CMS Enrollment Report

2009 MEDICAID MANAGED CARE ENROLLMENT REPORT SUMMARY STATISTICS AS OF JUNE 30, 2009

This report is composed annually by the Finance, Systems, and Budget Group (FSBG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a plan-specific basis as of June 30, 2009. County level data is not collected. The information was collected from State Medicaid agencies and CMS Regional Offices. Data is presented for all States, the District of Columbia, Puerto Rico, and the Virgin Islands. Data is not presented for the following territories: Guam, Northern Mariana Islands, and American Somoa. Special Thanks to Loan Swisher and Carolyn Lawson of DSG for developing this publication and Joseph Del Pilar of DSG for designing this publication. Please Contact Carolyn Lawson at 410-786-0704; E-mail: [email protected] or Loan Swisher at 410-786-4650; E-mail: [email protected], if you have any questions concerning this report.

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Medicaid Managed Care Enrollment Report as of June 30, 2009

Table of Contents

Managed Care Trends (2000-2009) and National Breakout of Managed Care Entities and Enrollment charts ....................................... Page 1 Total Medicaid Population (in percentages) Distribution by Year: Managed Care versus “Other” from 2004-2009 .................... Page 2 Total Medicaid Population (in millions) Distribution by Year: Managed Care versus “Other” from 2004-2009 ..................... Page 3 Medicaid Managed Care Penetration Rates by State.............................. Page 4 Managed Care Entity Type Enrollment by State .................................... Page 5 Number of Managed Care Entities by State ........................................... Page 6 Top 20 Medicaid Managed Care States ................................................. Page 7 Regional Breakout of Medicaid Managed Care Enrollment & States with Comprehensive Health Care Reform Demonstrations ...... Page 8 Prepaid Ambulatory Health Plans (PAHPs) and Enrollment by State ... Page 9 Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State .......... Page 10 Medicaid Dual Eligible Enrollment by State .......................................... Page 11 Dual Eligible Enrollment by Managed Care Entity Type ...................... Page 12 Dual Eligible Enrollment by Plan ........................................................... Page 13 Medicaid Managed Care Enrollment Plan level data by State .............. Page 22 Facts Sheet (Major changes from 6/30/2008-6/30/2009)………………Page 75 New Medicaid Managed Care Plans……………………………………Page 77 Terminated Medicaid Managed Care Plans…………………………….Page 79 Glossary…………………………………………………………………Page 80

NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT AS OF JUNE 30, 2009

1

TOTAL MEDICAID MANAGED CARE OTHER % MANAGED CAREYEAR POPULATION POPULATION POPULATION ENROLLMENT

2009 50,471,859 36,202,281 14,269,578 71.73%

2008 47,142,791 33,427,582 13,715,209 70.91%

2007 45,962,271 29,463,098 16,499,173 64.10%

2006 45,652,642 29,830,406 15,822,236 65.34%

2005 45,392,325 28,575,585 16,816,740 62.95%

2004 44,355,955 26,913,570 17,442,385 60.68%

2003 42,740,719 25,262,873 17,477,846 59.11%

2002 40,147,539 23,117,668 17,029,871 57.58%

2001 36,562,567 20,773,813 15,788,754 56.82%

2000 33,690,364 18,786,137 14,904,227 55.76%

These figures represent point-in-time enrollment as of June 30th for each reporting year.

The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits. This table also provides unduplicated national figures for the Total Medicaid population and

Other population. The statistics also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

NATIONAL BREAKOUT OF MANAGED CARE ENTITIES

AND ENROLLMENT AS OF JUNE 30, 2009

MANAGED CARE ENTITY TYPE # OF PLANS # OF ENROLLEES

Health Insuring Organization 4 601,662

Commercial Managed Care Organization

159 10,284,082

Medicaid-only Managed Care Organization

159 13,176,581

Primary Care Case Management 36 7,275,241

Prepaid Inpatient Health Plan 152 8,593,773

Prepaid Ambulatory Health Plan 60 7,866,947

Program of ALL-inclusive Care for the Elderly

67 17,091

Other 9 2,113,534

TOTAL 646 49,928,911

This table provides duplicated figures by plan type. The total number of enrollees include 13,726,630 individuals who were individuals who were enrolled in more than one managed care plan. It also includes individuals enrolled in State healthcare reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

MANAGED CARE TRENDS

NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT

2

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

2004 2005 2006 2007 2008 2009

60.68% 62.95% 65.34% 64.10%70.91% 71.73%

39.32% 37.05% 34.66% 35.90%29.09% 28.27%

Perc

ent o

f Tot

al Me

dica

id P

opul

atio

n

Year

Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009

Other

Managed Care

NATIONAL SUMMARY OF MEDICAID MANAGED CARE PROGRAMS AND ENROLLMENT

* Note: Numbers may not add up to totals due to rounding.

3

0.00

10.00

20.00

30.00

40.00

50.00

60.00

2004 2005 2006 2007 2008 2009

26.91 28.58 29.83 29.4633.43 36.20

17.44 16.82 15.82 16.5013.72

14.27

Tota

l Med

icaid

Pop

ulat

ion

(in m

illion

s)

Year

Total Annual Medicaid Population Distribution by Year: Managed Care v. Otheras of June 30, 2009

Other

Managed Care

4

ROW STATE MEDICAID MANAGED CARE PERCENT IN NUMBER ENROLLMENT ENROLLMENT MANAGED CARE

1 ALABAMA 812,220 540,093 66.50%2 ALASKA 101,702 0 0.00%3 ARIZONA 1,223,271 1,096,365 89.63%4 ARKANSAS 645,389 511,014 79.18%5 CALIFORNIA 6,955,761 3,632,547 52.22%6 COLORADO 467,556 444,819 95.14%7 CONNECTICUT 455,878 342,784 75.19%8 DELAWARE 170,562 126,089 73.93%9 DISTRICT OF COLUMBIA 153,779 150,406 97.81%

10 FLORIDA 2,426,010 1,600,550 65.97%11 GEORGIA 1,385,721 1,274,823 92.00%12 HAWAII 235,203 228,174 97.01%13 IDAHO 198,000 166,524 84.10%14 ILLINOIS 2,320,700 1,278,200 55.08%15 INDIANA 961,986 711,636 73.98%16 IOWA 397,823 329,897 82.93%17 KANSAS 297,290 257,464 86.60%18 KENTUCKY 768,777 638,083 83.00%19 LOUISIANA 1,006,842 692,048 68.73%20 MAINE 280,148 178,353 63.66%21 MARYLAND 787,366 620,024 78.75%22 MASSACHUSETTS 1,227,109 731,123 59.58%23 MICHIGAN 1,629,959 1,447,373 88.80%24 MINNESOTA 675,149 426,009 63.10%25 MISSISSIPPI 673,630 512,796 76.12%26 MISSOURI 895,077 883,423 98.70%27 MONTANA 84,785 56,434 66.56%28 NEBRASKA 214,699 179,512 83.61%29 NEVADA 213,440 178,711 83.73%30 NEW HAMPSHIRE 124,498 96,553 77.55%31 NEW JERSEY 968,598 725,614 74.91%32 NEW MEXICO 464,852 344,977 74.21%33 NEW YORK 4,422,121 2,926,950 66.19%34 NORTH CAROLINA 1,442,396 1,012,474 70.19%35 NORTH DAKOTA 60,111 40,605 67.55%36 OHIO 1,951,511 1,374,520 70.43%37 OKLAHOMA 625,546 553,385 88.46%38 OREGON 474,835 418,096 88.05%39 PENNSYLVANIA 1,920,134 1,576,523 82.10%40 PUERTO RICO 1,013,486 977,648 96.46%41 RHODE ISLAND 177,981 110,584 62.13%42 SOUTH CAROLINA 763,225 763,225 100.00%43 SOUTH DAKOTA 107,196 85,476 79.74%44 TENNESSEE 1,230,750 1,230,750 100.00%45 TEXAS 3,343,241 2,161,210 64.64%46 UTAH 238,358 204,793 85.92%47 VERMONT 156,503 137,385 87.78%48 VIRGIN ISLANDS 7,728 0 0.00%49 VIRGINIA 814,820 520,773 63.91%50 WASHINGTON 1,103,291 949,263 86.04%51 WEST VIRGINIA 325,653 149,694 45.97%52 WISCONSIN 1,004,704 606,509 60.37%53 WYOMING 64,489 0 0.00%

TOTALS 50,471,859 36,202,281 71.73%The unduplicated Medicaid enrollment figures include individuals in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards. The unduplicated managed care enrollment figures includes enrollees receiving comprehensive and limited benefits.

MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009

Page 5

Commercial Medicaid-only

STATE HIO MCO MCO PCCM PIHP PAHP PACE OTHERAlabama 0 0 0 443,327 540,093 0 0 0Alaska 0 0 0 0 0 0 0 0Arizona 0 0 1,096,365 0 104,101 0 0 0Arkansas 0 0 0 411,351 0 451,863 21 0California 601,662 2,996,873 7,507 0 157 447,661 2,311 0Colorado 0 0 44,247 22,426 463,464 0 1,421 0Connecticut 0 83,069 259,547 168 0 0 0 0Delaware 0 0 117,602 0 0 0 0 8,487Dist of Columbia 0 0 96,639 0 3,593 50,174 0 0Florida 0 684,903 249,331 455,877 700,431 341,100 329 9,392Georgia 0 0 838,344 108,619 0 1,274,823 0 0Hawaii 0 160,120 68,037 0 0 0 17 0Idaho 0 0 0 166,524 0 130,338 0 0Illinois 0 133,200 44,700 1,100,300 0 0 0 0Indiana 0 455,565 191,413 64,189 0 0 0 469Iowa 0 0 0 170,659 329,897 0 55 0Kansas 0 0 141,000 24,050 243,352 243,352 227 0Kentucky 0 0 159,005 304,973 0 638,083 0 0Louisiana 0 0 0 729,219 0 0 119 0Maine 0 0 0 178,353 0 0 0 0Maryland 0 0 589,540 0 0 30,346 138 0Massachusetts 0 147,546 288,628 284,404 304,821 0 2,178 0Michigan 0 0 1,088,815 0 1,447,373 0 387 0Minnesota 0 375,046 50,963 0 0 0 0 0Mississippi 0 0 0 0 0 512,796 0 0Missouri 0 0 401,314 0 0 481,926 183 0Montana 0 0 0 371 0 368 24 0Nebraska 0 36,119 0 38,623 0 0 0 179,512Nevada 0 59,381 46,921 0 0 178,711 0 0New Hampshire 0 0 0 0 0 96,553 0 0New Jersey 0 268,734 456,880 0 0 0 31 0New Mexico 0 275,942 69,035 0 312,498 0 376 0New York 0 862,624 2,013,976 16,639 24,353 0 3,210 6,148North Carolina 0 0 0 998,909 72,734 0 50 0North Dakota 0 0 0 29,339 0 2,427 25 0Ohio 0 0 1,373,828 0 0 0 692 0Oklahoma 0 0 0 412,473 0 553,385 49 0Oregon 0 35,501 303,046 12,207 399,545 410,448 555 0Pennsylvania 0 965,188 0 262,583 1,442,729 457,520 1,637 0Puerto Rico 0 959,059 0 0 505,302 0 0 0Rhode Island 0 46,216 74,027 0 0 41,717 164 0South Carolina 0 0 341,782 90,136 0 763,367 407 0South Dakota 0 0 0 85,476 0 0 0 0Tennessee 0 0 1,159,089 0 143,322 0 309 1,909,526Texas 0 210,066 1,218,036 732,219 306,513 54,794 889 0Utah 0 0 0 58,484 273,016 176,036 0 0Vermont 0 0 137,385 0 0 0 76 0Virgin Islands 0 0 0 0 0 0 0 0Virginia 0 312,878 153,794 54,101 0 520,773 315 0Washington 0 581,587 0 4,495 949,263 8,386 319 0West Virginia 0 149,694 0 14,747 0 0 0 0Wisconsin 0 484,771 95,785 0 27,216 0 577 0Wyoming 0 0 0 0 0 0 0 0TOTALS 601,662 10,284,082 13,176,581 7,275,241 8,593,773 7,866,947 17,091 2,113,534This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

NUMBER OF MANAGED CARE ENTITY ENROLLEES BY STATE AS OF JUNE 30, 2009

Page 6

Commercial Medicaid-onlySTATE HIO MCO MCO PCCM PIHP PAHP PACE OTHERAlabama 0 0 0 1 2 0 0 0Alaska 0 0 0 0 0 0 0 0Arizona 0 0 29 0 1 0 0 0Arkansas 0 0 0 1 0 1 1 0California 4 23 2 0 1 13 5 0Colorado 0 0 2 1 6 0 3 0Connecticut 0 1 2 1 0 0 0 0Delaware 0 0 2 0 0 0 0 1Dist of Columbia 0 0 3 0 1 1 0 0Florida 0 22 5 1 26 10 2 3Georgia 0 0 3 1 0 1 0 0Hawaii 0 4 1 0 0 0 1 0Idaho 0 0 0 1 0 2 0 0Illinois 0 1 2 1 0 0 0 0Indiana 0 4 1 2 0 0 0 1Iowa 0 0 0 1 1 0 1 0Kansas 0 0 2 1 1 1 2 0Kentucky 0 0 1 1 0 1 0 0Louisiana 0 0 0 1 0 0 1 0Maine 0 0 0 1 0 0 0 0Maryland 0 0 7 0 0 5 1 0Massachusetts 0 2 2 1 1 0 6 0Michigan 0 0 14 0 18 0 4 0Minnesota 0 6 3 0 0 0 0 0Mississippi 0 0 0 0 0 1 0 0Missouri 0 0 6 0 0 1 1 0Montana 0 0 0 1 0 1 1 0Nebraska 0 1 0 1 0 0 0 1Nevada 0 1 1 0 0 1 0 0New Hampshire 0 0 0 0 0 1 0 0New Jersey 0 2 3 0 0 0 2 0New Mexico 0 5 1 0 1 0 1 0New York 0 21 13 4 17 0 5 1North Carolina 0 0 0 2 1 0 2 0North Dakota 0 0 0 1 0 1 1 0Ohio 0 0 7 0 0 0 2 0Oklahoma 0 0 0 2 0 1 1 0Oregon 0 2 13 1 9 8 1 0Pennsylvania 0 11 0 1 38 2 10 0Puerto Rico 0 10 0 0 2 0 0 0Rhode Island 0 2 1 0 0 1 1 0South Carolina 0 0 6 1 0 3 2 0South Dakota 0 0 0 1 0 0 0 0Tennessee 0 0 6 0 2 0 1 2Texas 0 6 13 1 1 1 2 0Utah 0 0 0 1 11 1 0 0Vermont 0 0 1 0 0 0 1 0Virgin Islands 0 0 0 0 0 0 0 0Virginia 0 3 2 1 0 1 4 0Washington 0 8 0 1 1 1 1 0West Virginia 0 3 0 1 0 0 0 0Wisconsin 0 21 5 0 11 0 1 0Wyoming 0 0 0 0 0 0 0 0

TOTALS 4 159 159 36 152 60 67 9

NUMBER OF MANAGED CARE ENTITIES BY STATE AS OF JUNE 30, 2009

7

MEDICAID MANAGED CARE ENROLLMENT AS OF 6/30/09STATES 1-10

Rank States Waiver Type Managed Care Enrollment1 California 1915(b), 1932(a), 1915(a), PACE 3,632,5472 New York 1115(a), 1915(a), PACE 2,926,9503 Texas 1915(b), 1932(a), 1915(a), 1915(b)/(c), PACE 2,161,2104 Florida 1915(b), 1115(a), 1915(b)/(c), 1915(a)/(c), PACE 1,600,5505 Pennsylvania 1915(b), 1915(a), 1902(a)(70), PACE 1,576,5236 Michigan 1915(b), PACE 1,447,3737 Ohio 1932(a), PACE 1,374,5208 Illinois 1932(a), 1915(a) 1,278,2009 Georgia 1932(a), 1902(a)(70) 1,274,823

10 Tennessee 1115(a), PACE 1,230,750Subtotal 18,503,446National Managed Care Grand Total 36,202,143Percentage 51.11%

STATES 11-2011 Arizona 1115(a) 1,096,36512 North Carolina 1915(b)/(c), 1932(a), PACE 1,012,47413 Puerto Rico 1915(a) 977,64814 Washington 1915(b), 1932(a), PACE 949,26315 Missouri 1915(b), 1902(a)(70), PACE 883,42316 South Carolina 1915(b), 1932(a), 1902(a)(70), PACE 763,22517 Massachusetts 1115(a), PACE 731,12318 New Jersey 1915(b), 1932(a), PACE 725,61419 Indiana 1915(b), 1115(a) 711,63620 Louisiana 1932(a), PACE 692,048

Subtotal 8,542,819National Managed Care Grand Total 36,202,143Percentage 23.60%

The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.

