Case Studies

Medicaid Managed Care: Model Variations and Arkansas Applications

September 1, 2015

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Joseph W. Thompson, MD, MPH
President & CEO
501-526-2244
achi@achi.net

 

Twenty-eight states and the District of Columbia (DC) opted to expand Medicaid in 2014, with the majority expanding coverage through existing Medicaid managed care arrangements. While Arkansas has used care management approaches to provide services to certain populations, the state’s Medicaid program has refrained from shifting the clinical and financial responsibility for beneficiary care to a third-party managed care organization like many other states. So when faced with the 2014 coverage expansion decision, Arkansas took quite the unique approach, electing to use an individual plan premium assistance model for eligible individuals to purchase private coverage in the newly created health insurance marketplace. The premium assistance approach was beneficial, in part, because it offered the opportunity for the state to extend the reach of the care management approaches adopted by the Arkansas Health Care Payment Improvement Initiative (AHCPII), namely patient centered medical homes (PCMHs). A legislative task force is currently considering options for providing services to Medicaid populations post-2016, including those covered by the state’s individual plan premium assistance model. Legislation establishing the task force directs them to consider capitated payment models, including third party managed care.

This fact sheet provides background information regarding Medicaid managed care, variation in managed care models, the use of managed care in Arkansas, and comparison of managed care and premium assistance models.