monroe, Washtenaw 67,544

MI Southwest Alliance Mental HealthPIHP


1915(b) Allegan, Cass, Kalamazoo, St. Joseph 67,132

MI Thumb Mental Health Alliance Mental HealthPIHP


1915(b) Lapeer, Sanilac, St. Clair 41,820

MI Total Health Care Medicaid MCO Risk-based

Capitation

1915(b) Genesee, Macomb, Oakland, Wayne 53,576




20/52


21/52



22/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

MO Missouri Care Medicaid MCO Risk-basedCapitation

1915(b) Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole,Cooper, Gasconade, Howard, Laclede, Linn, Macon, Maries,Marion, Miller, Moniteau, Monroe, Montgomery, Morgan,Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline,Shelby

40,763

MO Molina Healthcare of Missouri Medicaid MCO Risk-basedCapitation

1915(b) Audrain, Bates, Benton, Boone, Callaway, Camden, Cass,Cedar, Chariton, Clay, Cole, Cooper, Franklin, Gasconade,Henry, Howard, Jackson, Jefferson, Johnson, Laclede,Lafayette, Lincoln, Linn, Macon, Madison, Maries, Marion,

Miller, Moniteau, Monroe, Montgomery, Morgan, Osage,Perry, Pettis, Phelps, Pike, Platte, Polk, Pulaski, Ralls,Randolph, Ray, Saline, Shelby, St. Charles, St. Clair, St.Francois, St. Louis, St. Louis City, Ste. Genevieve, Vernon,Warren, Washington

77,507

MS LogistiCare Soultions, LLC Transp PAHP Risk-basedCapitation

1902(a)(70) Statewide 512,796

MT Billings Clinic PACE Risk-basedCapitation

PACE 59002, 59006, 59015, 59024, 59037, 59044, 59047, 59064,59079, 59088, 59101, 59102, 59105, 59106

24

MT McKesson Health Solutions DiseaseManagement

PAHP



MT Passport to Health PCCM Fee-For-Service 1915(b) Statewide 371

NC Carolina Access PCCM Fee-For-Service 1932(a) Statewide 77,803

NC Community Care of North Carolina(Access II/III)


NC Elderhaus PACE Risk-basedCapitation

PACE Brunswick, New Hanover 26

NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-basedCapitation

1915(b)/(c) Rowan, Stanly, Davidson, Union and Cabarrus Counties 72,734

NC Piedmont SeniorCare PACE Risk-basedCapitation

PACE Caswell, Yancy 24

ND ExperienceHealth ND DiseaseManagement

PAHP



ND Northland PACE PACE Risk-basedCapitation

PACE 58501, 58502, 58503, 58504, 58554, 58558, 58601, 58602,58652, 58655, 58656

25





23/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

ND Primary Care Case Management PCCM Fee-For-Service 1932(a) Statewide 29,339

NE Magellan Behavioral Health *SpecialtyPhysician CaseManagement

(SPCM) Program

Fee-For-Service 1915(b) Statewide 179,512

NE Primary Care Plus PCCM Fee-For-Service 1915(b), 1932(a) Douglas, Lancaster, Sarpy 38,623

NE Share Advantage Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Douglas, Lancaster, Sarpy 36,119

NH McKesson Health Solutions DiseaseManagement

PAHP



NJ AmeriChoice of New Jersey, Inc. Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Statewide 222,083

NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-basedCapitation

1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cape May,Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer,Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset,Sussex, Union, Warren

90,055

NJ Health Net of New Jersey, Inc. Medicaid MCO Risk-basedCapitation

1915(b), 1932(a) Bergen, Burlington, Camden, Cumberland, Essex,Gloucester, Hudson, Mercer, Middlesex, Monmouth, Morris,Ocean, Passaic, Salem, Somerset, Union

41,914

NJ Horizon NJ Health Medicaid MCO Risk-basedCapitation

1915(b), 1932(a) Statewide 324,911

NJ Life at Loudes PACE Risk-basedCapitation

PACE 08002, 08003, 08004, 08007, 08009, 08012, 08021, 08026,08029, 08030, 08031, 08033, 08034, 08035, 08043, 08045,08049, 08059, 08078, 08081, 08083, 08084, 08091, 08095,08099, 08101, 08102, 08103, 08104, 08105, 08106, 08107,

08108, 08109, 08110

14

NJ Life St. Francis PACE Risk-basedCapitation

PACE 08505, 08518, 08554 17

NJ University Health Plans, Inc. Commercial MCO Risk-basedCapitation

1915(b), 1932(a) Atlantic, Bergen, Burlington, Camden, Cumberland, Essex,Gloucester, Hudson, Hunterdon, Mercer, Middlesex,Monmouth, Morris, Ocean, Passaic, Salem, Somerset,Sussex, Union, Warren

46,651

NM AMERIGROUP Community Care of NewMexico, Inc.