REGIONAL BREAK-OUT OF MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2009

REGION MEDICAID MANAGED CARE % REGION BENEFICIARIES % NATIONAL MANAGED ENROLLMENT ENROLLMENT ENROLLED IN MANAGED CARE CARE ENROLLMENT

I - Boston 2,422,117 1,596,782 65.93% 4.41%

II - New York 6,411,933 4,630,212 72.21% 12.79%

III - Philadelphia 4,172,314 3,143,509 75.34% 8.68%

IV - Atlanta 9,502,729 7,572,794 79.69% 20.92%

V - Chicago 8,544,009 5,844,247 68.40% 16.14%

VI - Dallas 6,085,870 4,262,634 70.04% 11.77%

VII - Kansas City 1,804,889 1,650,296 91.43% 4.56%

VIII - Denver 1,022,495 832,127 81.38% 2.30%

IX - San Francisco 8,627,675 5,135,797 59.53% 14.19%

X - Seattle 1,877,828 1,533,883 81.68% 4.24%

TOTALS 50,471,859 36,202,281 71.73% 100.00%

The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.

This table also provides unduplicated Medicaid enrollment figures by region. The enrollment figures include individuals

enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

STATES WITH COMPREHENSIVE HEALTH CARE REFORM DEMONSTRATIONS AS OF JUNE 30, 2009

STATE MEDICAID EXPANSION MANAGED CARE % ENROLLEDENROLLMENT ENROLLMENT ENROLLMENT IN MANAGED CARE

Arizona 1,223,271 183,789 1,096,365 89.63%Arkansas 645,389 3,376 511,014 79.18%Delaware 170,562 24,550 126,089 73.93%Florida 2,426,010 225,749 1,600,550 65.97%Hawaii 235,203 26,277 228,174 97.01%Indiana 961,986 44,828 711,636 73.98%Kentucky 768,777 0 638,083 83.00%Maryland 787,366 30,346 620,024 78.75%Massachusetts 1,227,109 115,929 731,123 59.58%Minnesota 675,149 68,557 426,009 63.10%New York 4,422,121 383,247 2,926,950 66.19%Oklahoma 625,546 0 553,385 88.46%Oregon 474,835 25,374 418,096 88.05%Rhode Island 177,981 20,428 110,584 62.13%Tennessee 1,230,750 30,667 1,230,750 100.00%Utah 238,358 24,022 204,793 85.92%Vermont 156,503 41,967 137,385 87.78%

TOTALS 16,446,916 1,249,106 12,271,010 74.61%

The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits.This table also provides unduplicated Medicaid and Expansion enrollment figures. The enrollment figures includeindividuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibilitystandards.

Page 8

Page 9

StateMedical-

only

Medical-only

EnrolleesMental Health

Mental Health

EnrolleesSubstance

Use Disorders

Substance Use Disorders Enrollees Dental

Dental Enrollees Transportation

Transportation Enrollees

Disease Management

Disease Management

Enrollees

Arkansas 1 451,863

California 13 447,661

District of Columbia 1 50,174

Florida 2 71,107 2 182,199 1 70,965 5 16,829

Georgia 1 1,274,823

Idaho 1 1,030 1 129,308

Kansas 1 243,352

Kentucky 1 638,083

Maryland 5 30,346

Montana 1 368

Mississippi 1 512,796

Missouri 1 481,926

Nevada 1 178,711

New Hampshire 1 96,553

North Dakota 1 2,427

Oklahoma 1 553,385

Oregon 1 15,615 7 394,833

Pennsylvania 1 406,732 1 50,788

Rhode Island 1 41,717

South Carolina 1 142 2 763,225

Texas 1 54,794

Utah 1 176,036

Virginia 1 520,773

Washington 1 8,386

Totals 9 102,625 1 243,352 1 15,615 24 1,195,718 14 6,079,492 11 230,145

Number of Prepaid Ambulatory Health Plans (PAHPs) and Enrollment by State as of June 30, 2009

Page 10

State# of Medical-

only PIHPs Medical-only

Enrollees# of Mental Health

(MH) PIHPsMH PIHP Enrollees

# of MH & SUD PIHPs

MH & SUD Enrollees

# of SUD PIHPs

SUD Enrollees

# of Long Term Care PIHPs

Long Term Care Enrollees

Alabama 2 540,093

Arizona 1 104,101

California 1 157

Colorado 1 15,157 5 448,307

District of Columbia 1 3,593

Florida 6 115,980 5 569,329 15 15122

Iowa 1 329,897

Kansas 1 243,352

Massachusetts 1 304,821

Michigan 18 1,447,373

New Mexico 1 312,498

New York 17 24,353

North Carolina 1 72,734

Oregon 9 399,545

Pennsylvania 4 203 34 1,442,526

Puerto Rico 2 505,302

Tennessee 1 71,661 1 71,661

Texas 1 306,513

Utah 2 71,454 9 201,562

Washington 1 949,263

Wisconsin 2 905 9 26,311

Totals 17 818,141 49 4,328,034 44 3,138,460 1 243,352 41 65,786

Number of Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State as of June 30, 2009

Page 11

State Medicaid Dual EligiblesAlabama 185,738Alaska 12,501Arizona 137,195Arkansas 107,520California 981,725Colorado 68,718Connecticut 83,246Delaware 25,437District of Columbia 19,462Florida 544,958Georgia 234,817Hawaii 28,476Idaho 25,000Illinois 516,032Indiana 128,779Iowa 72,528Kansas 64,358Kentucky 152,054Louisiana 162,278Maine 84,539Maryland 94,159Massachusetts 233,181Michigan 228,609Minnesota 116,451Mississippi 147,884Missouri 160,535Montana 18,904Nebraska 32,875Nevada 32,322New Hampshire 24,891New Jersey 184,158New Mexico 60,067New York 643,204North Carolina 279,230North Dakota 13,385Ohio 267,085Oklahoma 98,219Oregon 82,148Pennsylvania 367,192Puerto Rico 217,652Rhode Island 34,461South Carolina 128,711South Dakota 17,914Tennessee 257,156Texas 559,954Utah 23,136Vermont 32,384Virginia 154,209Washington 136,149West Virginia 69,065Wisconsin 160,867Wyoming 9,050National Total 8,520,568

DUAL ELIGIBLE ENROLLMENT AS OF JUNE 30, 2009

This table provides an unduplicated number of Medicaid dual eligibles receiving full or partial Medicaid benefits.

DUAL ELIGIBLE ENROLLMENT BY MANAGED CARE ENTITY TYPE AS OF JUNE 30, 2009

Page 12

STATE HIO MCO PCCM PIHP PAHP PACE OTHERArizona 93,768Arkansas 45,645 19California 113,960 82,215 14,886 2,068Colorado 2,788 4,786 53,278 1,356Dist. of Columbia 251 17 11,048Florida 21,668 16,776 95 319 294Georgia 129,559Hawaii 25,313 13Idaho 15,822 1,030Iowa 32,222 3Kansas 33,252 33,252 225Kentucky 12,557 88,914Louisiana 97Maryland 129Massachusetts 153 2,047Michigan 370Minnesota 49,553Missouri 152Mississippi 69,166Nebraska 19,557Nevada 38,060New Jersey 20,271 28New Mexico 31,345 355New York 5,291 1,019 20,917 2,626North Carolina 46,957 13,241 28North Dakota 20Ohio 579Oklahoma 98,219 46Oregon 30,569 905 52,344 48,956 555Pennsylvania 2,581 626 188,192 50,955 1,540Puerto Rico 216,417 33,498Rhode Island 153South Carolina 8,337 128,711 395Tennessee 187,246 11,056 309 193,121Texas 86,354 1,017 826Utah 4,621 20,789 14,534Vermont 14,832 72Virginia 106,372 296Washington 519 97,637 304Wisconsin 9,958 36,316 499TOTALS 113,960 893,649 83,073 610,552 879,402 15,429 212,972

MANAGED CARE ENTITY TYPES

This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include invididuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

DUAL ELIGIBLE ENROLLMENT BY PLAN AS OF 6/30/2009

13

State Plan Managed Care Entity EnrollmentAR Total Life Healthcare PACE 19AR Non-Emergency Transportation Transportation PAHP 45,645AZ AZ Physicians IPA (HP) Medicaid-only MCO 15,360AZ Bridgeway Health Solution (HP) Medicaid-only MCO 1,665AZ Bridgeway Health Solution (PC) Medicaid-only MCO 2,173AZ Care 1st Health Plan Medicaid-only MCO 2,834AZ Cochise Co. Dept. of Health Services (PC) Medicaid-only MCO 844

AZDepartment of Economic Security/Division of Developmental Disabilities (PC) Medicaid-only MCO 4,773

AZ Evercare Select (PC) Medicaid-only MCO 3,117AZ Health Choice Arizona (HP) Medicaid-only MCO 12,019AZ Maricopa County Health Plan (HP) Medicaid-only MCO 3,250AZ Mercy Care Plan (HP) Medicaid-only MCO 19,107AZ Mercy Care Plan (PC) Medicaid-only MCO 6,658AZ Phoenix Health Plan/Community Connection (HP) Medicaid-only MCO 9,741AZ Pima Health System (HP) Medicaid-only MCO 137AZ Pima Health System (PC) Medicaid-only MCO 3,559AZ Pinal County Long Term Care (PC) Medicaid-only MCO 1,241AZ SCAN Medicaid-only MCO 2,396AZ University Family Care (HP) Medicaid-only MCO 3,983AZ Yavapai County Long Term Care (PC) Medicaid-only MCO 911CA Access Dental Plan-LA Dental PAHP 1,886CA Access Dental Plan-Sacramento Dental PAHP 2,039CA Alameda Alliance for Health Commercial MCO 3,972CA AltaMed Health Services Corporation PACE 492CA American Health Guard-Dental Plan-LA Dental PAHP 411CA Anthem Blue Cross Partnership Plan - Sacramento Commercial MCO 2,207CA Anthem Blue Cross Partnership Plan-TPMP Commercial MCO 7,880CA Caloptima-Orange HIO 67,165CA Care 1st Health Plan/San Diego Commercial MCO 154CA Care 1st Health Plan-Dental-LA Dental PAHP 733CA Central Coast Alliance For Health HIO 15,153

CACoalition of Elders Independence dba Center for Elders Independence PACE 358

CA Community Dental Services/Sacramento Dental PAHP 361CA Community Dental Services-LA Dental PAHP 196CA Community Eldercare of San Diego dba St. Paul's PACE PACE 64CA Community Health Group Partnership Plan-San Diego Commercial MCO 2,206CA Contra Costa Health Plan Commercial MCO 2,129CA Health Net Community Solutions, Inc. - Sacramento Commercial MCO 724CA Health Net Community Solutions, Inc.-San Diego Commercial MCO 491CA Health Net Community Solutions, Inc.-TPMP Commercial MCO 7,188CA Health Net of CA-Dental-LA Dental PAHP 1,097CA Health Net of CA-Dental-Sacramento Dental PAHP 211CA Health Plan of San Joaquin Commercial MCO 1,461CA Health Plan of San Mateo *MCO/COHS 14,945


14

CA Inland Empire Health Plan Commercial MCO 5,699CA Kern Family Health Care Commercial MCO 1,771CA KP Cal, LLC Commercial MCO 362CA KP Cal, LLC - Sacramento Commercial MCO 1,840CA KP Cal, LLC-San Diego Commercial MCO 1,139CA LA Care Health Plan Commercial MCO 10,856CA Liberty Dental Plan of CA/Sacramento Dental PAHP 949CA Liberty Dental Plan of CA-LA Dental PAHP 328CA Molina Healthcare of California Partner Plan, Inc. - Sacramento Commercial MCO 595CA Molina Healthcare of California Partner Plan, Inc. - San Diego Commercial MCO 903CA Molina Healthcare of California Partner Plan, Inc.-TPMP Commercial MCO 665CA On Lok Senior Health Services dba On Lok Lifeways PACE 958CA Partnership Health Plan HIO 16,835CA Positive Healthcare/AHF Healthcare Centers Medicaid-only MCO 250CA Safeguard Dental-LA Dental PAHP 1,654CA San Francisco Health Plan Commercial MCO 1,457CA Santa Barbara San luis Obispo Regional Health Authority HIO 14,807CA Santa Clara Family Health Plan Commercial MCO 5,491CA Senior Care Action Network (SCAN) Medicaid-only MCO 6,920CA Sutter Health sacramento Sierra dba Sutter Senior Care PACE 196CA Western Dental Services-LA Dental PAHP 2,315CA Western Dental Services-Sacramento Dental PAHP 2,706

CA Western Health Advantage Community Health Plan-Sacramento Commercial MCO 910CO Access Behavioral Care Mental Health (MH) PIHP 9,155CO Behavioral Healthcare, Inc. Mental Health (MH) PIHP 9,421CO Colorado Health Partnerships Mental Health (MH) PIHP 19,627CO Denver Health and Hospital Authority Medicaid-only MCO 2,788CO Foothills Behavioral Health Partners Mental Health (MH) PIHP 6,906CO Northeast Behavioral Health Partnership Mental Health (MH) PIHP 6,285CO Primary Care Physician Program PCCM Provider 4,786CO Rocky Mountain Health Plan Authority Medical-only PIHP 1,884CO Rocky Mountain PACE PACE 23CO Total Long Term Care PACE 1,215CO VOANS PACE, Inc PACE 118DC DC Chartered Health Plan, Incorporated Medicaid-only MCO 173DC Health Right Incorporated Medicaid-only MCO 42DC Health Services For Children with Special Needs Medical-only PIHP 17DC Medical Transportation Management Transportation PAHP 11,048DC Unison Health Plan of the Capital Area Medicaid-only MCO 36FL Access Health Solutions (Reform) Medical-only PIHP 467FL Alzheimer's Waiver Service Provider *Community Care for the Elderly 294FL American Eldercare Long Term Care PIHP 3,821FL Amerigroup Commercial MCO 4,765FL Amerigroup (NHD) Long Term Care PIHP 2,301FL Amerigroup (Reform) Commercial MCO 121FL Atlantic Dental, Inc. Dental PAHP 94


15

FL Better Health (Reform) Medical-only PIHP 25FL Buena Vista Commercial MCO 469FL Children's Medical Services (Reform) Medical-only PIHP 12FL Citrus (NHD) Long Term Care PIHP 1,226FL Citrus Health Care Commercial MCO 488FL First Coast Advantage (Reform) Medical-only PIHP 570FL Florida PACE Centers PACE 221FL Freedom Health Plan Commercial MCO 24FL Freedom Health Plan (Reform) Commercial MCO 9FL HealthEase Medicaid-only MCO 3,724FL HealthEase (Reform) Commercial MCO 78FL Healthy Palm Beaches Medicaid-only MCO 2FL Hope Life Care Long Term Care PIHP 203FL Hope Select Care PACE 98FL Humana Family Commercial MCO 1,584FL Humana Family (Reform) Commercial MCO 172FL Humana Medical Plan Long Term Care PIHP 605FL Humana Senior's Choice Long Term Care PIHP 303FL JMH Health Plan Commercial MCO 571FL Little Havana Activities and Nutrition Centers Long Term Care PIHP 847FL Managed Care of North America Dental PAHP 1FL Molina Health Care of Florida Medicaid-only MCO 234FL Molina Health Care of Florida (Reform) Commercial MCO 32FL Neighborly Care Network Long Term Care PIHP 522FL NetPass (Reform) Medical-only PIHP 251FL Preferred Medical Plan Commercial MCO 416FL Preferred Medical Plan (Reform) Commercial MCO 31FL Project Independence at Home Long Term Care PIHP 105FL South Florida Community Care Network (Reform) Medical-only PIHP 329FL StayWell Commercial MCO 3,725FL Sunshine State Health Plan Medicaid-only MCO 150FL Total Health Choice Commercial MCO 70FL Total Health Choice (Reform) Commercial MCO 199FL United Evercare Commercial MCO 1,940FL United Health Care Commercial MCO 2,092FL United Health Care (NHD) Long Term Care PIHP 2,198FL United Health Care (Reform) Commercial MCO 29FL United Home Care Services Long Term Care PIHP 918FL Universal Health Care Commercial MCO 285FL Universal Health Care (NHD) Long Term Care PIHP 682FL Universal Health Care (Reform) Commercial MCO 86FL Urban Jacksonville Long Term Care PIHP 96FL Vista Health Plan of South Florida Commercial MCO 372FL Vista Independence Plan Long Term Care PIHP 1,233FL YourCare Brevard Long Term Care PIHP 62GA Non-Emergency Transportation Brokerage Program Transportation PAHP 129,559Hi Evercare Commercial MCO 12,450


