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If states provide a choice of at least two plans, they can mandate enrollment in managed care. Healthy children and families make up the majority of Medicaid managed care enrollees, but an increasing number of states are expanding managed care to previously excluded groups, such as people with disabilities, pregnant women, and children in ...
In the 1980s, as Medicaid managed care expanded across the county, safety net providers, such as Community Health Centers (CHCs) and public hospitals, feared that managed care would reduce reimbursements for Medicaid-eligible services, making it more difficult for them to provide care to the un- and under-insured, and result in a loss of Medicaid volume, as beneficiaries would choose to see ...
The expansion of Medicaid through the Affordable Care Act made adults with incomes of up to 138% of the federal poverty level, or about $20,783 for an individual, eligible in 2024, according to ...
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a ...
2.6 million were in the "coverage gap" due to the 19 states that chose not to expand the Medicaid program under the ACA/Obamacare, meaning their income was above the Medicaid eligibility limit but below the threshold for subsidies on the ACA exchanges (~44% to 100% of the federal poverty level or FPL); 5.4 million were undocumented immigrants;
In 1997, to protect health centers under managed care, Congress mandated that state Medicaid agencies make a "wrap-around" payment to FQHCs to cover the difference between their costs for providing care and the rates they were receiving from managed care organizations (MCOs). [1]
The Oklahoma Health Care Authority has the primary duty of executing SoonerCare, the Oklahoma version of Medicaid. SoonerCare is a health coverage program jointly funded by the United States federal government and the Oklahoma state government. The program provides payments to cover medical services to economically challenged individuals.
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related to: largest medicaid managed care plans by county in oklahoma list of states