1915(b)/(c) Statewide 19,080





24/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

NM Blue Cross Blue Shield of New Mexico Commercial MCO Risk-basedCapitation


NM Evercare of New Mexico Commercial MCO Risk-basedCapitation

1915(b)/(c) Statewide 17,891

NM Lovelace Community Health Plan Commercial MCO Risk-basedCapitation


NM Molina Healthcare of New Mexico Medicaid MCO Risk-basedCapitation


NM Presbyterian Health Plan Commercial MCO Risk-basedCapitation


NM Total Community Care (PACE) PACE Risk-basedCapitation

PACE Bernalillo County, Sandoval County, Valencia County 376

NM ValueOptions of New Mexico Mental HealthPIHP



NV Amerigroup Community Care Medicaid MCO Risk-basedCapitation


NV Health Plan of Nevada Commercial MCO Risk-basedCapitation

1932(a) Clark, Washoe 59,381

NV Logisticare Transp PAHP Risk-basedCapitation


NY Affinity Health Plan Medicaid MCO Risk-basedCapitation

1115 Bronx, Kings, Nassau, New York, Orange, Queens,Richmond, Rockland, Suffolk, Westchester

204,166

NY Affinity/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 81

NY Amerigroup Medicaid MCO Risk-basedCapitation

1115 New York City, Putnam 98,618

NY Amerigroup Community Connections Long Term CarePIHP


1915(a) New York City 585

NY Broome County MC PCCM Fee-For-Service 1115 Broome 3,366

NY Capital District Physicians Health Plan Commercial MCO Risk-basedCapitation

1115 Albany, Broome, Columbia, Fulton, Greene, Montgomery,Rensselaer, Saratoga, Schenectady, Schoharie, Tioga,Washington

53,410





25/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

NY CCM Select Long Term CarePIHP



NY Comprehensive Care Management (CCM) PACE Risk-basedCapitation

PACE New York City, Westchester 2,488

NY Eddy Senior Care PACE Risk-basedCapitation

PACE Albany, Schenectady 113

NY Excellus Commercial MCO Risk-basedCapitation

1115 Broome, Chemung, Clinton, Essex, Franklin, Herkimer,Livingston, Madison, Monroe, Oneida, Onondaga, Ontario,

Orleans, Oswego, Otsego, Seneca, St Lawrence, Wayne,Yates

105,454

NY GHI *PPO Risk-basedCapitation


NY GHI HMO Select Commercial MCO Risk-basedCapitation

1115 Albany, Bronx, Broome, Columbia, Delaware, Dutchess,Greene, Kings, Manhattan, Montgomery, Orange, Otsego,Putnam, Rensselaer, Richmond, Rockland, Saratoga,Schenectady, Sullivan, Ulster, Warren, Washington,Westchester

36,547

NY GHI/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 940

NY Guildnet Long Term CarePIHP


1915(a) New York City 6,522

NY GuildNet/Medicaid Advantage Plus Long Term CarePIHP


1915(a) Statewide 162

NY Health Advantage/Elant Choice Long Term CarePIHP


1915(a) Orange 136

NY Health First Medicaid MCO Risk-basedCapitation

1115 Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk 381,548

NY Health Now Commercial MCO Risk-basedCapitation

1115 Albany, Allegany, Cattauragus, Chautauqua, Clinton,Columbia, Erie, Essex, Fulton, Genesee, Greene,Montgomery, Niagara, Orleans, Rensselaer, Saratoga,Schenectady, Warren, Washington, Wyoming