16

HI Maui PACE PACE 13HI Ohana Commercial MCO 12,863IA Iowa Plan For Behavioral Health MH/SUD PIHP 32,222IA Siouxland PACE PACE 3ID Healthy Connections PCCM Provider 15,822ID Medicare-Medicaid Coordinated Plan Medical-only PAHP 1,030KS Kansas Health Solutions Mental Health (MH) PAHP 33,252KS Midland Care Services PACE 53

KS ValueOptions-KansasSubstance Use Disorders (SUD) PIHP 33,252

KS Via Christi Healthcare Outreach Programs for Elders PACE 172KY Human Service Transportation Transportation PAHP 88,914KY Passport Health Plan Medicaid-only MCO 12,557LA Greater New Orleans PACE 97MA Elder Service Plan of Cambridge Health Alliance PACE 178MA Elder Service Plan of East Boston PACE 277MA Elder Service Plan of Harbor Health Services, Inc. PACE 284MA Elder Service Plan of the North Shore, Inc. PACE 595MA Neighborhood Health Plan Commercial MCO 153MA Summit Elder Care PACE 578MA Uphams Elder Service Plan PACE 135MD Hopkins Elder Plus PACE 129MI Care Resources PACE 146MI Comprehensive Senior Care Corporation PACE 14MI Henry Ford Health System-Center for Senior Independence PACE 189MI Life Circles PACE 21MN Blue Plus Commercial MCO 12,801MN First Plan Blue Commercial MCO 1,450MN Health Partners Commercial MCO 3,845MN Itasca Medical Care Medicaid-only MCO 614MN Medica Commercial MCO 12,266MN Metropolitan Health Plan Commercial MCO 1,371MN PrimeWest Health System Medicaid-only MCO 3,319MN South Country Health Alliance Medicaid-only MCO 3,544MN UCARE Commercial MCO 10,343MO Alexian Brothers Community Services PACE 152MS LogistiCare Soultions, LLC Transportation PAHP 69,166NC Carolina Access PCCM Provider 6,623NC Community Care of North Carolina (Access II/III) PCCM Provider 40,334NC Piedmont Cardinal Health Plan MH/SUD PIHP 13,241NC Piedmont Senior Care PACE 4NC Elderhaus PACE 24ND Northland PACE PACE 20NE Magellan Behavioral Health *Specialty Physician Case 19,557NJ AmeriChoice of New Jersey, Inc. Commercial MCO 5,853NJ AMERIGROUP New Jersey, Inc. Medicaid-only MCO 2,184NJ Health Net of New Jersey, Inc. Medicaid-only MCO 1,490


17

NJ Horizon NJ Health Medicaid-only MCO 9,394NJ LIFE St. Francis PACE 14NJ LIFE at Lourdes PACE 14NJ University Health Plans, Inc. Commercial MCO 1,350NM AMERIGROUP Community Care of New Mexico, Inc. Commercial MCO 16,250NM Evercare of New Mexico Commercial MCO 15,095NM Total Community Care (PACE) PACE 355NV Logisticare Transportation PAHP 38,060NY Affinity/Medicaid Advantage Commercial MCO 81NY Amerigroup Community Connections Long Term Care PIHP 355NY Broome County MC PCCM Provider 11NY CCM Select Long Term Care PIHP 1,017NY Comprehensive Care Management (CCM) PACE 1,986NY Eddy Senior Care PACE 97NY GHI/Medicaid Advantage Commercial MCO 904NY Guildnet Long Term Care PIHP 5,402NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP 160NY Health Advantage/Elant Choice Long Term Care PIHP 129NY Health Now/Medicaid Advantage Commercial MCO 165NY HHH Choices Long Term Care PIHP 617NY HIP Health Plan/Medicaid Advantage Commercial MCO 1,949NY HomeFirst Long Term Care PIHP 2,975NY Independent Care Systems Long Term Care PIHP 722NY Independent Living For Seniors PACE 219NY Liberty Health Advantage/Medicaid Advantage Commercial MCO 610NY Managed Health Inc/Medicaid Advantage Commercial MCO 51NY MetroPlus/Medicaid Advantage Commercial MCO 8NY Neighborhood Health Provider/Medicaid Advantage Commercial MCO 193NY NYS Catholic Health Plan/Fidelis/Medicaid Advantage Commercial MCO 229NY PACE CNY PACE 309NY Partners In Community Care Long Term Care PIHP 245NY Physician Case Management Program PCCM Provider 1,000NY Senior Health Partners Long Term Care PIHP 1,371NY Senior Network Health Long Term Care PIHP 355NY Senior Whole Health Medicaid Advantage Plus Long Term Care PIHP 135NY Senior Whole Health/ Medicaid Advantage Commercial MCO 593NY Southern Tier Priority PCCM Provider 8NY Total Aging in Place Long Term Care PIHP 135NY Total Senior Care PACE 15NY Touchstone/Prestige/Medicaid Advantage Commercial MCO 508NY VNS Choice Long Term Care PIHP 6,904NY VNS Choice Plus/Medicaid Advantage Plus Long Term Care PIHP 21NY WellCare Advantage Plus/Medicaid Advantage Plus Long Term Care PIHP 123NY WellCare Advocate Long Term Care PIHP 251OH Concordia Care PACE 204OH TriHealth Senior Link PACE 375OK Cherokee Elder Care PACE 46


18

OK SoonerRide Transportation PAHP 98,219OR Accountable Behavioral Health Mental Health (MH) PIHP 3,427OR Capitol Dental Care Inc. Dental PAHP 13,921OR Care Oregon Medicaid-only MCO 10,229OR Cascade Comprehensive Care Medicaid-only MCO 690OR Central Oregon Independent Health Solutions Medicaid-only MCO 911OR Clackamas County Mental Health Mental Health (MH) PIHP 3,959

OR Deschutes County CDOSubstance Use Disorder (SUD) PAHP 2,300

OR Doctors of the Oregon Coast South Medicaid-only MCO 1,113OR Douglas County IPA Commercial MCO 1,333OR FamilyCare (Mental Health) Mental Health (MH) PIHP 995OR FamilyCare Health Plans Commercial MCO 1,861OR Greater Oregon Behavioral Health, Inc. Mental Health (MH) PIHP 6,206OR Hayden Family Dentistry Dental PAHP 5,305OR Inter-Community Health Network Medicaid-only MCO 1,893OR Jefferson Behavioral Health Mental Health (MH) PIHP 7,494OR Kaiser Permanente Oregon Plus Medicaid-only MCO 706OR Lane Care MHO Mental Health (MH) PIHP 5,464OR Lane Individual Practice Association Medicaid-only MCO 2,945OR Managed Dental Care of Oregon Dental PAHP 968OR Marion Polk Community Health Plan Medicaid-only MCO 3,958OR Mid Valley Behavioral Care Network Mental Health (MH) PIHP 8,979OR Mid-Rogue Independent Practice Assoc. Medicaid-only MCO 1,346OR Multicare Dental Dental PAHP 2,438OR Multnomah County Verity Mental Health (MH) PIHP 11,313OR Northwest Dental Services Dental PAHP 6,498OR ODS Community Health Inc. Medicaid-only MCO 300OR Oregon Dental Service Dental PAHP 10,064OR Oregon Health Management Service Medicaid-only MCO 433OR PCCM PCCM Provider 905OR Providence Elder Place PACE 555OR Providence Health Assurance Medicaid-only MCO 2,040OR Tuality Health Care Medicaid-only MCO 811OR Washington County Health (Mental Health) Mental Health (MH) PIHP 4,507OR Willamette Dental Dental PAHP 7,462PA Access Plus Program PCCM Provider 626PA Albright LIFE Medical-only PIHP 44PA AmeriChoice of Pennsylvania Commercial MCO 271PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan Commercial MCO 255PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL Commercial MCO 5PA Community Care Behavioral Health - North Central MH/SUD PIHP 18,939PA Community Care Behavioral Health - Northeast MH/SUD PIHP 11,562PA Community LIFE PACE 283

PA Counties of Armstrong/Indiana - Value Behavioral Health of PA MH/SUD PIHP 2,863


19

PACounties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,275

PACounties of Carbon/Monroe/Pike - Community Care Behavioral Health MH/SUD PIHP 3,401

PA Counties of Crawford/Mercer/Venango - Value Behavioral Health MH/SUD PIHP 5,378

PACounties of Franklin/Fulton - Community Behavorial Healthcare Network of Pennsylvania MH/SUD PIHP 1,838

PACounties of Lycoming/Clinton - Community Behavioral Healthcare Network of Pennsylvania MH/SUD PIHP 2,752

PA County of Adams - Community Care Behavioral Health MH/SUD PIHP 849PA County of Allegheny - Community Care Behavioral Health MH/SUD PIHP 19,370PA County of Beaver - Value Behavioral Health of PA MH/SUD PIHP 2,841PA County of Berks - Community Care Behavioral Health MH/SUD PIHP 5,020

PACounty of Blair County - Community Behavioral Healthcare Network of PA MH/SUD PIHP 2,654

PA County of Bucks - Magellan Behavioral Health MH/SUD PIHP 5,074PA County of Butler - Value Behavioral Health of PA MH/SUD PIHP 1,991PA County of Cambria - Value Behavioral Health MH/SUD PIHP 2,756PA County of Chester - Community Care Behavioral Health MH/SUD PIHP 2,999

PACounty of Cumberland - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,711

PACounty of Dauphin - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 3,470

PA County of Delaware - Magellan Behavioral Health MH/SUD PIHP 6,516PA County of Erie - Value Behavioral Health MH/SUD PIHP 4,506PA County of Fayette - Value Behavioral Health of PA MH/SUD PIHP 3,776

PACounty of Lancaster - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 5,288

PA County of Lawrence - Value Behavioral Health of PA MH/SUD PIHP 1,819

PACounty of Lebanon - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 1,485

PA County of Lehigh - Magellan Behavioral Health MH/SUD PIHP 4,965PA County of Montgomery - Magellan Behavioral Health MH/SUD PIHP 5,900PA County of Northampton - Magellan Behavioral Health MH/SUD PIHP 3,333

PACounty of Perry - Community Behavioral Healthcare Network of PA, Inc. MH/SUD PIHP 456

PA County of Philadelphia - Community Behavioral Health MH/SUD PIHP 38,630PA County of Washington - Value Behavioral Health of PA MH/SUD PIHP 3,081PA County of Westmoreland - Value Behavioral Health of PA MH/SUD PIHP 5,387PA County of York - Community Care Behavioral Health MH/SUD PIHP 4,265PA Everyday LIFE PACE 4PA Gateway Health Plan, Inc. Commercial MCO 504PA Gateway Health Plan, Inc. -VOL Commercial MCO 42PA Health Partners of Philadelphia Commercial MCO 351PA Keystone Mercy Health Plan Commercial MCO 526PA LIFE - Beaver County PACE 114


20

PA LIFE - Geisinger PACE 96PA LIFE - Pittsburgh PACE 303PA LIFE - University of Pennsylvania PACE 314PA LIFE at Home PACE 51PA LIFE Butler County Medical-only PIHP 15PA LIFE Lutheran Services PACE 14PA LIFE NWPA Medical-only PIHP 27PA Logisticare Solutions, LLC Transportation PAHP 50,942PA McKesson Health Solutions Disease Management PAHP 13PA Mercy LIFE PACE 221PA New Courtland LIFE Medical-only PIHP 100PA Senior LIFE Johnstown PACE 140PA Unison Health Plan / MedPLUS Commercial MCO 280PA Unison Health Plan/MedPlus - VOL Commercial MCO 63PA UPMC Health Plan, Inc./UPMC for You Commercial MCO 277PA UPMC Health Plan, Inc./UPMC for You - VOL Commercial MCO 7PA Value Behavioral Health of PA (Greene County) MH/SUD PIHP 856PR American Health Medicare Commercial MCO 14,134PR APS Healthcare MH/SUD PIHP 22,054PR FHC Healthcare MH/SUD PIHP 11,444PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO 14,065PR Humana Puerto Rico Commercial MCO 8,338PR MCS Advantage Commercial MCO 40,124PR MCS Health Management Options, Inc. Commercial MCO 16,382PR MMM Healthcare Inc. Commercial MCO 48,755PR PMC Medicare Choice Commercial MCO 32,093PR Salud Dorada con Medicare Commercial MCO 3,292PR Triple S Commercial MCO 18,405PR Triple-S, Inc. Commercial MCO 20,829RI PACE Organization of Rhode Island PACE 153SC Logisticare Transportation PAHP 128,711SC Palmetto SeniorCare (PACE) PACE 367SC South Carolina Solutions PCCM Provider 8,337SC The Oaks PACE PACE 28TN Alexian Brothers Community Services PACE 309TN AmeriChoice - East TN Medicaid-only MCO 34,401TN AmeriChoice - Middle TN Medicaid-only MCO 27,960TN AmeriChoice - West TN Medicaid-only MCO 24,883TN AmeriGroup Community Care Medicaid-only MCO 28,086TN Doral Dental of Tennessee, LLC Dental Benefit Manager 347TN Premier Behavioral Systems of TN MH/SUD PIHP 5,528TN SXC Health Solution Corperation Pharmacy Benefit Manager 192,774TN Volunteer State Health Plan (Bluecare) - East Medicaid-only MCO 45,569TN Volunteer State Health Plan (Bluecare) - West Medicaid-only MCO 26,347TN Volunteer State Health Plan (TennCare Select) *PIHP 5,528TX Amerigroup (STAR+PLUS) Medicaid-only MCO 27,021TX Bienvivir Senior Health Service PACE 700


21

TX Evercare Medicaid-only MCO 32,312TX Jan Werner Adult Day Care Center PACE 126TX Molina (STAR+Plus) Medicaid-only MCO 10,087TX Superior HealthPlan (STAR+Plus) Medicaid-only MCO 16,934TX ValueOptions MH/SUD PIHP 1,017UT Bear River Mental Health Mental Health (MH) PIHP 715UT Central Utah Counseling Center Mental Health (MH) PIHP 631UT Davis Behavioral Health Mental Health (MH) PIHP 1,106UT Four Corners Community Behavioral Health Mental Health (MH) PIHP 488UT Healthy U Medical-only PIHP 2,855UT Molina Healthcare of Utah (Molina) Medical-only PIHP 2,797UT Non-Emergency Medical Transportation Transportation PAHP 14,534UT Northeastern Counseling Center Mental Health (MH) PIHP 366UT Select Access PCCM Provider 4,621UT Southwest Behavioral Health Services Mental Health (MH) PIHP 1,205UT Valley Mental Health Mental Health (MH) PIHP 6,825UT Wasatch Mental Health Mental Health (MH) PIHP 1,938UT Weber Human Services Mental Health (MH) PIHP 1,863VA AllCare for Seniors PACE 26VA LogistiCare Solutions Transportation PAHP 106,372VA Mountain Empire PACE 45VA Riverside Peninsula PACE 104VA Sentara Senior Community Care PACE 121VT Global Committment to Health Medicaid-only MCO 14,832VT Vermont PACE PACE 72WA Molina Healthcare (WMIP) Commercial MCO 519WA Providence ElderPlace - Seattle PACE 304WA Regional Support Network Mental Health (MH) PIHP 97,637WI Abri Health Plan -- Medicaid HMO Commercial MCO 8WI Abri Health Plan -- SSI Commercial MCO 373WI Care Wisconsin First, Inc. Long Term Care PIHP 2,243WI Care Wisconsin Health Plan, Inc. (Partnership) Medicaid-only MCO 977WI Children's Community Health Plan - Medicaid HMO Commercial MCO 1WI CHP-LTS, Inc. Long Term Care PIHP 704WI Community Care Health Plan, Inc. Commercial MCO 1,006WI Community Care, Inc. Long Term Care PIHP 2,916WI Community Care of Central Wisconsin Long Term Care PIHP 2,434WI Community Care Organization (PACE) PACE 499WI Community Health Partnership -- Partnership Commercial MCO 247WI Compcare (formerly Atrium Health Plan) -- Medicaid HMO Commercial MCO 18WI Dean Health Plan -- Medicaid HMO Commercial MCO 6WI Family Care Long Term Care PIHP 16,912WI Group Health Cooperative Of Eau Claire -- Medicaid HMO Commercial MCO 13WI Group Health Cooperative of Eau Claire County SSI Commercial MCO 101

