As some states try to overhaul their programs for Medicare-Medicaid eligible beneficiaries, Indiana is turning to managed care plans to improve services.
The Indiana Family and Social Services Administration has selected three companies -- WellPoint's Anthem Blue Cross and Blue Shield, MDwise and Centene subsidiary Managed Health Services of Indiana -- to manage and coordinate services for about 84,000 aged, blind and disabled Medicaid beneficiaries in the new Hoosier Care Connect program.
The Family and Social Services Administration is expecting the program to improve clinical quality and outcomes for the members, protect provider choice and access, coordinate a broad range of services and make the overall experience more personalized.
The beneficiaries targeted for the Hoosier Care Connect program are not dual eligibles, but Medicaid recipients age 65 and over and children and adults with blindness or disabilities, who have long been and are currently covered by Medicaid on a fee-for-service basis. In 2013, the state legislature tasked the Family and Social Services Administration with finding managed care policies that could be used to oversee the populations needs and attempt to make financing more predictable.
An agency task force developed the Hoosier Care Connect program, featuring risk-based capitated managed care plans that cover rehabilitation, nursing home services, institutional hospice, intermediate care for intellectual disabilities, home- and community-based care, dental benefits and pharmaceutical drugs.
Six health plan companies made bids for the contracts, and three met the Family and Sociality Services Administration's requirements, including "Buy Indiana" and minority- and women-owned business subcontracting commitments. The agency is planning an April 1, 2015 rollout date for the Hoosier Care Connect, with beneficiaries able to choose among the health plans.
The Hoosier Care Connect program will not cover perhaps the most complex patient population, Medicare-Medicaid dual eligibles. Indiana is not among the states working with the Centers for Medicare & Medicaid Services on new financing and delivery models for dual eligibles.
Among those states, the managed care rollout in California has been very controversial and confusing for some of the 500,000 seniors being targeted in the three-year phase-in. More than 40 percent of those offered enrollment through October 1 have opted out. In Massachusetts, the first state to embrace the CMS demonstration program, the state has increased rates for participating health plans, amid higher than expected costs.
In Indiana, dual eligibles will remain covered in traditional fee-for-service. But the Hooser Care Connect program could help state leaders determine if insurers like Anthem, Centene and nonprofit MDWise could take on the risk and complexity of Medicare-Medicaid eligible residents.
"With new value-added benefits for the aged, blind and disabled population," Centene's Managed Health Services of Indiana will be " focusing on wellness, prevention, early detection and ongoing healthcare management," said Patrick Rooney, senior vice president of health plans.