39,462

NY Health Now/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 166

NY HealthPlus Medicaid MCO Risk-based

Capitation

1115 Bronx, Kings, New York, Queens, Richmond 258,988





26/52

State Plan

June 30, 2009


Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

NY HHH Choices Long Term CarePIHP



NY HIP Combined Commercial MCO Risk-basedCapitation

1115 Bronx, Kings, Nassau, New York, Queens, Richmond,Suffolk, Westchester

255,511

NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-basedCapitation


NY HomeFirst Long Term CarePIHP



NY Hudson Health Plan Medicaid MCO Risk-basedCapitation

1115 Dutchess, Orange, Rockland, Sullivan, Ulster, Westchester 64,812

NY Independent Care Systems Long Term CarePIHP



NY Independent Health/Hudson Valley&WNY Commercial MCO Risk-basedCapitation

1115 Erie, Niagara 31,030

NY Independent Living For Seniors PACE Risk-basedCapitation

PACE Monroe 253

NY Liberty Health Advantage/MedicaidAdvantage


1115 Statewide 703

NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 51

NY MetroPlus Health Plan Medicaid MCO Risk-basedCapitation

1115 Bronx, Kings, New York, Queens 339,331

NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-basedCapitation

1115 Bronx, Brooklyn, Manhattan, Queens 2,962

NY MetroPlus/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 8

NY MVP Health Plan Commercial MCO Risk-basedCapitation

1115 Dutchess, Ulster 32,276

NY Neighborhood Health Provider/MedicaidAdvantage


1115 Statewide 195

NY Neighborhood Health Providers Medicaid MCO Risk-basedCapitation

1115 Bronx, Kings, New York, Queens, Richmond 199,517





27/52

State Plan

June 30, 2009

g g y

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

NY NYPS Select Health Special Needs Medicaid MCO Risk-basedCapitation


NY NYS Catholic Health Plan 1199 Commercial MCO Risk-basedCapitation


NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-basedCapitation

1115 Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton,Columbia, Cortland, Dutchess, Erie, Essex, Greene,Hamilton, Herkimer, Kings, Nassau, New York, Niagara,Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer,Richmond, Rockland, Saratoga, Schenectady, Suffolk,Warren, Washington, Westchester

393,919

NY NYS Catholic HealthPlan/Fidelis/Medicaid Advantage


1115 Statewide 240

NY PACE CNY PACE Risk-basedCapitation

PACE Onondaga 340

NY Partners In Community Care Long Term CarePIHP


1915(a) Orange, Rockland 270

NY Physician Case Management Program PCCM Risk-based

Capitation

1115 Erie 4,947

NY SCHC TotalCare Medicaid MCO Risk-basedCapitation

1115 Onondaga, Oswego, Tompkins 31,284

NY Senior Health Partners Long Term CarePIHP



NY Senior Network Health Long Term CarePIHP



NY Senior Whole Health Medicaid Advantage

Plus

Long Term Care

PIHP

Risk-based

Capitation


NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 599

NY Southern Tier Pediatrics PCCM Risk-basedCapitation

1115 Chemung, Steuben 4,050

NY Southern Tier Priority PCCM Risk-basedCapitation

1115 Chemung, Schuyler, Steuben 4,276

NY Total Aging in Place Long Term Care

PIHP

Risk-based

Capitation

1915(a) Erie 147





28/52

State Plan

June 30, 2009

g g y

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

NY Total Senior Care PACE Risk-basedCapitation

PACE Cattaraugus 16

NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-basedCapitation

1115 Statewide 551

NY United Healthcare Commercial MCO Risk-basedCapitation

1115 Bronx, Kings, Nassau, Queens, Richmond, Suffolk 209,812

NY Univera Community Health Medicaid MCO Risk-basedCapitation

1115 Allegany, Cattaraugus, Chautauqua, Erie 36,123

NY VidaCare Inc. Special Needs Medicaid MCO Risk-basedCapitation

1115 Bronx, Brooklyn, Manhattan, Queens, Staten Island 1,374

NY VNS Choice Long Term CarePIHP



NY VNS Choice Plus/Medicaid AdvantagePlus

Long Term CarePIHP



NY Wellcare Commercial MCO Risk-basedCapitation

1115 Albany, Bronx, Columbia, Dutchess, Greene, Kings, NewYork, Orange, Queens, Rensselaer, Rockland, Sullivan, Ulster

89,419

NY WellCare Advantage Plus/MedicaidAdvantage Plus

Long Term CarePIHP



NY WellCare Advocate Long Term CarePIHP



OH Amerigroup Ohio Medicaid MCO Risk-basedCapitation

1932(a) Southwest, West Central 59,762

OH Buckeye Community Health Plan Medicaid MCO Risk-basedCapitation

1932(a) East Central, Northeast, Northwest, Southwest 140,296

OH CareSource Medicaid MCO Risk-basedCapitation

1932(a) Central, East Central, Northeast, Northeast Central,Northwest, Southeast, Southwest, West Central