WI Group Health Cooperative Of South Central WI -- Medicaid HMO Commercial MCO 1WI Gundersen Lutheran Health Plan - Medicaid HMO Commercial MCO 5


22

WI Health Tradition Health Plan -- Medicaid HMO Commercial MCO 5WI Independent Care (iCare) - Medicaid HMO Medicaid-only MCO 9WI Independent Care Health Plan -- SSI Medicaid-only MCO 3,077WI Lakeland Care District Long Term Care PIHP 863WI Managed Health Services -- Medicaid HMO Medicaid-only MCO 31WI Managed Health Services -- SSI Medicaid-only MCO 928WI MercyCare Insurance Company -- Medicaid HMO Commercial MCO 8WI Milwaukee County Dept. on Aging Long Term Care PIHP 6,295WI Network Health Plan -- Medicaid HMO Commercial MCO 40WI Network Health Plan - SSI Commercial MCO 403WI Northern Bridges Long Term Care PIHP 739WI Partnership Health Plan Inc. Commercial MCO 1,667WI Security Health Plan -- Medicaid HMO Commercial MCO 27WI Southern Family Care Alliance Long Term Care PIHP 771WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO 111WI UnitedHealthcare of WI -- SSI Commercial MCO 880WI Unity Health Insurance -- Medicaid HMO Commercial MCO 16WI Western Wisconsin Cares Long Term Care PIHP 2,439Total 2,809,037

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-only PIHP

Risk-based Capitation

1915(b) Statewide 21,324

AL Partnership Hospital Program Medical-only PIHP


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-based Capitation


AR Total Life Healthcare PACE Risk-based Capitation

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 Planning Extension)

Medicaid MCO Risk-based Capitation

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-based Capitation

1115 Yavapai 56

AZ Bridgeway Health Solution (HP) Medicaid MCO Risk-based Capitation

1115 LaPaz, Maricopa, Yuma 16,182

AZ Bridgeway Health Solution (PC) Medicaid MCO Risk-based Capitation

1115 Yavapai 2,405

AZ Care 1st Health Plan Medicaid MCO Risk-based Capitation

1115 Maricopa 49,355

AZ Care 1st Health Plan (Family Planning Extension)


1115 Maricopa 208

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

1115 Cochise, Graham, Greenlee 938

AZ Department of Economic Security/Childrens Medical and Dental Program (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

State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

AZ Department of Economic Security/Childrens Medical and Dental Program (HP)


1115 Statewide 9,533

AZ Department of Economic Security/Division of Developmental Disabilities (PC)



AZ Department of Health Services (Behavioral Health)

MH/SUD PIHP Risk-based Capitation

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-based Capitation

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

AZ Health Choice Arizona (Family Planning Extension)


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

791

AZ Health Choice Arizona (HP) Medicaid MCO Risk-based Capitation

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

177,142

AZ Maricopa County Health Plan (Family Planning Extension)


1115 Maricopa 109

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

1115 Maricopa 51,234

AZ Mercy Care Plan (Family Planning Extension)


1115 Cochise, Graham, Greenlee, Maricopa, Pima 994

AZ Mercy Care Plan (HP) Medicaid MCO Risk-based Capitation

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

AZ Mercy Care Plan (PC) Medicaid MCO Risk-based Capitation

1115 Maricopa 8,388

AZ Phoenix Health Plan/Community Connection (Family Planning Extension)


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

710

AZ Phoenix Health Plan/Community Connection (HP)


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

174,038

AZ Pima Health System (Family Planning Extension)


1115 Pima 12

AZ Pima Health System (HP) Medicaid MCO Risk-based Capitation

1115 Pima 2,153



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

AZ Pima Health System (PC) Medicaid MCO Risk-based Capitation

1115 Pima, Santa Cruz 4,210

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

1115 Gila, Pinal 1,433

AZ SCAN Medicaid MCO Risk-based Capitation

1115 Maricopa 2,591

AZ University Family Care (Family Planning Extension)


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

AZ University Family Care (HP) Medicaid MCO Risk-based Capitation

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

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

1115 Yavapai 1,016

CA Access Dental Plan-LA Dental PAHP Risk-based Capitation

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-based Capitation

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

CA AltaMed Health Services Corporation PACE Risk-based Capitation

PACE LA 622

CA American Health Guard-Dental Plan-LA Dental PAHP Risk-based Capitation


CA Anthem Blue Cross Partnership Plan - Sacramento

Commercial MCO Risk-based Capitation

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

CA Anthem Blue Cross Partnership Plan-TPMP


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

349,162

CA Caloptima-Orange HIO Risk-based Capitation

1915(b) Orange 327,163

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

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

CA Care 1st Health Plan-Dental-LA Dental PAHP Risk-based Capitation




State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

CA Central Coast Alliance For Health HIO Risk-based Capitation

1915(b) Monterey, Santa Cruz 96,468

CA Coalition of Elders Independence dba Center for Elders Independence

PACE Risk-based Capitation

PACE Alameda 413

CA Community Dental Services/Sacramento Dental PAHP Risk-based Capitation

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

CA Community Dental Services-LA Dental PAHP Risk-based Capitation


CA Community Eldercare of San Diego dba St. Paul's PACE


PACE San Diego 77

CA Community Health Group Partnership Plan-San Diego


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

CA Contra Costa Health Plan Commercial MCO Risk-based Capitation

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

CA Health Net Community Solutions, Inc. - Sacramento


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-based Capitation


CA Health Net of CA-Dental-Sacramento Dental PAHP Risk-based Capitation

1915(a) Sacramento 12,078

CA Health Plan of San Joaquin Commercial MCO Risk-based Capitation

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

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

1915(b) San Mateo 52,908

CA Inland Empire Health Plan Commercial MCO Risk-based Capitation

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

CA Kern Family Health Care Commercial MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

CA KP Cal, LLC Commercial MCO Risk-based Capitation

1915(a) Marin, Sonoma 2,328

CA KP Cal, LLC - Sacramento Commercial MCO Risk-based Capitation

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

CA KP Cal, LLC-San Diego Commercial MCO Risk-based Capitation

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-based Capitation

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

CA Liberty Dental Plan of CA-LA Dental PAHP Risk-based Capitation

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

CA Molina Healthcare of California Partner Plan, Inc. - Sacramento


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

CA Molina Healthcare of California Partner Plan, Inc. - San Diego


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

CA Molina Healthcare of California Partner Plan, Inc.-TPMP


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

CA On Lok Senior Health Services dba On Lok Lifeways


PACE San Francisco 995

CA Partnership Health Plan HIO Risk-based Capitation

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

CA Positive Healthcare/AHF Healthcare Centers


1915(a) Los Angeles 587

CA Safeguard Dental-LA Dental PAHP Risk-based Capitation

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

CA San Francisco City & CO/Family Mosaic *Emotional and Mental Health Support PIHP


1915(a) San Francisco 157

CA San Francisco Health Plan Commercial MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

CA Santa Clara Family Health Plan Commercial MCO Risk-based Capitation

1915(b), 1932(a) Santa Clara 89,930

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

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

CA Sutter Health sacramento Sierra dba Sutter 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-based Capitation

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

CA Western Health Advantage Community Health Plan-Sacramento


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

CO Access Behavioral Care Mental Health PIHP


1915(b) Denver 80,507

CO Behavioral Healthcare, Inc. Mental Health PIHP


1915(b) East Metro Denver 103,730

CO Colorado Access Medicaid MCO Risk-based Capitation

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

CO Colorado Health Partnerships Mental Health PIHP


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-based Capitation

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

CO Foothills Behavioral Health Partners Mental Health PIHP


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

CO Northeast Behavioral Health Partnership Mental Health PIHP


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-only PIHP

Non-risk Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

CO Rocky Mountain PACE PACE Risk-based Capitation

PACE El Paso 37

CO Total Long Term Care PACE Risk-based Capitation

PACE Adams, Arapahoe, Denver, Jefferson 1,263

CO VOANS PACE, Inc PACE Risk-based Capitation

PACE Delta, Montrose 121

CT Aetna Better Health Commercial MCO Risk-based Capitation


CT Americhoice by United HealthCare Medicaid MCO Risk-based Capitation


CT Community Health Network of Connecticut Medicaid MCO Risk-based Capitation


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

DC DC Chartered Health Plan, Incorporated Medicaid MCO Risk-based Capitation

1932(a) Statewide 63,915

DC Health Right Incorporated Medicaid MCO Risk-based Capitation


DC Health Services For Children with Special Needs

Medical-only PIHP



DC Medical Transportation Management Transp PAHP Non-risk Capitation

1902(a)(70) Statewide 50,174

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


DE Delaware Physicians Care, Inc Medicaid MCO Risk-based Capitation


DE Diamond State Partners *Fee for Service Model

Fee-For-Service 1115 Statewide 8,487

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


FL Access Health Solutions Medical-only PAHP

Non-risk Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

FL Access Health Solutions (Reform) Medical-only PIHP

FFS/Some Risk Capitation

1115 Baker, Broward, Clay, Duval, Nassau 51,260

FL Adult Day Health Care *Adult Day Health Care

Facility

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

FL AIDS Healthcare Foundation, Inc. Disease Management

PAHP

Non-risk Capitation


FL Alternative Medicine Integration Disease Management

PAHP

Non-risk Capitation

1915(b) Hillsborough, Pasco, Pinellas 428

FL Alzheimer's Waiver Service Provider *Community Care for the

Elderly Agencies

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

FL American Eldercare Long Term Care PIHP


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

3,821

FL Amerigroup Commercial MCO Risk-based Capitation

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 Care PIHP


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-based Capitation

1115 Broward 22,262

FL Atlantic Dental, Inc. Dental PAHP Risk-based Capitation

1915(b) Dade 175,971

FL Better Health (Reform) Medical-only PIHP

FFS w/Some Risk Capitation

1115 Broward County 4,410

FL Buena Vista Commercial MCO Risk-based Capitation

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

20,981

FL Caremark Disease Management

PAHP

Non-risk Capitation

1915(b) Statewide 85



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

FL Children's Medical Services (Reform) Medical-only PIHP


1115 Broward, Duval 5,484

FL Citrus (NHD) Long Term Care PIHP


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-based Capitation

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

27,039

FL Commission for the Transportation of the Disadvantaged

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

FL First Coast Advantage (Reform) Medical-only PIHP


1115 Duval 29,032

FL Florida Health Partners, Inc. Mental Health PIHP


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

FL Florida PACE Centers PACE Risk-based Capitation

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-based Capitation

1915(b) Dade, Palm Beach 2,191

FL Freedom Health Plan (Reform) Commercial MCO Risk-based Capitation

1115 Broward 1,022

FL HealthEase Medicaid MCO Risk-based Capitation

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-based Capitation

1115 Duval 23,508

FL HealthierFlorida (Pfizer Health Solutions, Inc.)

Disease Management

PAHP

Non-risk Capitation


FL Healthy Palm Beaches Medicaid MCO Risk-based Capitation

1915(b) Palm Beach 7,833

FL Hemophilia of the Sunshine State Disease Management

PAHP

Non-risk Capitation




State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

FL Hope Life Care Long Term Care PIHP


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

FL Hope Select Care PACE Risk-based Capitation

PACE Lee 98

FL Humana Family Commercial MCO Risk-based Capitation

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 Care PIHP


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 Care PIHP


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

303

FL JMH Health Plan Commercial MCO Risk-based Capitation

1915(b) Dade 15,200

FL Lakeview Center, Inc. Mental Health PIHP


1915(b) Escambia 31,116

FL Little Havana Activities and Nutrition Centers

Long Term Care PIHP


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

FL Magellan Behavioral Health of Florida Mental Health PIHP


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

FL Managed Care of North America Dental PAHP Risk-based Capitation

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-based Capitation

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

23,731

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

1115 Broward County 5,023

FL Neighborly Care Network Long Term Care PIHP


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

522



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

FL NetPass Medical-only PAHP


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-only PIHP


1115 Broward 8,002

FL North Florida Behavioral Health Partnership

Mental Health PIHP


1915(b) Alachua 88,856

FL Preferred Medical Plan Commercial MCO Risk-based Capitation

1915(b) Broward, Dade 14,512

FL Preferred Medical Plan (Reform) Commercial MCO Risk-based Capitation

1115 Broward 2,735

FL Prestige Health Choice Medicaid MCO Risk-based Capitation

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

FL Project Independence at Home Long Term Care PIHP


1915(a)/(c) Dade 105

FL Provider Service Network *Shared Savings Model


1915(b) Dade 9,045

FL Public Health Trust of Dade County Mental Health PIHP


1915(b) Dade 47,332

FL South Florida Community Care Network (Reform)

Medical-only PIHP


1115 Broward 17,792

FL StayWell Commercial MCO Risk-based Capitation

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-based Capitation

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

FL Total Health Choice Commercial MCO Risk-based Capitation


FL Total Health Choice (Reform) Commercial MCO Risk-based Capitation

1115 Broward 18,819

FL United Evercare Commercial MCO Risk-based Capitation




State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

FL United Health Care Commercial MCO Risk-based Capitation

1915(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 Care PIHP


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 Care PIHP


1915(a)/(c) Dade 918

FL Universal Health Care Commercial MCO Risk-based Capitation

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 Care PIHP


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-based Capitation

1115 Broward, Duval 7,003

FL Urban Jacksonville Long Term Care PIHP


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

FL Vista Health Plan of South Florida Commercial MCO Risk-based Capitation

1915(b) Dade 18,945

FL Vista Independence Plan Long Term Care PIHP


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

FL YourCare Brevard Long Term Care PIHP


1915(a)/(c) Brevard 62

GA Amerigroup Community Care Medicaid MCO Risk-based Capitation

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 Transportation Brokerage Program

Transp PAHP Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

GA WellCare Medicaid MCO Risk-based Capitation

1932(a) Atlanta Region, Central Region, East Region, North Region, Southeast Region, Southwest Region

421,656

HI Aloha Care Medicaid MCO Risk-based Capitation


HI Evercare Commercial MCO Risk-based Capitation


HI HMSA-Medical Commercial MCO Risk-based Capitation

1115 Big Island, Kauai, Oahu 97,164

HI Kaiser Permanente Commercial MCO Risk-based Capitation

1115 Maui, Oahu 22,223

HI Maui PACE PACE Risk-based Capitation

PACE Maui 17

HI Ohana Commercial MCO Risk-based Capitation

1115 Maui 22,239

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


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-based Capitation

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

ID Blue Cross of Idaho Dental PAHP Risk-based Capitation


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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

ID Medicare-Medicaid Coordinated Plan Medical-only PAHP


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-based Capitation

1915(a) Cook 44,500

IL Harmony Health Plan Commercial MCO Risk-based Capitation

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-based Capitation

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-based Capitation


IN Anthem-Hoosier Healthwise Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 148,426

IN Enhanced Services Plan (ESP)-Healthy Indiana Plan

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

IN Managed Health Services (MHS)-Hoosier Healthwise


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-based Capitation


IN MDwise-Hoosier Healthwise Commercial MCO Risk-based Capitation

1115, 1915(b) Statewide 262,780

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

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 Health PAHP

Non-risk Capitation

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

KS Midland Care Services PACE Risk-based Capitation

PACE Dogulas, Jackson, Jeffferson, Osage, Pottawatomie, Shawnee, Wabaunsee

54



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

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


KS ValueOptions-Kansas Substance Use Disorders PIHP


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

KS Via Christi Healthcare Outreach Programs 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-based Capitation

1115 Jefferson County (Louisville) Kentucky and 15 surrounding counties

159,005

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

LA Greater New Orleans PACE Risk-based Capitation

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-based Capitation

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

181,342

MA Elder Service Plan of Cambridge Health Alliance


PACE Allston, Cambridge, Somerville 194

MA Elder Service Plan of East Boston PACE Risk-based Capitation

PACE East Boston 297

MA Elder Service Plan of Harbor Health Services, Inc.


