Delivery System Status: RI Medicaid March 31, 2015 (*) Figures for 2014 are preliminary, and do not include the new population of Medicaid Expansion Adults.

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Presentation transcript:

Delivery System Status: RI Medicaid March 31, 2015 (*) Figures for 2014 are preliminary, and do not include the new population of Medicaid Expansion Adults fully funded by the Federal Government. Temporary Federally-funded PCP Rate Increase is also excluded in SFY 2013 and 2014.

Medicaid Populations Enrolled in Managed Care - 232,809 (86.7%) In FFS pending MC enrollment - 6,167 (2.3%) RIte Share - 9,780 (3.6%) FFS -19,621 (7.3%) TOTAL MEDICAID 268, % 2

Managed Care Programs RIteCare – Low income children and families Rhody Health Partners – Disabled adults and ACA expansion adults Rhody Health Options – Dually eligible and Medicaid only receiving Long Term Care Services Connect Care Choice – State-managed program for disabled adults and dually eligible (about 5,000 members) 3

Services “Carved out” of MC Services administered through BHDDH – substance abuse residential, opioid treatment, and Community Mental Health services for Severe Mental Illness Services for Children with Special Needs Childrens BH services administered by DCYF NICU 4

Current Payment Strategies – Primarily FFS MCOs received PMPM capitation MCO payment arrangements with providers predominantly FFS – some Primary Care Capitation Hospitals paid APR DRG for inpatient services FFS system: paid directly from State to enrolled providers Medicaid MCOs participants in Medical Home program: FFS with PMPM – partially based on performance 5

Opportunities: Highest cost/highest utilizing members concentrated in: Disabled adults Elders in NH Institutional Care (Slater, group homes) Children with special needs Majority of highest cost members have a behavioral health diagnosis (although majority of costs are NOT behavioral health related). 6

Opportunities to move Medicaid to Value- based purchasing: Integrate BH and physical health Address social determinants (housing, transportation, food, heat) Align measurement strategies with commercial market Align payment strategies with commercial market 7