689,818

OH Concordia Care PACE Risk-basedCapitation

PACE Cuyahoga 238

OH Molina Healthcare of Ohio Medicaid MCO Risk-basedCapitation

1932(a) Central, Southeast, Southwest, West Central 201,551

OH Paramount Advantage Medicaid MCO Risk-basedCapitation

1932(a) Northwest 76,841





29/52

State Plan

June 30, 2009

g g y

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

OH TriHealth Senior Link PACE Risk-basedCapitation

PACE Butler, Clermont, Hamilton, Warren 454

OH Unison Health Plan of Ohio Medicaid MCO Risk-basedCapitation

1932(a) East Central, Northeast Central, Southeast 108,213

OH WellCare of Ohio Medicaid MCO Risk-basedCapitation

1932(a) Northeast 97,347

OK Cherokee Elder Care PACE Risk-basedCapitation

PACE 74347, 74352, 74364, 74368, 74401, 74423, 74427, 74434,74441, 74451, 74452, 74464, 74471

49

OK SoonerCare American Indian PCCM PCCM Fee-For-Service 1115 Statewide 11,831

OK SoonerCare PCCM PCCM Fee-For-Service 1115 Statewide 400,642

OK SoonerRide Transp PAHP Risk-basedCapitation

1902(a)(70) Statewide 553,385

OR Accountable Behavioral Health Mental HealthPIHP


1115 Benton, Crook, Deschutes, Jefferson, Lincoln 30,076

OR Capitol Dental Care Inc. Dental PAHP Risk-based

Capitation

1115 Benton, Clackamas, Clatsop, Columbia, Hood River,

Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion,Morrow, Multnomah, Polk, Umatilla, Union, Wasco,Washington, Yamhill

131,921

OR Care Oregon Medicaid MCO Risk-basedCapitation

1115 Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson,Klamath, Marion, Morrow, Multnomah, Polk, Umatilla,Washington, Yamhill

114,606

OR Cascade Comprehensive Care Medicaid MCO Risk-basedCapitation

1115 Klamath 6,678

OR Central Oregon Independent Health

Solutions

Medicaid MCO Risk-based

Capitation

1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson,

Klamath, Lake, Sherman, Wasco, Wheeler

22,859

OR Clackamas County Mental Health Mental HealthPIHP


1115 Clackamas, Gilliam, Hood River, Marion, Sherman, Wasco 27,427

OR Deschutes County CDO Substance UseDisorders PAHP


1115 Deschutes 15,615

OR Doctors of the Oregon Coast South Medicaid MCO Risk-basedCapitation

1115 Coos 8,444

OR Douglas County IPA Commercial MCO Risk-based

Capitation

1115 Douglas 12,369





30/52

State Plan

June 30, 2009

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

OR FamilyCare (Mental Health) Mental HealthPIHP


1115 Clackamas, Multnomah, Washington 12,727

OR FamilyCare Health Plans Commercial MCO Risk-basedCapitation

1115 Clackamas, Jackson, Josephine, Morrow, Multnomah,Umatilla, Washington

23,132

OR Greater Oregon Behavioral Health, Inc. Mental HealthPIHP


1115 Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur,Morrow, Umatilla, Union, Wallowa, Wheeler

46,127

OR Hayden Family Dentistry Dental PAHP Risk-basedCapitation

1115 Benton, Clackamas, Coos, Crook, Deschutes, Douglas,Gilliam, Grant, Harney, Jackson, Jefferson, Klamath, Lake,

Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Polk,Sherman, Umatilla, Wasco, Wheeler