PACE Greater Boston 293

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

PACE Northeastern MA 652

MA Fallon Community Health Plan Commercial MCO Risk-based Capitation

1115 Central Region 12,259

MA MA Behavioral Health Partnership MH/SUD PIHP Risk-based Capitation


MA Neighborhood Health Plan Commercial MCO Risk-based Capitation

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

135,287



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MA Network Health Medicaid MCO Risk-based Capitation

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-based Capitation

PACE Worchester 592

MA Uphams Elder Service Plan PACE Risk-based Capitation

PACE Boston 150

MD AMERIGROUP - PAC Medical-only PAHP


1115 Statewide except for Allegany and Washington Count 624

MD AMERIGROUP Maryland Inc. Medicaid MCO Risk-based Capitation

1115 Statewide except Allegany and Wahington Counties 182,360

MD Hopkins Elder Plus PACE Risk-based Capitation

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

138

MD JAI Medical System Medicaid MCO Risk-based Capitation

1115 Baltimore City, Baltimore County 11,012

MD JAI Medical Systems - PAC Medical-only PAHP


1115 Baltimore City, Baltimore County 6,136

MD Maryland Physicians Care Medicaid MCO Risk-based Capitation

1115 Statewide except Cecil County 100,608

MD Maryland Physicians Care - PAC Medical-only PAHP



MD Medstar Family Choice Medicaid MCO Risk-based Capitation

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

24,795

MD Priority Partners - PAC Medical-only PAHP



MD Priority Partners MCO Medicaid MCO Risk-based Capitation

1115 Statewide except North and East Baltimore County and Cecil County

143,839

MD The Diamond Plan Medicaid MCO Risk-based Capitation

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

MD United Health Care Medicaid MCO Risk-based Capitation




State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MD United HealthCare - PAC Medical-only PAHP



ME MaineCare Primary Care Case Management


MI Access Alliance of Michigan Mental Health PIHP


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

MI BlueCaid of Michigan Medicaid MCO Risk-based Capitation

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

MI Care Resources PACE Capitation PACE Kent 154

MI CareSource of Michigan Medicaid MCO Risk-based Capitation

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 Health PIHP


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

84,957

MI CMH for Central Michigan Mental Health PIHP


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

MI CMHSA Network of West Michigan Mental Health PIHP


1915(b) Kent 88,718

MI Comprehensive Senior Care Corporation PACE Risk-based Capitation

PACE Calhoun 18

MI Detroit-Wayne County CMH Agency Mental Health PIHP


1915(b) Wayne 400,370

MI Genesee County CMH Services Mental Health PIHP


1915(b) Genesee 84,805

MI Great Lakes Health Plan Medicaid MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MI Health Plan of Michigan Medicaid MCO Risk-based Capitation

1915(b) Allegan, Barry, Berrien, Branch, Calhoun, Cass, Clinton, Crawford, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Manistee, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newago, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren, Wayne

202,710

MI HealthPlus Partners, Inc. Medicaid MCO Risk-based Capitation

1915(b) Bay, Genesee, Lapeer, Saginaw, Shiawassee, Tuscola 67,721

MI Healthy Kids Dental Dental PAHP Risk-based Capitation

1915(b) Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Benzie, Branch, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickinson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Gratiot, Hillsdale, Houghton, Huron, Ionia, Iosco, Iron, Isabella, Kalkaska, Keweenaw, Lake, Lapeer, Leelanau, Lenawee, Livingston, Luce, Mackinac, Manistee, Marquette, Menominee, Midland, Missaukee, Monroe, Montmorency, Ogemaw, Ontonagon, Oscoda, Otsego, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawassee, St. Clair, St. Joseph, Tuscola, Van Buren

295,794

MI Henry Ford Health System-Center for Senior Independence


PACE 48201, 48202, 48203, 48204, 48205, 48206, 48207, 48208, 48209, 48210, 48211, 48212, 48213, 48214, 48215, 48216, 48217, 48218, 48219, 48221, 48223, 48224, 48225, 48226, 48227, 48228, 48229, 48230, 48234, 48235, 48236, 48238, 48239, 48240

194

MI Lakeshore Behavioral Health Alliance Mental Health PIHP


1915(b) Muskegon, Ottawa 58,964

MI Life Circles PACE Risk-based Capitation

PACE Muskegon, Ottawa 21

MI LifeWays Mental Health PIHP


1915(b) Hillsdale, Jackson 31,591

MI Macomb County CMH Services Mental Health PIHP


1915(b) Macomb 87,717

MI McLaren Health Plan Medicaid MCO Risk-based Capitation

1915(b) Arenac, Bay, Clinton, Crawford, Eaton, Genesee, Gratiot, Ingham, Ionia, Isabella, Lapeer, Macomb, Montcalm, Oakland, Ogemaw, Oscoda, Roscommon, Saginaw, Shiawassee, Tuscola

71,083

MI Midwest Health Plan Medicaid MCO Risk-based Capitation

1915(b) Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne 66,934



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MI Molina Healthcare of Michigan Medicaid MCO Risk-based Capitation

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 Health PIHP


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

41,636

MI Northern Affiliation Mental Health PIHP


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

43,437

MI Northern Lakes CMH Authority Mental Health PIHP


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

40,434

MI Oakland County CMH Authority Mental Health PIHP


1915(b) Oakland 95,564

MI Omnicare Health Plan Medicaid MCO Risk-based Capitation

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-based Capitation

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

59,560

MI ProCare Health Plan Medicaid MCO Risk-based Capitation

1915(b) Wayne 1,113

MI Saginaw County CMH Authority Mental Health PIHP


1915(b) Saginaw 38,276

MI Southeast Partnership Mental Health PIHP


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

MI Southwest Alliance Mental Health PIHP


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

MI Thumb Mental Health Alliance Mental Health PIHP


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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MI Upper Peninsula Health Plan Medicaid MCO Risk-based Capitation

1915(b) Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keewenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft

26,540

MI Venture Behavioral Health Mental Health PIHP


1915(b) Barry, Berrien, Branch, Calhoun, VanBuren 81,054

MN Blue Plus Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Lac Qui Parle, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mcleod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Rouseau, Scott, Sherburne, Sibley, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine

99,354

MN First Plan Blue Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Carlton, Cook, Koochiching, Lake, St. Louis 8,679

MN Health Partners Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Anoka, Benton, Carver, Chisago, Dakota, Hennepin, McLeod, Meeker, Ramsey, Scott, Sherburne, Stearns, Washington, Wright

45,170

MN Itasca Medical Care Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Itasca, Koochiching 5,017

MN Medica Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Lake, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Polk, Ramsey, Rice, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright

119,185

MN Metropolitan Health Plan Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Anoka, Carver, Hennepin, Mower, Polk, Scott 14,352



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MN PrimeWest Health System Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse

18,248

MN South Country Health Alliance Medicaid MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Brown, Cass, Crow Wing, Dodge, Freeborn, Goodhue, Kanabec, Morrison, Sibley, Steele, Todd, Wabasha, Wadena, Waseca

27,698

MN UCARE Commercial MCO Risk-based Capitation

1115, 1932(a), 1915(a),

1915(b)/(c)

Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac Qui Parle, Lake, LeSueur, Lincoln, Lyon, Marshall, Martin, McLeod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Winona, Wright, Yellow Medicine

88,306

MO Alexian Brothers Community Services PACE Risk-based Capitation

PACE St. Louis City, St. Louis County 183

MO Blue Advantage Plus of Kansas City Medicaid MCO Risk-based Capitation

1915(b) Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair

29,057

MO Childrens Mercy Family Health Partners Medicaid MCO Risk-based Capitation

1915(b) Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Polk, Ray, St. Clair, Vernon

51,512

MO Harmony Health Plan of Missouri Medicaid MCO Risk-based Capitation

1915(b) Franklin, Jefferson, Lincoln, Madison, Perry, Pike, St. Charles, St. Francois, St. Louis, St. Louis City, Ste. Genevieve, Warren, Washington

15,318

MO HealthCare USA Medicaid MCO Risk-based Capitation

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, Maries, Marion, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, 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

187,157

MO LogistiCare Solutions, LLC Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 481,926



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

MO Missouri Care Medicaid MCO Risk-based Capitation

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-based Capitation

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-based Capitation

1902(a)(70) Statewide 512,796

MT Billings Clinic PACE Risk-based Capitation

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

24

MT McKesson Health Solutions Disease Management

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-based Capitation

PACE Brunswick, New Hanover 26

NC Piedmont Cardinal Health Plan MH/SUD PIHP Risk-based Capitation

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

NC Piedmont SeniorCare PACE Risk-based Capitation

PACE Caswell, Yancy 24

ND ExperienceHealth ND Disease Management

PAHP



ND Northland PACE PACE Risk-based Capitation

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

25



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

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

NE Magellan Behavioral Health *Specialty Physician Case Management

(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-based Capitation

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

NH McKesson Health Solutions Disease Management

PAHP



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

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

NJ AMERIGROUP New Jersey, Inc. Medicaid MCO Risk-based Capitation

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-based Capitation

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-based Capitation

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

NJ Life at Loudes PACE Risk-based Capitation

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-based Capitation

PACE 08505, 08518, 08554 17

NJ University Health Plans, Inc. Commercial MCO Risk-based Capitation

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 New Mexico, Inc.


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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

NM Blue Cross Blue Shield of New Mexico Commercial MCO Risk-based Capitation


NM Evercare of New Mexico Commercial MCO Risk-based Capitation

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

NM Lovelace Community Health Plan Commercial MCO Risk-based Capitation


NM Molina Healthcare of New Mexico Medicaid MCO Risk-based Capitation


NM Presbyterian Health Plan Commercial MCO Risk-based Capitation


NM Total Community Care (PACE) PACE Risk-based Capitation

PACE Bernalillo County, Sandoval County, Valencia County 376

NM ValueOptions of New Mexico Mental Health PIHP



NV Amerigroup Community Care Medicaid MCO Risk-based Capitation


NV Health Plan of Nevada Commercial MCO Risk-based Capitation

1932(a) Clark, Washoe 59,381

NV Logisticare Transp PAHP Risk-based Capitation


NY Affinity Health Plan Medicaid MCO Risk-based Capitation

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

204,166

NY Affinity/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 81

NY Amerigroup Medicaid MCO Risk-based Capitation

1115 New York City, Putnam 98,618

NY Amerigroup Community Connections Long Term Care PIHP


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-based Capitation

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

53,410



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

NY CCM Select Long Term Care PIHP



NY Comprehensive Care Management (CCM) PACE Risk-based Capitation

PACE New York City, Westchester 2,488

NY Eddy Senior Care PACE Risk-based Capitation

PACE Albany, Schenectady 113

NY Excellus Commercial MCO Risk-based Capitation

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-based Capitation


NY GHI HMO Select Commercial MCO Risk-based Capitation

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-based Capitation

1115 Statewide 940

NY Guildnet Long Term Care PIHP


1915(a) New York City 6,522

NY GuildNet/Medicaid Advantage Plus Long Term Care PIHP


1915(a) Statewide 162

NY Health Advantage/Elant Choice Long Term Care PIHP


1915(a) Orange 136

NY Health First Medicaid MCO Risk-based Capitation

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

NY Health Now Commercial MCO Risk-based Capitation

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-based Capitation

1115 Statewide 166

NY HealthPlus Medicaid MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

NY HHH Choices Long Term Care PIHP



NY HIP Combined Commercial MCO Risk-based Capitation

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

255,511

NY HIP Health Plan/Medicaid Advantage Commercial MCO Risk-based Capitation


NY HomeFirst Long Term Care PIHP



NY Hudson Health Plan Medicaid MCO Risk-based Capitation

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

NY Independent Care Systems Long Term Care PIHP



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

1115 Erie, Niagara 31,030

NY Independent Living For Seniors PACE Risk-based Capitation

PACE Monroe 253

NY Liberty Health Advantage/Medicaid Advantage


1115 Statewide 703

NY Managed Health Inc/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 51

NY MetroPlus Health Plan Medicaid MCO Risk-based Capitation

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

NY MetroPlus Health Plan Special Needs Medicaid MCO Risk-based Capitation

1115 Bronx, Brooklyn, Manhattan, Queens 2,962

NY MetroPlus/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 8

NY MVP Health Plan Commercial MCO Risk-based Capitation

1115 Dutchess, Ulster 32,276

NY Neighborhood Health Provider/Medicaid Advantage


1115 Statewide 195

NY Neighborhood Health Providers Medicaid MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

NY NYPS Select Health Special Needs Medicaid MCO Risk-based Capitation


NY NYS Catholic Health Plan 1199 Commercial MCO Risk-based Capitation


NY NYS Catholic Health Plan/Fidelis Medicaid MCO Risk-based Capitation

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 Health Plan/Fidelis/Medicaid Advantage


