The Department of Health and Social Services announced today that it has selected two companies to operate its Medicaid Managed Care Program.
DHSS’ Division of Medicaid and Medical Assistance will continue its MCO partnership with Highmark Health Options Blue Cross Blue Shield, which began in 2015.
In addition, DHSS announced its intent to contract with AmeriHealth Caritas to join the Medicaid program on Jan. 1, 2018. AmeriHealth Caritas has managed care for Medicaid clients in Pennsylvania since 1983.
“We are pleased to reach agreement with Highmark and AmeriHealth to provide these vital services to the Medicaid clients we serve,” DHSS Secretary Dr. Kara Odom Walker stated. “Both of these companies understand Delaware’s commitment to value-based care through a health care spending benchmark, a robust network and keeping down costs. Highmark and AmeriHealth also are committed to providing care and supports to our clients that will help them achieve their optimal health.”
Gov. John Carney earlier signed House Joint Resolution 7, which gave DHSS and Secretary Walker the authority to develop a health care spending benchmark that will be linked to the growth rate of Delaware’s economy. Under a benchmark – or a spending target – payments are linked to paying for value and quality of care instead of the number of services provided. The benchmark will cover all health care spending.
The Division of Medicaid and Medical Assistance’s MCO contract with United Healthcare will end on Dec. 31, 2017.
“We appreciate the partnership we have shared with United Healthcare and the quality services it has provided our members,” Medicaid Director Steve Groff said. “We look forward to working with Highmark and AmeriHealth to smoothly transition the United Healthcare membership.”
About 200,000 of the current 230,000 Medicaid clients in Delaware are served by managed care organizations. Groff said clients will receive information during the next several weeks about their options in choosing a new plan. Open enrollment will begin Nov. 1.
The Medicaid program for those with low incomes covers a sizable percentage of the state’s population. The Affordable Care Act offered funding that allowed the state to add more people to the program.
The Affordable Care Act offered funding that allowed the state to add more people to the program as a way to reduce the number of “working poor” who are employed but cannot afford health insurance.
Rising Medicaid and employee health cost growth has been a big factor in the state’s structural budget deficit led to a $350 million shortfall earlier this year. A combination of spending cuts and tax increases balanced the budget.
However, another shortfall is expected in 2018.