60,900

OR Inter-Community Health Network Medicaid MCO Risk-basedCapitation

1115 Benton, Linn 17,999

OR Jefferson Behavioral Health Mental HealthPIHP


1115 Coos, Curry, Douglas, Jackson, Josephine, Klamath 55,904

OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-basedCapitation

1115 Clackamas, Marion, Multnomah, Polk 6,355

OR Lane Care MHO Mental HealthPIHP


1115 Lane 38,210

OR Lane Individual Practice Association Medicaid MCO Risk-basedCapitation

1115 Benton, Lane, Linn 31,541

OR Managed Dental Care of Oregon Dental PAHP Risk-basedCapitation

1115 Benton, Clackamas, Clatsop, Columbia, Hood River,Jackson, Josephine, Linn, Marion, Multnomah, Polk,Tillamook, Washington, Yamhill

10,509

OR Marion Polk Community Health Plan Medicaid MCO Risk-basedCapitation

1115 Benton, Clackamas, Linn, Marion, Polk, Yamhill 45,642

OR Mid Valley Behavioral Care Network Mental HealthPIHP


1115 Linn, Marion, Polk, Tillamook, Yamhill 79,755

OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-basedCapitation

1115 Douglas, Jackson, Josephine 12,880

OR Multicare Dental Dental PAHP Risk-basedCapitation

1115 Clackamas, Multnomah, Washington 28,057

OR Multnomah County Verity Mental HealthPIHP


1115 Multnomah 74,430




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Managed

Care Entity

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Arrangement

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Enrollees

PA County of Beaver - Value BehavioralHealth of PA


1915(b) Beaver 19,792

PA County of Berks - Community CareBehavioral Health


1915(b) Berks 48,242

PA County of Blair County - CommunityBehavioral Healthcare Network of PA


1915(b) Blair 17,435

PA County of Bucks - Magellan BehavioralHealth


1915(b) Bucks 35,983

PA County of Butler - Value BehavioralHealth of PA


1915(b) Butler 13,462

PA County of Cambria - Value BehavioralHealth


1915(b) Cambria 17,308

PA County of Chester - Community CareBehavioral Health


1915(b) Chester 24,311

PA County of Cumberland - CommunityBehavioral Healthcare Network of PA, Inc.


1915(b) Cumberland 13,100

PA County of Dauphin - CommunityBehavioral Healthcare Network of PA, Inc.


1915(b) Dauphin 30,360

PA County of Delaware - MagellanBehavioral Health


1915(b) Delaware 56,058

PA County of Erie - Value Behavioral Health MH/SUD PIHP Risk-basedCapitation

1915(b) Erie 39,483

PA County of Fayette - Value BehavioralHealth of PA


1915(b) Fayette 24,132

PA County of Lancaster - CommunityBehavioral Healthcare Network of PA, Inc.


1915(b) Lancaster 44,157

PA County of Lawrence - Value BehavioralHealth of PA


1915(b) Lawrence 12,361

PA County of Lebanon - CommunityBehavioral Healthcare Network of PA, Inc.


1915(b) Lebanon 12,248

PA County of Lehigh - Magellan BehavioralHealth


1915(b) Lehigh 41,315



J 30 2009



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State Plan

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Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

PA County of Montgomery - MagellanBehavioral Health


1915(b) Montgomery 47,007

PA County of Northampton - MagellanBehavioral Health


1915(b) Northampton 25,482

PA County of Perry - Community BehavioralHealthcare Network of PA, Inc.


1915(b) Perry 3,517

PA County of Philadelphia - C ommunityBehavioral Health


1915(b) Philadelphia 353,115

PA County of Washington - Value BehavioralHealth of PA


1915(b) Washington 20,798

PA County of Westmoreland - ValueBehavioral Health of PA


1915(b) Westmoreland 35,123

PA County of York - Community CareBehavioral Health


1915(b) York 37,574

PA Everyday LIFE PACE Risk-basedCapitation

PACE Lehigh, Northampton 5

PA Gateway Health Plan, Inc. Commercial MCO Risk-basedCapitation

1915(b) Adams, Allegheny, Armstrong, Beaver, Berks, Butler,Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster,Lawrence, Lebanon, Lehigh, Northampton, Perry,Washington, Westmoreland, York

192,419

PA Gateway Health Plan, Inc. -VOL Commercial MCO Risk-basedCapitation

1915(a) Blair, Cambria, Carbon, Clarion, Columbia, Erie, Franklin,Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour,Northumberland, Pike, Schuylkill, Somerset, Susquehanna,Wyoming