1115 Statewide 240

NY PACE CNY PACE Risk-based Capitation

PACE Onondaga 340

NY Partners In Community Care Long Term Care PIHP


1915(a) Orange, Rockland 270

NY Physician Case Management Program PCCM Risk-based Capitation

1115 Erie 4,947

NY SCHC TotalCare Medicaid MCO Risk-based Capitation

1115 Onondaga, Oswego, Tompkins 31,284

NY Senior Health Partners Long Term Care PIHP



NY Senior Network Health Long Term Care PIHP



NY Senior Whole Health Medicaid Advantage Plus

Long Term Care PIHP



NY Senior Whole Health/ Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 599

NY Southern Tier Pediatrics PCCM Risk-based Capitation

1115 Chemung, Steuben 4,050

NY Southern Tier Priority PCCM Risk-based Capitation

1115 Chemung, Schuyler, Steuben 4,276

NY Total Aging in Place Long Term Care PIHP


1915(a) Erie 147



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

NY Total Senior Care PACE Risk-based Capitation

PACE Cattaraugus 16

NY Touchstone/Prestige/Medicaid Advantage Commercial MCO Risk-based Capitation

1115 Statewide 551

NY United Healthcare Commercial MCO Risk-based Capitation

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

NY Univera Community Health Medicaid MCO Risk-based Capitation

1115 Allegany, Cattaraugus, Chautauqua, Erie 36,123

NY VidaCare Inc. Special Needs Medicaid MCO Risk-based Capitation

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

NY VNS Choice Long Term Care PIHP



NY VNS Choice Plus/Medicaid Advantage Plus

Long Term Care PIHP



NY Wellcare Commercial MCO Risk-based Capitation

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

89,419

NY WellCare Advantage Plus/Medicaid Advantage Plus

Long Term Care PIHP



NY WellCare Advocate Long Term Care PIHP



OH Amerigroup Ohio Medicaid MCO Risk-based Capitation

1932(a) Southwest, West Central 59,762

OH Buckeye Community Health Plan Medicaid MCO Risk-based Capitation

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

OH CareSource Medicaid MCO Risk-based Capitation

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

689,818

OH Concordia Care PACE Risk-based Capitation

PACE Cuyahoga 238

OH Molina Healthcare of Ohio Medicaid MCO Risk-based Capitation

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

OH Paramount Advantage Medicaid MCO Risk-based Capitation

1932(a) Northwest 76,841



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

OH TriHealth Senior Link PACE Risk-based Capitation

PACE Butler, Clermont, Hamilton, Warren 454

OH Unison Health Plan of Ohio Medicaid MCO Risk-based Capitation

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

OH WellCare of Ohio Medicaid MCO Risk-based Capitation

1932(a) Northeast 97,347

OK Cherokee Elder Care PACE Risk-based Capitation

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-based Capitation

1902(a)(70) Statewide 553,385

OR Accountable Behavioral Health Mental Health PIHP


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-based Capitation

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

114,606

OR Cascade Comprehensive Care Medicaid MCO Risk-based Capitation

1115 Klamath 6,678

OR Central Oregon Independent Health Solutions


1115 Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler

22,859

OR Clackamas County Mental Health Mental Health PIHP


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

OR Deschutes County CDO Substance Use Disorders PAHP


1115 Deschutes 15,615

OR Doctors of the Oregon Coast South Medicaid MCO Risk-based Capitation

1115 Coos 8,444

OR Douglas County IPA Commercial MCO Risk-based Capitation

1115 Douglas 12,369



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

OR FamilyCare (Mental Health) Mental Health PIHP


1115 Clackamas, Multnomah, Washington 12,727

OR FamilyCare Health Plans Commercial MCO Risk-based Capitation

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

23,132

OR Greater Oregon Behavioral Health, Inc. Mental Health PIHP


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

46,127

OR Hayden Family Dentistry Dental PAHP Risk-based Capitation

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-based Capitation

1115 Benton, Linn 17,999

OR Jefferson Behavioral Health Mental Health PIHP


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

OR Kaiser Permanente Oregon Plus Medicaid MCO Risk-based Capitation

1115 Clackamas, Marion, Multnomah, Polk 6,355

OR Lane Care MHO Mental Health PIHP


1115 Lane 38,210

OR Lane Individual Practice Association Medicaid MCO Risk-based Capitation

1115 Benton, Lane, Linn 31,541

OR Managed Dental Care of Oregon Dental PAHP Risk-based Capitation

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-based Capitation

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

OR Mid Valley Behavioral Care Network Mental Health PIHP


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

OR Mid-Rogue Independent Practice Assoc. Medicaid MCO Risk-based Capitation

1115 Douglas, Jackson, Josephine 12,880

OR Multicare Dental Dental PAHP Risk-based Capitation

1115 Clackamas, Multnomah, Washington 28,057

OR Multnomah County Verity Mental Health PIHP


1115 Multnomah 74,430



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

OR Northwest Dental Services Dental PAHP Risk-based Capitation

1115 Baker, Coos, Crook, Curry, Deschutes, Douglas, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Malheur, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler

58,028

OR ODS Community Health Inc. Medicaid MCO Risk-based Capitation

1115 Baker, Deschutes, Jackson, Malheur, Union, Wallowa 7,232

OR Oregon Dental Service Dental PAHP Risk-based Capitation

1115 Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Grant, Hood River, Jackson, Jefferson, Josephine, Lane, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Wasco, Washington, Yamhill

48,745

OR Oregon Health Management Service Medicaid MCO Risk-based Capitation

1115 Douglas, Jackson, Josephine 4,351

OR PCCM PCCM Fee-For-Service 1115 Statewide 12,207

OR Providence Elder Place PACE Risk-based Capitation

PACE 97009, 97010, 97014, 97019, 97024, 97030, 97034, 97035, 97056, 97060, 97080, 97124, 97133, 97201, 97202, 97203, 97204, 97205, 97206, 97209, 97210, 97211, 97212, 97213, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97222, 97225, 97227, 97229, 97230, 97231, 97232, 97233, 97236, 97239, 97258, 97266

555

OR Providence Health Assurance Medicaid MCO Risk-based Capitation

1115 Clackamas, Multnomah, Washington, Yamhill 17,183

OR Tuality Health Care Medicaid MCO Risk-based Capitation

1115 Washington 7,276

OR Washington County Health (Mental Health)

Mental Health PIHP


1115 Washington 34,889

OR Willamette Dental Dental PAHP Risk-based Capitation

1115 Benton, Clackamas, Deschutes, Douglas, Jackson, Josephine, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Tillamook, Washington

56,673

PA Access Plus Program PCCM Fee-For-Service 1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming

262,583

PA Albright LIFE Medical-only PIHP


1915(a) Clinton, Lancaster, Lycoming 46



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PA AmeriChoice of Pennsylvania Commercial MCO Risk-based Capitation

1915(b) Bucks, Chester, Delaware, Montgomery, Philadelphia 57,378

PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan


1915(b) Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, York

87,673

PA AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL


1915(a) Carbon, Lackawanna, Luzerne, Monroe, Pike 2,262

PA Community Care Behavioral Health - North Central


1915(b) Bradford, Cameron, Centre, Clarion, Clearfield, Columbia, Elk, Forest, Huntingdon, Jefferson, Juniat

121,194

PA Community Care Behavioral Health - Northeast


1915(b) Lackawanna, Luzerne, Susquehanna, Wyoming 74,059

PA Community LIFE PACE Risk-based Capitation

PACE 14145, 15014, 15018, 15020, 15024, 15025, 15028, 15030, 15032, 15034, 15035, 15037, 15045, 15047, 15049, 15051, 15065, 15075, 15076, 15084, 15088, 15102, 15104, 15110, 15112, 15120, 15122, 15129, 15131, 15132, 15133, 15135, 15137, 15139, 15140, 15144, 15146, 15147, 15148, 15206, 15207, 15208, 15215, 15217, 15218, 15221, 15227, 15232, 15234, 15235, 15236, 15238, 15239

298

PA Counties of Armstrong/Indiana - Value Behavioral Health of PA


1915(b) Armstrong, Indiana 17,134

PA Counties of Bedford/Somerset - Community Behavioral Healthcare Network of Pennsylvania


1915(b) Bedford 13,280

PA Counties of Carbon/Monroe/Pike - Community Care Behavioral Health


1915(b) Carbon, Monroe, Pike 30,595

PA Counties of Crawford/Mercer/Venango - Value Behavioral Health


1915(b) Crawford, Mercer, Venango 35,594

PA Counties of Franklin/Fulton - Community Behavorial Healthcare Network of Pennsylvania


1915(b) Franklin, Fulton 13,874

PA Counties of Lycoming/Clinton - Community Behavioral Healthcare Network of Pennsylvania


1915(b) Clinton, Lycoming 18,341

PA County of Adams - Community Care Behavioral Health


1915(b) Adams 6,971

PA County of Allegheny - Community Care Behavioral Health


1915(b) Allegheny 133,123



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PA County of Beaver - Value Behavioral Health of PA


1915(b) Beaver 19,792

PA County of Berks - Community Care Behavioral Health


1915(b) Berks 48,242

PA County of Blair County - Community Behavioral Healthcare Network of PA


1915(b) Blair 17,435

PA County of Bucks - Magellan Behavioral Health


1915(b) Bucks 35,983

PA County of Butler - Value Behavioral Health of PA


1915(b) Butler 13,462

PA County of Cambria - Value Behavioral Health


1915(b) Cambria 17,308

PA County of Chester - Community Care Behavioral Health


1915(b) Chester 24,311

PA County of Cumberland - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Cumberland 13,100

PA County of Dauphin - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Dauphin 30,360

PA County of Delaware - Magellan Behavioral Health


1915(b) Delaware 56,058

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

1915(b) Erie 39,483

PA County of Fayette - Value Behavioral Health of PA


1915(b) Fayette 24,132

PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Lancaster 44,157

PA County of Lawrence - Value Behavioral Health of PA


1915(b) Lawrence 12,361

PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Lebanon 12,248

PA County of Lehigh - Magellan Behavioral Health


1915(b) Lehigh 41,315



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PA County of Montgomery - Magellan Behavioral Health


1915(b) Montgomery 47,007

PA County of Northampton - Magellan Behavioral Health


1915(b) Northampton 25,482

PA County of Perry - Community Behavioral Healthcare Network of PA, Inc.


1915(b) Perry 3,517

PA County of Philadelphia - Community Behavioral Health


1915(b) Philadelphia 353,115

PA County of Washington - Value Behavioral Health of PA


1915(b) Washington 20,798

PA County of Westmoreland - Value Behavioral Health of PA


1915(b) Westmoreland 35,123

PA County of York - Community Care Behavioral Health


1915(b) York 37,574

PA Everyday LIFE PACE Risk-based Capitation

PACE Lehigh, Northampton 5

PA Gateway Health Plan, Inc. Commercial MCO Risk-based Capitation

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-based Capitation

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


PA Keystone Mercy Health Plan Commercial MCO Risk-based Capitation


PA LIFE - Beaver County PACE Risk-based Capitation

PACE Beaver 122

PA LIFE - Geisinger PACE Risk-based Capitation

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

98



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PA LIFE - Pittsburgh PACE Risk-based Capitation

PACE 15006, 15007, 15015, 15017, 15031, 15044, 15046, 15056, 15064, 15071, 15082, 15086, 15090, 15091, 15101, 15106, 15108, 15116, 15126, 15127, 15136, 15142, 15143, 15201, 15202, 15203, 15204, 15205, 15209, 15210, 15211, 15212, 15213, 15214, 15216, 15219, 15220, 15222, 15223, 15224, 15225, 15226, 15228, 15229, 15233, 15237, 15241, 15243

320

PA LIFE - University of Pennsylvania PACE Risk-based Capitation

PACE 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153

341

PA LIFE at Home PACE Risk-based Capitation

PACE Chester, Delaware 59

PA LIFE Butler County Medical-only PIHP


1915(a) Butler 16

PA LIFE Lutheran Services PACE Risk-based Capitation

PACE Franklin 15

PA LIFE NWPA Medical-only PIHP


1915(a) Erie 28

PA Logisticare Solutions, LLC Transp PAHP Risk-based Capitation

1902(a)(70) Philadelphia 406,732

PA McKesson Health Solutions Disease Management

PAHP


1915(b) Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntington, Jefferson, Juniata, Lackwanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming

50,788

PA Mercy LIFE PACE Risk-based Capitation

PACE 19106, 19107, 19111, 19114, 19115, 19116, 19123, 19124, 19125, 19134, 19135, 19136, 19137, 19145, 19146, 19147, 19148, 19149, 19152, 19154

234

PA New Courtland LIFE Medical-only PIHP


1915(a) Philadelphia County zip codes 19118, 19119, 19120, 19126, 19127, 19128, 19129, 19132, 19138, 19141,

113

PA Senior LIFE Johnstown PACE Risk-based Capitation

PACE Blair, Cambria, Dauphin, Somerset County zip codes 15531, 15928, 15935, 15953 and 15963, Westmoreland County zip codes 15944 and 15954, York

145

PA Unison Health Plan / MedPLUS Commercial MCO Risk-based Capitation

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

90,679



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PA Unison Health Plan/MedPlus - VOL Commercial MCO Risk-based Capitation

1915(a) Blair, Bradford, Cambria, Carbon, Clarion, Columbia, Crawford, Erie, Forest, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Montour, Pike, Schuylkill, Somerset, Sullivan, Susquehanna, Warren, Wyoming

30,188

PA UPMC Health Plan, Inc./UPMC for You Commercial MCO Risk-based Capitation

1915(b) Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, Westmoreland

90,899

PA UPMC Health Plan, Inc./UPMC for You - VOL


1915(a) Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango

5,607

PA Value Behavioral Health of PA (Greene County)


1915(b) Greene 5,998

PR American Health Medicare Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

14,134

PR APS Healthcare MH/SUD PIHP Risk-based Capitation

1915(a) Aguas Buenas, Arecibo, Barceloneta, Caguas, Camuy, Canovanas, Carolina, Cayey, Ceiba, Ciales, Cidra, Culebra, Fajardo, Florida, Gurabo, Hatillo, Humacao, Juncos, Lares, Las Piedras, Loiza, Luquillo, Manati, Morovis, Naguabo, Quebradillas, Rio Grande, San Lorenzo, Trujillo Alto, Utuado, Vega Baja, Vieques, Yabucoa

323,126

PR FHC Healthcare MH/SUD PIHP Risk-based Capitation

1915(a) Adjuntas, Aibonito, Arroyo, Barranquitas, Coamo, Guanica, Guayama, Guayanilla, Jayuya, Juana Diaz, Maunabo, Orocovis, Patillas, Penuelas, Ponce, Salinas, Santa Isabel, Villalba, Yauco

182,176

PR Humana Health Plans of Puerto Rico, Inc. Commercial MCO Risk-based Capitation

1915(a) Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, Cayey, Cidra, Coamo, Guayama, Gurabo, Humacao, Juana Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa

210,422



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PR Humana Puerto Rico Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canóvanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerío, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marias, Las Piedras, Loíza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincon, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastian, 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-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Gurabo, Gyanabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Loiza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, 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-based Capitation

1915(a) Aguada, Aguadilla, Añasco, 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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PR MMM Healthcare Inc. Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamón, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Lioza, Luquillo, Manatí, Maricao, Maunabo, Mayaguëz, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

48,755

PR PMC Medicare Choice Commercial MCO Risk-based Capitation


32,093

PR Salud Dorada con Medicare Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Aguada, Aguadilla, Aguas Buenas, Aibonito, Añasco, Arecibo, Arroyo, Barceloneta, Barranquitas, Bayamon, Cabo Rojo, Caguas, Camuy, Canovanas, Carolina, Cataño, Cayey, Ceiba, Ciales, Cidra, Coamo, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guanica, Guayama, Guayanilla, Guaynabo, Gurabo, Hatillo, Hormigueros, Humacao, Isabela, Jayuya, Juana Díaz, Juncos, Lajas, Lares, Las Marías, Las Piedras, Loiza, Luquillo, Manatí, Maricao, Maunabo, Mayagüez, Moca, Morovis, Naguabo, Naranjito, Orocovis, Patillas, Peñuelas, Ponce, Quebradillas, Rincón, Río Grande, Sabana Grande, Salinas, San German, San Juan, San Lorenzo, San Sebastián, Santa Isabel, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Villalba, Yabucoa, Yauco

3,292



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

PR Triple S Commercial MCO Risk-based Capitation


18,405

PR Triple-S, Inc. Commercial MCO Risk-based Capitation

1915(a) Adjuntas, Arecibo, Barceloneta, Bayamón, Camuy, Cataño, Ciales, Comerío, 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 Rhode Island



RI PACE Organization of Rhode Island PACE Risk-based Capitation

PACE Statewide except for Zip Codes Block Island 02807 164

RI United HealthCare Dental - RIte Smiles Dental PAHP Risk-based Capitation


RI United HealthCare of New England Commercial MCO Risk-based Capitation


SC Absolute Total Care Medicaid MCO Risk-based Capitation

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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

SC BlueChoice Health Plan Medicaid MCO Risk-based Capitation

1915(a) Abbeville, Allendale, Anderson, Bamberg, Barnwell, Beaufort, Berkeley, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Darlington, Dorchester, Fairfield, Florence, Greenville, Hampton, Jasper, Kershaw, Lancaster, Laurens, Lee, Lexington, Newberry, Oconee, Orangeburg, Pickens, Richland, Spartanburg, Sumter, Union, Williamsburg, York

19,464

SC Carolina Crescent Health Plan Medicaid MCO Risk-based Capitation

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

33,867

SC CHCcares of South Carolina Medicaid MCO Risk-based Capitation

1915(a) Aiken, Bamberg, Barnwell, Berkley, Calhoun, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Dorchester, Edgefield, Fairfield, Kershaw, Lancaster, Lexington, McCormick, Newberry, Orangeburg, Richland, Saluda, Sumter, Union, York

4,254

SC First Choice by Select Health of South Carolina, Inc.


