Managed Care Organizations MCO’s

Overview What is Managed Care? A health care delivery system organized to manage cost, utilization and quality. States have choices in their approach to reimbursement and delivery system design under Medicaid Managed Care. Is Managed Care typical in Medicaid programs? Nation wide, approximately 80% of enrollees are served through a managed care delivery system. 45 states have some type of managed care. Wisconsin has 8 MCO’s.

Iowa Medicaid Enterprise Overview Iowa Medicaid Enterprise United Health Care AmeriGroup AmeriHealth-Caritas MTM Logisticare Access2Care

Overview DART contracts with HIRTA contracts with Access2Care AmeriHealth-Caritas Logisticare MTM HIRTA contracts with Access2Care

Overview HCBS Waiver NEMT Home and Community Based Services Homemaker, home health aid, personal care, adult day health, habilitation, respite care “other” types of services that may assist NEMT Federal Regulations require States to ensure have a ride to medical appointments Every State’s Medicaid program is different

Overview When do I call my MCO for a ride? Logisticare and MTM require you schedule all NEMT and HCBS rides with them Access2Care will schedule NEMT rides only AmeriHealth HCBS rides call your transit provider All other rides you will need to pay for as general public or

UnitedHealth Care / MTM Contact Info We Care Line – for customers 866-436-0457

UnitedHealth Care / MTM

UnitedHealth Care / MTM

AmeriGroup / Logisticare Contact Info Schedule a ride 844-544-1389 Where’s my ride line 844-544-1390

AmeriHealth-Caritas / Access2Care Contact Info Schedule a ride 855-346-9760

AmeriHealth-Caritas / Access2Care A2C will only schedule for NEMT rides if MCO is AmeriHealth-Caritas AmeriHealth-Caritas is keeping the HCBS process This means people assigned to AHC will contact their transportation provider directly for HCBS rides