19,681

PA Health Partners of Philadelphia Commercial MCO Risk-based

Capitation

1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 124,518

PA Keystone Mercy Health Plan Commercial MCO Risk-basedCapitation

1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 263,884

PA LIFE - Beaver County PACE Risk-basedCapitation

PACE Beaver 122

PA LIFE - Geisinger PACE Risk-basedCapitation

PACE Lackawanna, Luzerne, Montour, Northumberland, Schuylkill,Snyder, Union, Wyoming

98




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State Plan

June 30, 2009

Managed

Care Entity

Reimbursement

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Operating


Enrollees

PR Humana Puerto Rico Commercial MCO Risk-basedCapitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canvanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comero, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Marias, Las Piedras, Loza,Luquillo, Manat, Maricao, Maunabo, Mayaguz, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincon, Ro Grande, Sabana Grande,

Salinas, San German, San Juan, San Lorenzo, SanSebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco

8,338

PR MCS Advantage Commercial MCO Risk-basedCapitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canovanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comerio, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Maras, Las Piedras, Loiza,Luquillo, Manat, Maricao, Maunabo, Mayagez, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincn, Ro Grande, Sabana Grande,Salinas, San German, San Juan, San Lorenzo, SanSebastin, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco

40,124

PR MCS Health Management Options, Inc. Commercial MCO Risk-basedCapitation

1915(a) Aguada, Aguadilla, Aasco, Cabo Rojo, Canovanas,Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela,

Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez,Moca, Rincon, Rio Grande, Sabana Grande, San German,San Juan, San Sebastian, Trujillo Alto, Vieques

260,470




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State Plan

J ,

Managed

Care Entity

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Operating


Enrollees

PR Triple S Commercial MCO Risk-basedCapitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito,Aasco, Arecibo, Arroyo, Barceloneta, Barranquitas,Bayamn, Cabo Rojo, Caguas, Camuy, Canovanas,Carolina, Catao, Cayey, Ceiba, Ciales, Cidra, Coamo,Comerio, Corozal, Culebra, Dorado, Fajardo, Florida,Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo,Hormigueros, Humacao, Isabela, Jayuya, Juana Daz,Juncos, Lajas, Lares, Las Maras, Las Piedras, Lioza,Luquillo, Manat, Maricao, Maunabo, Mayaguz, Moca,Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peuelas,Ponce, Quebradillas, Rincn, Ro Grande, Sabana Grande,

Salinas, San German, San Juan, San Lorenzo, SanSebastin, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto,Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa,Yauco

18,405

PR Triple-S, Inc. Commercial MCO Risk-basedCapitation

1915(a) Adjuntas, Arecibo, Barceloneta, Bayamn, Camuy, Catao,Ciales, Comero, Corozal, Dorado, Florida, Guanica,Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati,Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta,Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco

323,026

RI Blue Cross & Blue Shield of Rhode Island Commercial MCO Risk-based

Capitation


RI Neighborhood Health Plan of RhodeIsland



RI PACE Organization of Rhode Island PACE Risk-basedCapitation

PACE Statewide except for Zip Codes Block Island 02807 164

RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-basedCapitation


RI United HealthCare of New England Commercial MCO Risk-based

Capitation


SC Absolute Total Care Medicaid MCO Risk-basedCapitation

1915(a) Aiken, Allendale, Anderson, Bamberg, Barnwell, Beaufort,Berkely, Calhoun, Charleston, Cherokee, Chester,Chesterfield, Clarendon, Colleton, Darlington, Dillon,Dorchester, Edgefield, Fairfield, Florence, Greenville,Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee,Lexington, Marion, Marlboro, Newberry, Oconee,Orangeburg, Pickens, Richland, Saluda, Spartanburg,Sumter, Union, Williamsburg, York

46,270




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State Plan

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

SC The Oaks PACE PACE Risk-basedCapitation

PACE Orangeburg County 32

SC Unison Health Plan of SC Medicaid MCO Risk-basedCapitation

1915(a) Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell,Beaufort, Berkeley, Calhoun, Chester, Chesterfield,Clarendon, Colleton, Darlington, Dillon, Dorchester,Edgefield, Fairfield, Florence, Georgetown, Greenville,Hampton, Horry, Jasper, Kershaw, Lancaster, Laurens, Lee,Lexington, Marion, Marlboro, Newberry, Oconee,Orangeburg, Pickens, Richland, Saluda, Sumter, Union,Williamsburg, York