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

184,059

SC Logisticare Transp PAHP Risk-based Capitation

1902(a)(70) Region 3, Region 4, Region 5, Region 6 508,817

SC Medical Transportation Management (MTM)

Transp PAHP Risk-based Capitation

1902(a)(70) Region 1, Region 2 254,408

SC Medically Fragile Children Medical-only PAHP


1915(a) Anderson, Berkeley, Charleston, Dorchester, Greenville, Lexington, Oconee, Pickens, Richland

142

SC Palmetto SeniorCare (PACE) PACE Risk-based Capitation

PACE Lexington, Richland 375

SC South Carolina Solutions PCCM Fee-For-Service 1932(a) Statewide 90,136



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

SC The Oaks PACE PACE Risk-based Capitation

PACE Orangeburg County 32

SC Unison Health Plan of SC Medicaid MCO Risk-based Capitation

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-based Capitation

PACE Hamilton 309

TN AmeriChoice - East TN Medicaid MCO Risk-based Capitation

1115 East Tennessee 172,670

TN AmeriChoice - Middle TN Medicaid MCO Risk-based Capitation

1115 Middle Tennessee 189,868

TN AmeriChoice - West TN Medicaid MCO Risk-based Capitation

1115 West Tennessee 162,647

TN AmeriGroup Community Care Medicaid MCO Risk-based Capitation

1115 Middle Tennessee 189,937

TN Doral Dental of Tennessee, LLC *Dental Benefit Manager

Administrative Services Fee


TN Premier Behavioral Systems of TN MH/SUD PIHP Risk-based Capitation


TN SXC Health Solution Corperation *Pharmacy Benefit Manager

Administrative Services 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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

TN Volunteer State Health Plan (TennCare Select)

*Prepaid Inpatient Health

Plan (PIHP), partial risk,

partial capitation

Partial Capitation 1115 Statewide 71,661

TX Aetna Commercial MCO Risk-based Capitation

1915(b) Atascosa, Bexar, Comal, Denton, Guadalupe, Hood, Johnson, Kendall, Medina, Parker, Tarrant, Wilson, Wise

38,597

TX Amerigroup (STAR) Medicaid MCO Risk-based Capitation

1915(b) Bastrop, Brazoria, Burnet, Caldwell, Collin, Dallas, Denton, Ellis, Fort Bend, Galveston, Harris, Hays, Hood, Hunt, Johnson, Kaufman, Lee, Montgomery, Navarro, Parker, Rockwell, Tarrant, Travis, Waller, Williamson, Wise

351,524

TX Amerigroup (STAR+PLUS) Medicaid MCO Risk-based Capitation

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

Atascosa, Bastrop, Bexar, Blanco, Brazoria, Burnet, Caldwell, Comal, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Lee, Medina, Montgomery, Travis, Waller, Williamson, Wilson

54,887

TX Bienvivir Senior Health Service PACE Risk-based Capitation

PACE 79901, 79902, 79903, 79904, 79905, 79907, 79915, 79924, 79925, 79930, 79935, 79936

761

TX Community First Commercial MCO Risk-based Capitation

1915(b) Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson 72,332

TX Community Health Choice Medicaid MCO Risk-based Capitation

1915(b) Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller 98,795

TX Cook Children's Medicaid MCO Risk-based Capitation

1915(b) Denton, Hood, Johnson, Parker, Tarrant, Wise 40,990

TX Driscoll Medicaid MCO Risk-based Capitation

1915(b) Aransas, Bee, Calhoun, Jim Wells, Kleberg, Nueces, Refugio, San Patricio, Victoria

36,982

TX El Paso First Premier Commercial MCO Risk-based Capitation

1915(b) El Paso 39,914

TX Evercare Medicaid MCO Risk-based Capitation

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

Bastrop, Blanco, Brazoria, Burnet, Caldwell, Crosby, Floyd, Fort Bend, Galveston, Garza, Hale, Harris, Hays, Hockley, Lamb, Lee, Lubbock, Lynn, Montgomery, Terry, Travis, Waller, Williamson

54,488

TX First Care Commercial MCO Risk-based Capitation

1915(b) Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry

24,937

TX Jan Werner Adult Day Care Center PACE Risk-based Capitation

PACE 79015, 79101, 79102, 79103, 79104, 79106, 79107, 79108, 79109, 79110, 79111, 79118, 79119, 79121, 79124

128



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

TX McKesson Health Solutions Disease Management

PAHP



TX Molina (STAR) Medicaid MCO Risk-based Capitation


TX Molina (STAR+Plus) Medicaid MCO Risk-based Capitation

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

Atascosa, Bexar, Brazoria, Comal, Fort Bend, Galveston, Guadalupe, Harris, Kendall, Medinal, Montgomery, Waller, Wilson

17,079

TX Parkland Community Health Plan Medicaid MCO Risk-based Capitation

1915(b) Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall 122,684

TX PCCM PCCM Fee-For-Service 1932(a) Anderson, Andrews, Angelina, Archer, Armstrong, Austin, Bailey, Bandera, Baylor, Bell, Bordon, Bosque, Bowie, Brazos, Brewster, Briscoe, Brooks, Brown, Burleson, Callahan, Cameron, Camp, Carson, Cass, Castro, Chambers, Cherokee, Childress, Clay, Cochran, Coke, Coleman, Collingsworth, Colorado, Comanche, Concho, Cooke, Coryell, Cottle, Crane, Crockett, Dallam, Dawson, Deaf Smith, Delta, DeWitt, Dickens, Dimmit, Donley, Duval, Eastland, Ector, Edwards, Erath, Falls, Fannin, Fayette, Fisher, Foard, Franklin, Freestone, Frio, Gaines, Gillespie, Glasscock, Goliad, Gonzales, Gray, Grayson, Gregg, Grimes, Hall, Hamilton, Hansford, Hardeman, Hardin, Harrison, Hartley, Haskell, Hemphill, Henderson, Hildalgo, Hill, Hopkins, Houston, Howard, Hutchinson, Irion, Jack, Jackson, Jasper, Jeff Davis, Jefferson, Jim Hogg, Jones, Karnes, Kenedy, Kent, Kerr, Kimble, King, Kinney, Knox, La Salle, Lamar, Lampasas, Lavaca, Leon, Liberty, Limestone, Lipscomb, Live Oak, Llano, Loving, Madison, Marion, Martin, Mason, Matagorda, Maverick, McCulloch, McLennan, McMullen, Menard, Midland, Milam, Mills, Mitchell, Montague, Moore, Morris, Motley, Nacogdoches, Newton, Nolan, Ochiltree, Oldham, Orange, Palo Pinto, Panola, Parmer, Pecos, Polk, Potter, Presidio, Rains, Randall, Reagan, Real, Red River, Reeves, Roberts, Robertson, Runnels, Sabine, San Augustine, San Jacinto, San Saba, Schleicher, Scurry, Shackelford, Shelby, Sherman, Smith, Somervell, Starr, Stephens, Sterling, Stonewall, Sutton, Swisher, Taylor, Terrell, Throckmorton, Titus, Tom Green, Trinity, Tyler, Upshur, Upton, Uvalde, Val Verde, Van Zandt, Walker, Ward, Washington, Webb, Wharton, Wheeler, Wichita, Wilbarger, Willacy, Winkler, Wood, Yoakum, Young, Zapata, Zavala

732,219



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

TX Superior HealthPlan (STAR Health) Medicaid MCO Risk-based Capitation


TX Superior HealthPlan (STAR) Medicaid MCO Risk-based Capitation

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-based Capitation

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-based Capitation


TX Unicare Commercial MCO Risk-based Capitation

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

TX United Commercial MCO Risk-based Capitation


TX ValueOptions MH/SUD PIHP FFS/Some Risk Based 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 Health PIHP


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

UT Central Utah Counseling Center Mental Health PIHP


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

UT Davis Behavioral Health Mental Health PIHP


1115, 1915(b) Davis 16,430

UT Four Corners Community Behavioral Health

Mental Health PIHP


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

UT Healthy U Medical-only PIHP

Non-risk Capitation

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

UT Molina Healthcare of Utah (Molina) Medical-only PIHP

Non-risk Capitation

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

UT Non-Emergency Medical Transportation Transp PAHP Risk-based Capitation


UT Northeastern Counseling Center Mental Health PIHP


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



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

UT Select Access PCCM Fee-For-Service 1115, 1915(b) Davis County, Salt Lake County, Utah County, Weber County 58,484

UT Southwest Behavioral Health Services Mental Health PIHP


1115, 1915(b) Beaver, Garfield, Iron, Kane, Washington 18,006

UT Valley Mental Health Mental Health PIHP


1115, 1915(b) Salt Lake, Summit, Tooele 83,812

UT Wasatch Mental Health Mental Health PIHP


1115, 1915(b) Utah County 34,822

UT Weber Human Services Mental Health PIHP


1115, 1915(b) Morgan, Weber 20,342

VA AllCare for Seniors PACE Risk-based Capitation

PACE Buchanan, Dickerson, Russell, Tazewell 27

VA AmeriGroup Community Care Medicaid MCO Risk-based Capitation

1915(b) Alexandria City, Arlington County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Loudoun County, Manassas City, Manassas Park City, Prince William County

24,889

VA Anthem Healthkeepers Plus Commercial MCO Risk-based Capitation

1915(b) Accomack County, Albemarle County, Alexandria City, Amelia County, Arlington County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Essex County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Franklin City, Frederick County, Fredericksburg City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King George County, King William County, Lancaster County, Loudoun County, Louisa County, Lunenburg County, Madison County, Manassas City, Manassas Park City, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Prince William County, Richmond City, Richmond County, Southampton County, Spotsylvania County, Stafford County, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Westmoreland County, Williamsburg City, Winchester City, York County

163,028



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

VA LogistiCare Solutions Transp PAHP Risk-based Capitation

1902(a)(70) Statewide 520,773

VA MEDALLION PCCM Fee-For-Service 1915(b) Alleghany County, Bath County, Bland County, Bristol City, Buchanan County, Carroll County, Covington City, Craig County, Dickenson County, Galax, Grayson County, Highland County, Lee County, Norton, Russell, Scott County, Smyth County, Tazewell County, Washington County, Wise County

54,101

VA Mountain Empire PACE Risk-based Capitation

PACE Lee, Norton, Scott, Wise 48

VA Optima Family Care Commercial MCO Risk-based Capitation

1915(b) Accomack County, Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Brunswick County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Cumberland County, Danville City, Dinwiddie County, Emporia City, Essex County, Fluvanna County, Franklin City, Frederick County, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wight County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Page County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Rappahannock County, Richmond City, Richmond County, Rockingham County, Shenandoah County, Southampton County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Williamsburg City, Winchester City, York County

130,954

VA Riverside Peninsula PACE Risk-based Capitation

PACE Hampton, Newport News, Poquoson, Southeastern portion of York County

114

VA Sentara Senior Community Care PACE Risk-based Capitation

PACE Chesapeake, Norfolk, Portsmouth, Virginia Beach 126



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

VA Southern Health CareNet Commercial MCO Risk-based Capitation

1915(b) Albemarle County, Amelia County, Amherst County, Appomattox County, Augusta County, Buckingham County, Campbell County, Caroline County, Charles City County, Charlottesville, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Fluvanna County, Goochland County, Greene County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Lynchburg, Mathews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Northumberland County, Nottoway County, Orange County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Staunton, Surry County, Sussex County, Waynesboro, Westmoreland County

18,896

VA Virginia Premier Health Plan Medicaid MCO Risk-based Capitation

1915(b) Accomack County, Albemarle County, Amelia County, Appomattox County, Augusta County, Bedford City, Bedford County, Botetourt County, Brunswick County, Buckingham County, Buena Vista City, Campbell County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Clarke County, Colonial Heights City, Culpeper County, Cumberland County, Danville, Dinwiddie County, Emporia City, Floyd County, Fluvanna County, Franklin City, Franklin County, Frederick County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Lynchburg City, Madison County, Martinsville City, Mecklenburg County, Montgomery County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Nottoway County, Orange County, Page County, Patrick County, Petersburg City, Pittsylvania County, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Rappahannock County, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Shenandoah County, Southampton County, Spotsylvania County, Stafford County, Staunton City, Suffolk City, Surry County, Sussex County, Virginia Beach City, Warren County, Waynesboro City, Westmoreland County, Winchester City, Wythe County

128,905

VT Global Committment to Health Medicaid MCO Risk-based Capitation




State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

VT Vermont PACE PACE Risk-based Capitation

PACE Chittereden, Dorset, Grand Isle, Manchester, Rupert, South Hero

76

WA Asuris Northwest Health Commercial MCO Risk-based Capitation

1932(a) Spokane County 2,003

WA City of Seattle Human Services Disease Management

PAHP


1932(a) King 8,386

WA Columbia United Providers Commercial MCO Risk-based Capitation

1932(a) Clark 37,848

WA Community Health Plan Commercial MCO Risk-based Capitation

1932(a) Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oriellle, Pierce, San Juan, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Wahkiakum, Walla Walla, Whatcom, Yakima

189,559

WA Group Health Cooperative Commercial MCO Risk-based Capitation

1932(a) King, Kitsap, Pierce, Snohomish, Spokane, Thurston 20,656

WA Kaiser Foundation Health Plan Commercial MCO Risk-based Capitation

1932(a) Clark, Cowlitz 876

WA Molina Healthcare Commercial MCO Risk-based Capitation

1932(a) Adams, Asotin, Benton, Chelan, Clallam, Clark, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Orielle, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima

291,562

WA Molina Healthcare (WMIP) Commercial MCO Risk-based Capitation

1932(a) Snohomish 2,990

WA PCCM Tribal Clinics PCCM Fee-For-Service 1932(a) Statewide 4,495

WA Providence ElderPlace - Seattle PACE Risk-based Capitation

PACE King 319

WA Regence Blue Shield Commercial MCO Risk-based Capitation

1932(a) Clallam, Grays Harbor, Island, Pacific, Pierce, San Juan, Skagit, Snohomish, Yakima

36,093

WA Regional Support Network Mental Health PIHP





State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

WI Abri Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago

14,403

WI Abri Health Plan -- SSI Commercial MCO Risk-based Capitation

1932(a) Brown, Dodge, Jefferson, Kenosha, Kewaunee, Milwaukee, Outagamie, Ozaukee, Racine, Washington, Waukesha, Waupace, Winnebago

1,783

WI Care Wisconsin First, Inc. Long Term Care PIHP


1915(b)/(c) Columbia, Dodge, Green Lake, Jefferson, Marquette, Washington, Waukesha, Waushara

2,774

WI Care Wisconsin Health Plan, Inc. (Partnership)


1932(a)/1915(c) Dane County 1,115

WI Children's Community Health Plan - Medicaid HMO


1932(a) Columbia, Dane, Iowa, Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington, Waukesha

21,705

WI CHP-LTS, Inc. Long Term Care PIHP


1915(b)/(c) Chippewa, Dunn, Eau Claire, Pierce, St. Croix 922

WI Community Care Health Plan, Inc. Commercial MCO Risk-based Capitation

1932(a)/1915(c) Milwaukee 1,147

WI Community Care of Central Wisconsin Long Term Care PIHP


1915(b)/(c) Marathon, Portage, Wood 6,122

WI Community Care Organization (PACE) PACE Risk-based Capitation

PACE Milwaukee 577

WI Community Care, Inc. Long Term Care PIHP


1915(b)/(c) Calumet, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha

3,803

WI Community Health Partnership -- Partnership


1932(a) Chippewa, Dunn, Eau Claire 935

WI Compcare -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Jackson, Juneau, La Crosse, Marquette, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn

29,955

WI Dane County Human Services Department -- CCF


1915(a) Dane 134

WI Dean Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Columbia, Dane, Dodge, Grant, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Sauk, Walworth, Waukesha

41,704



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

WI Group Health Cooperative Of Eau Claire -- Medicaid HMO


1932(a) Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Columbia, Crawford, Douglas, Dunn, Eau Claire, Grant, Green, Iowa, Jackson, Juneau, Lafayette, Lincoln, Marathon, Pepin, Pierce, Polk, Price, Rusk, Sauk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn

30,529

WI Group Health Cooperative of Eau Claire County SSI


1932(a) Buffalo, Jackson, La Crosse, Monroe, Trempealeau, Vernon 760

WI Group Health Cooperative Of South Central WI -- Medicaid HMO


1932(a) Dane, Monroe, Vernon 3,867

WI Gundersen Lutheran Health Plan - Medicaid HMO


1932(a) Buffalo, Crawford, Grant, Jackson, Juneau, La Crosse, Monroe, Trempealeau, Vernon

13,317

WI Health Tradition Health Plan -- Medicaid HMO


1932(a) Buffalo, Crawford, Grant, La Crosse, Monroe, Trempealeau, Vernon

8,069

WI Independent Care (iCare) - Medicaid HMO Medicaid MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha

5,200

WI Independent Care Health Plan -- SSI Medicaid MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Washington, Waukesha

8,372

WI Lakeland Care District Long Term Care PIHP


1915(b)/(c) Fond du Lac 1,040

WI Managed Health Services -- Medicaid HMO


1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Green Lake, Jefferson, Kenosha, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

76,347

WI Managed Health Services -- SSI Medicaid MCO Risk-based Capitation

1932(a) Kensosha, Milwaukee, Racine, Waukesha 4,751

WI MercyCare Insurance Company -- Medicaid HMO


1932(a) Dane, Green, Jefferson, Rock, Walworth 13,309

WI Milwaukee County Department on Aging Long Term Care PIHP


1915(b)/(c) Milwaukee 6,796

WI Milwaukee County Human Services Department -- Wraparound Milwaukee


1915(a) Milwaukee 771



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

WI Network Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Brown, Calumet, Clark, Dodge, Fond du lac, Forest, Green Lake, Jefferson, Kenosha, Langlade, Lincoln, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Oneida, Outagamie, Ozaukee, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Vilas, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

47,302

WI Network Health Plan - SSI Commercial MCO Risk-based Capitation

1932(a) Kenosha, Milwaukee, Racine, Waukesha 2,657

WI Northern Bridges Long Term Care PIHP


1915(b)/(c) Ashland, Barron, Bayfield, Burnett, Douglas, Iron, Polk, Price, Rusk, Sawyer, Washburn

870

WI Partnership Health Plan, Inc. Commercial MCO Risk-based Capitation

1932(a)/1915(c) Chippewa, Dunn, Eau Claire 1,884

WI Physicians Plus Health Plan - Medicaid HMO


1932(a) Dane 4,573

WI Security Health Plan -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Polk, Portage, Price, Rusk, Sawyer, Shawano, Taylor, Vilas, Washburn, Waupaca, Wood

40,823

WI Southwest Family Care Alliance Long Term Care PIHP


1915(b)/(c) Crawford, Green, Juneau, Lafayette, Richland, Sauk 917

WI UnitedHealthcare of WI -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Walworth, Washburn, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood

187,573

WI UnitedHealthcare of WI -- SSI Commercial MCO Risk-based Capitation

1932(a) Ashland, Bayfield, Brown, Burnett, Calumet, Dodge, Douglas, Fond du lac, Green Lake, Jefferson, Kenosha, Kewaunee, Langlade, Manitowoc, Marathon, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Polk, Portage, Racine, Rock, Shawano, Sheboygan, Taylor, Walworth, Washburn, Washington, Waukesha, Waupace, Waushara, Winnebago, Wood

7,346

WI Unity Health Insurance -- Medicaid HMO Commercial MCO Risk-based Capitation

1932(a) Columbia, Dane, Dodge, Green, Jefferson, Sauk 11,130

WI Western Wisconsin Cares Long Term Care PIHP


1915(b)/(c) Buffalo, Clark, Jackson, La Crosse, Monroe, Pepin, Trempealeau, Vernon

3,067



State Plan

June 30, 2009


Managed Care Entity



Number of Enrollees

WV Carelink Health Plan Commercial MCO Risk-based Capitation

1915(b), 1937 Boone, Brooke, Clay, Fayette, Hancock, Jackson, Kanawha, Lincoln, Logan, Marshall, Mingo, Nicholas, Ohio, Pleasants, Putnam, Raleigh, Tyler, Webster, Wetzel, Wirt, Wood

45,168

WV Health Plan of the Upper Ohio Valley Commercial MCO Risk-based Capitation

1915(b), 1937 Barbour, Brooke, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Randolph, Ritchie, Taylor, Tucker, Tyler, Upshur, Wetzel, Wirt, Wood

29,142

WV Physician Assured Access System PCCM Fee-For-Service 1915(b) Statewide 14,747

WV Unicare Health Plan of WV Commercial MCO Risk-based Capitation

1915(b), 1937 Barbour, Berkeley, Boone, Braxton, Calhoun, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Hampshire, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, Marshall, McDowell, Mercer, Mineral, Mingo, Monongalia, Monroe, Morgan, Nicholas, Ohio, Pleasants, Pocahontas, Preston, Putnam, Raleigh, Randolph, Ritchie, Roane, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming

75,384

TOTAL NUMBER OF ENROLLEES: 50,224,705



2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)

75

Arizona – The State Medicaid Enrollment increase was due to the economy. Bridgeway2 is now providing family planning services for the SOBRA family planning population.

Georgia – The State Medicaid Enrollment increase was due to the economy.

Hawaii – APS BHS, Child &Adolescent Mental Health Division, Department, and Early Intervention Programs, Department of Health are no longer valid mental PHIP plans under the Hawaii Quest Expanded (QEx) due to the removal of their mental health carve-out portion of their Hawaii Quest Expanded (QEx). The mental health portion is now under the fee-for-service model.

Massachusetts - The State Medicaid Enrollment increase was due to the economy and the unemployment rate.

Michigan – North Country CMH6 is now Northern Affiliation6.

Mississippi – Due to the inclusion of the 1902(a)(70) NEMT program, the State has managed care

enrollment.

Missouri – Mercy Care Plus2 is now Molina Healthcare of Missouri2. The State Medicaid Managed Care Enrollment is higher than normal due to the inclusion of the 1902(a)(70) NEMT program.

Nebraska – Mercy Care Plus plan2 is now Molina Healthcare of Missouri2.

New Jersey – The State Medicaid Enrollment increase was due to the economy and unemployment rate.

New York – The 1115 Expansion Enrollment decrease was due to the State aligning the Medicaid Resource Level to the Family Health Plus (FHP) Level from $3,000 to $13,000. The State Medicaid Enrollment increase was due to the economy. Care Plus Health Plan2 is now AmeriGroup2. CarePlus Connections14 is now AmeriGroup Community Connections14. Suffolk Health Plan2 was bought out by Neighborhood Health Providers2.

North Carolina – The State Medicaid Enrollment and State Medicaid Managed Care Enrollment increases were due to statewide outreach efforts, the economy, and the inclusion of the CHIP Expansion enrollment.

Ohio – The State Medicaid Enrollment increase was due to economy and the unemployment rate. Buckeye Community Health Plan1, CareSource1, Molina Healthcare of Ohio1, Unison Health Plans of Ohio1, and WellCare of Ohio1 were defined as Medicaid MCO but changed their status to Commercial MCO.

Pennsylvania – The total transportation enrollment for Logisticare Solutions, LLC11 of 34,978 for 2008 reporting period was incorrectly.

Rhode Island – Neighborhood Health Plan of Rhode Island2 was operating under 1115(a) and 1915(a) authorities but it’s currently only operating under 1115(a).

South Carolina – Total Carolina Care Inc.2 is now Absolute Total Care2. Amerigroup Community Care2 merged with Absolute Total Care2. Logisticare and MTM are the two transportation brokers under the 1902(a)(70). The State was unable to accurately separate the number of enrollees in Logisticare and MTM ; therefore, the total number of enrollees of 683,966 were divided with 2/3 in LogistiCare and 1/3 in MTM.

2009 ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2008 – 6/30/2009)

76

South Dakota – The South Dakota Dental Program does not operate under any waiver authority or

managed care entity type. This program solely operates under the authority of the South Dakota State Plan. At the State’s request, it will no longer be reported in this report.

Tennessee – Volunteer State Health Plan (BlueCare)1 was divided into 2 separate regions – Volunteer State Health Plan (BlueCare)2 East and Volunteer State Health Plan (BlueCare)2 West. AmeriGroup Community Care2, Volunteer State Health Plan (Bluecare) East2, Volunteer State Health Plan (Bluecare) West2 were defined as Commercial-only MCO but changed their status to Medicaid-only MCO. TennCare Select4 is now Volunteer State Health Plan (TennCare Select)4. For reporting purposes, TennCare Select plan enrollment is incorporated under the Medical-only PIHP category.

Texas – The State Medicaid Enrollment increase was due partly to the Women’s Health Program and normal growth.

___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10 Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term-Care PIHP

NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009

77

Arkansas – Total Life Healthcare9 is a new PACE organization.

California – Life Circles9 and Comprehensive Senior Care Corporation9 are new PACE organizations.

Colorado – Rocky Mountain PACE9 and VOANS PACE9 are new PACE organizations.

District of Columbia – Medical Transportation Management11 is a new transportation PAHP under the Non-Emergency Medical Transportation Program.

Florida – Prestige Health Choice2 and Molina Health Care of Florida2 are new MCO plans under the Managed Health Care program. Alternative Medicine Integration10, CareMark10, and Hemophilia of the Sunshine State10 are new Disease Management PAHP plans under the Managed Health Care program. Managed Care of North America8 is a new Dental PAHP under the Managed Health Care Program. Molina Health Care of Florida (Reform)1 is a new plan under Florida Medicaid Reform program.

Hawaii – Maui PACE9 is a new PACE organization. Evercare1 and Ohana1 are new MCO plans.

Illinois - Meridian Health Plan2 is a new MCO plan under the Voluntary Managed Care program.

Iowa – Sioux PACE9 is a new PACE organization.

Maryland – AMERIGROUP-PAC5 and Priority Partners –PAC5 are new medical-only PAHP plans under the HealthChoice program.

Michigan – Health Kids Dental8 is a new Dental PAHP plan under Healthy Kids Dental program.

Montana – Billings Clinic 9is a new PACE organization.

Nevada – Amerigroup Community Care2 is a new MCO plan under the Mandatory Health Maintenance Program.

New Jersey – LIFE St. Francis9 and LIFE at Lourdes9 are new PACE organizations.

New Mexico – AMERIGROUP Community Care of New Mexico, Inc.1 and Evercare of New Mexico1 are new MCO plans under the Coordinated Long-term Care Services program. Blue Cross Blue Shield of New Mexico1 is a new MCO plan under the NEW MEXICO SALUD! program.

New York – Senior Whole Health/Medicaid Advantage Plus14 is a new LTC PIHP under the F-SHRP Medicaid Advantage program. Total Senior Care9 is a new PACE Organization. Health Plus2 is a new MCO plan under the Federal-State Health Reform Partnership (F-SHRP) program. NYPS Catholic Health Plan 11991 is a new MCO plan under the Partnership Plan Medicaid Managed Care Program.

North Dakota – Northland PACE9 is a new PACE organization.

North Carolina – Piedmont Senior Care9 and Elderhaus9 are new PACE organizations.

Oklahoma – Cherokee Elder Care9 is a new PACE organization.

NEW MEDICAID MANAGED CARE PLANS AS OF 6/30/2009

78

Tennessee – SXC Health Solutions12 is a new plan under TennCare program. Volunteer State Health

Plan (Bluecare) was broken into regions – AmeriChoice – West TN2 and Volunteer State Health Plan (Bluecare) – East2 are new plans under TennCare program.

Wisconsin – Gundersen Lutheran Health Plan1 and Physicians Plus Health Plan1 are new MCO plans under the BadgerCare Plus program. Care Wisconsin First, Inc.14, CHP-LTS, Inc., Community Care of Central Wisconsin14, Community Care, Inc.14, Lakeland Care District14, Milwaukee County Dept. on Aging14, Northern Bridges14, Southern Family Care Alliance14, and Western Wisconsin Cares14 are new Long Term Care PIHP plans under the Family Care program. Partnership Health Plan Inc.1 is a new MCO plan under the Wisconsin Partnership Program.

___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8Dental PAHP 9PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP

TERMINATED MEDICAID MANAGED CARE PLANS AS OF 6/30/2009

79

Florida – Pediatric Associates (Reform)4 terminated under the Florida Medicaid Reform program. Vista Health Plan of South Florida1, Community Based Care Partnership6, and Buena Vista1 were terminated under the Managed Health Care program. StayWell (Reform)1 was terminated under the Florida Medicaid Reform program.

Hawaii – Summerlin1 was terminated under the Hawaii Quest Expanded (QEx) program.

Iowa – Coventry HealthCare1 plan was terminated under the Iowa Medicaid Managed Care program.

Nevada – Anthem Blue Cross Blue Shield Partnership1 plan was terminated under the Mandatory Health Maintenance program.

New York - Manhattan PHSP/CenterCare2, NY Presbyterian Hospital Health Plan1, and Preferred Care1 were terminated under the Federal-State Health Reform Partnership (FSHRP), Partnership-Family Health Plus, and Partnership Plan Medicaid Managed Care Program.

Ohio – Anthem Blue Cross Blue Shield Partnership Plan2 was terminated under the State Plan Amendment for Ohio's Full-Risk Managed Care Program.

Puerto Rico – COSVIMed1 and MAPFRE1 were terminated under the Medicare Platino program.

Tennessee – First Health Services Corporation12, Preferred health Partnership/PHP2, TLC Family Healthplan2, Unison Health Plan-BHHP1, UAHC Health Plan of Tennessee2, Inc, Tennessee Behavioral Health13 plans were terminated under the TennCare program.

Texas - Evercare of Texas2 was terminated under ICM program.

Washington – United Healthcare Services Inc.10 was terminated under the Chronic Care

Management Program (CCMP). ___________________________ 1 Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7Mental Health PAHP 8 Dental PAHP 9 PACE 10Disease Management PAHP 11Transportation PAHP 12 Other 13MH/SUD PIHP 14 Long-Term Care PIHP

80

Medicaid Managed Care Enrollment Report Glossary as of June 30, 2009

Terms used in "Managed Care Entity" column

• Primary Care Case Management (PCCM) Provider is a provider (usually a physician, physician group practice, or an entity employing or having other arrangements with such physicians, but sometimes with such physicians, but sometimes also including nurse practitioners, nurse midwives, or physician assistants who contracts directly with the State to locate, coordinate, and monitor covered primary care (and sometimes additional services). This category also includes those PIHPs that contract with the State as “primary care case managers.”

• Commercial Managed Care Organization (MCO) – A Commercial MCO is a health

maintenance organization, an eligible organization with a contract under §1876 or a Medicare+Choice organization, a provider sponsored organization or any other private or public organization, which meets the requirements of §1902(w). A Commercial MCO provides comprehensive services to both Medicaid and commercial and/or Medicare.

• Medicaid-only Managed Care Organization (MCO) – A Medicaid-only MCO provides

comprehensive services to only Medicaid beneficiaries, not to commercial or Medicare enrollees.

• Health Insuring Organization (HIO) – A HIO is a managed care entity which, by law, is

exempt from certain rules governing MCO program operation such as the requirement for beneficiaries to have a choice of at least two managed care entities in mandatory programs.

• Prepaid Inpatient Health Plan (PIHP) – A PIHP is a prepaid inpatient health plan that

provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and provides, arranges for, or otherwise has responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are define in 42 CFR 438.2} There are several types of PIHPs that States use to deliver a range of services. For example, a Mental Health (MH) PIHP is a managed care entity that provides only mental health services.

• Prepaid Ambulatory Health Plan (PAHP) – A PAHP is a prepaid ambulatory health

plan that provides less than comprehensive services on an at-risk or other than state plan reimbursement basis, and does not provide, arrange for, or otherwise have responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are defined in 42 CFR 438.2} There are several types of PAHPs that States use to deliver a range of services. For example, a Dental PAHP is a managed care entity that provides only dental services.

• Program for All-inclusive Care for the Elderly (PACE) – program that provides pre-

paid, capitated comprehensive, health care services to the frail elderly.

• Other – The structure of the managed care plan is not considered a PCCM, PIHP, PAHP, Commercial MCO, Medicaid-only MCO, HIO, or PACE.

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Terms used in "Reimbursement Arrangement" Column

• Risk-based Capitation –The managed care entity is paid for providing services to enrollees primarily through capitation. (There may be other payments under the contract such as incentive arrangements or risk sharing.)

• Non-risk Capitation – The managed care entity is paid for providing services to

enrollees through capitation, but payments are settled at the end of the year at amounts that do not exceed the FFS cost for services actually provided, plus an amount for administration.

• Fee-For-Service (FFS) – The managed care entity is paid for providing services to

enrollees solely through fee-for service payments plus in most cases, a case management fee.

• Other – The managed care entity is providing services to enrollees through means other

than through capitation or fee-for-service reimbursements.

Documents

CMS Enrollment Report