Medicaid Managed Care - U.S. Senate Special Committee on Aging

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experience with special populations. (Volume II contains more information on the
use of outcomes measures.)
With Whom will the State Contract?
<strong>Medicaid</strong> agencies use a variety of contractors to serve vulnerable populations,
including commercial HMOs, county-based plans, community-based providers, and
HMO/specialty center partnerships. Selected examples are shown in the table below.
Type
<strong>Special</strong> Population Contractors: State Examples
Commercial HMOs Arizona AHCCCS (CIGNA)
Colorado (Rocky Mountain HMO)
Oregon (Providence Health Plans)
Tennessee (Prudential)
Examples
<strong>Medicaid</strong> Plans, Arizona ALTCS (Maricopa County Health Plan)
including County Plans Oregon (<strong>Care</strong> Oregon)
Sister State Agency Arizona ALTCS (Department of Economic Security, for people with
developmental disabilities)
Community-based Massachusetts (Community Medical Alliance)
Providers Wisconsin (Partnership)
HMO/<strong>Special</strong>ty Ohio (ABC)
Center Partnerships Wisconsin (I<strong>Care</strong>)
A quick glance at the table shows that states are not limiting themselves to one
approach. In fact, in order to meet HCFA's two-plan requirement for mandatory
programs, states may need to encourage the development of multiple contracting
arrangements. Factors states consider when selecting an approach include the
following.
Purchasing Philosophy and Market Conditions
A state's purchasing philosophy and the market conditions within the state can
affect its contractor selection process in a number of ways.
* Commercial Market. Those states with a well-developed and
competitive commercial HMO marketplace may find that these
existing HMOs offer the best opportunity to obtain the highest quality
health care at the best price. Commercial HMOs already have the
infrastructure needed to manage care and so can generally afford to
offer the 'best deal'-although some states have also found that what a
plan can provide does not always match what a plan is willing to offer.
Generally speaking, Massachusetts fall into this category, and Arizona
The National Academy for State Health Policy e © 8/97
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