53,868

SD PRIME PCCM Fee-For-Service 1932(a) Statewide 85,476

TN Alexian Brothers Community Services PACE Risk-basedCapitation

PACE Hamilton 309

TN AmeriChoice - East TN Medicaid MCO Risk-basedCapitation

1115 East Tennessee 172,670

TN AmeriChoice - Middle TN Medicaid MCO Risk-basedCapitation

1115 Middle Tennessee 189,868

TN AmeriChoice - West TN Medicaid MCO Risk-basedCapitation

1115 West Tennessee 162,647

TN AmeriGroup Community Care Medicaid MCO Risk-basedCapitation

1115 Middle Tennessee 189,937

TN Doral Dental of Tennessee, LLC *Dental BenefitManager

AdministrativeServices Fee


TN Premier Behavioral Systems of TN MH/SUD PIHP Risk-basedCapitation


TN SXC Health Solution Corperation *PharmacyBenefit Manager AdministrativeServices Fee 1115 Statewide 1,230,750

TN Volunteer State Health Plan (Bluecare) -East


1115 East Tennessee 249,726

TN Volunteer State Health Plan (Bluecare) -West


1115 West Tennessee 194,241




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State Plan

Managed

Care Entity

Reimbursement

Arrangement

Operating


Enrollees

TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-basedCapitation


TX Superior HealthPlan (STAR) Medicaid MCO Risk-basedCapitation

1915(b) Atascosa, Bastrop, Bexar, Burnet, Caldwell, Comal, Crosby,El Paso, Floyd, Garza, Guadalupe, Hale, Hays, Hockley,Hudspeth, Kendall, Lamb, Lee, Lubbock, Lynn, Medina,Terry, Travis, Williamson, Wilson

211,806

TX Superior HealthPlan (STAR+Plus) Medicaid MCO Risk-basedCapitation

1915(b),1915(b)/(c)

Aransas, Atascosa, Bee, Bexar, Calhoun, Comal,Guadalupe, Jim Wells, Kendall, Kleberg, Medina, Nueces,Refugio, San Patricio, Victoria, Wilson

35,680

TX Texas Children's Health Plan Medicaid MCO Risk-basedCapitation

1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 153,468

TX Unicare Commercial MCO Risk-basedCapitation

1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 23,699

TX United Commercial MCO Risk-basedCapitation

1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 10,587

TX ValueOptions MH/SUD PIHP FFS/Some RiskBased Capitation

1915(b) Collin County, Dallas County, Ellis County, Hunt County,Kaufman County, Navarro County, Rockwall County

306,513

UT Bear River Mental Health Mental HealthPIHP


1115, 1915(b) Box Elder, Cache, Rich 12,284

UT Central Utah Counseling Center Mental HealthPIHP


1115, 1915(b) Juab, Millard, Piute, Sanpete, Sevier, Wayne 7,115

UT Davis Behavioral Health Mental HealthPIHP


1115, 1915(b) Davis 16,430

UT Four Corners Community BehavioralHealth

Mental HealthPIHP


1115, 1915(b) Carbon, Emery, Grand 4,544

UT Healthy U Medical-onlyPIHP

Non-riskCapitation

1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 29,338

UT Molina Healthcare of Utah (Molina) Medical-onlyPIHP

Non-riskCapitation

1115, 1915(b) Davis, Salt Lake, Utah, Weber 42,116

UT Non-Emergency Medical Transportation Transp PAHP Risk-basedCapitation


UT Northeastern Counseling Center Mental HealthPIHP


1115, 1915(b) Daggett, Duchesne, Uintah 4,207




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State Plan

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Care Entity

Reimbursement

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Operating


Enrollees

VT Vermont PACE PACE Risk-basedCapitation

PACE Chittereden, Dorset, Grand Isle, Manchester, Rupert, SouthHero

76

WA Asuris Northwest Health Commercial MCO Risk-basedCapitation

1932(a) Spokane County 2,003

WA City of Seattle Human Services DiseaseManagement

PAHP


1932(a) King 8,386

WA Columbia United Providers Commercial MCO Risk-basedCapitation

1932(a) Clark 37,848

WA Community Health Plan Commercial MCO Risk-basedCapitation

1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry,Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap,K

Documents

063009 Cms Summary of State MCOs