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CareStar has provided case management services since 1988 in various mid-western states, predominantly in Ohio and Indiana.In 2004, CareStar signed a five-year, $140 million contract with the Ohio Department of Job and Family Services to provide case management services for its medicaid waiver homecare program.
By 2010, the company was the third largest Medicaid HMO in the country, with $2.5 billion in revenue and 800,000 members across Ohio and Michigan. [12] In 2010, CareSource announced expansion of its provider network in Southeastern Ohio through a partnership with Quality Care Partners (QCP), a physician-hospital organization (PHO). [13]
Prior to July 2013, ODJFS was also the state agency responsible for the administration of Ohio's Medicaid program. In July 2013, a new state agency was created, the Ohio Department of Medicaid (ODM), Ohio’s first Executive-level Medicaid agency. ODJFS employs about 2,300 full time employees and has an annual budget of $3.3 billion. [2]
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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 1985, Medicaid patients made up 28% of all CHC patients but only 15% of CHC revenues. [5] By 2007, the share of Medicaid patients matched their share of revenues. In the same time period, grants for the uninsured decreased from 51% to 21%. [5] In 2008, Medicaid payments had grown to account for 37% of all CHC revenues. [4]
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In June 2011, the Department of Health and Human Services announced the Federally Qualified Health Center Advanced Primary Care Practice (FQHC APCP) demonstration project. [7] This demonstration project is conducted under the authority of Section 1115A of the Social Security Act, which was added by section 3021 of the ACA and establishes the ...
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