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Of those, 147 were Medicaid-focused health plans that specialize in serving the unique needs of Medicaid and other public program beneficiaries. Over 11 million are enrolled in Medicaid focused health plans . All states except Alaska, and Wyoming have all, or a portion of, their Medicaid population enrolled in an MCO. [4]
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.
WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. WellCare began operations in 1985 and has its headquarters in Tampa, Florida.
In addition, dual-eligibles may choose a type of MA plan called a dual-eligible special needs plan (D-SNP), which is designed to target the needs of this population. For Medicaid benefits, beneficiaries generally enroll in their state's Medicaid FFS program or a Medicaid managed care plan administered by an MCO under contract with the state.
Essentials of Managed Care, 4th Ed, Peter Kongstvedt; De Wolf W, and A Stanten. 1995. "The Independent Practice Association". JAMA : the Journal of the American Medical Association. 274, no. 22: 1761. Roth M. 1979. "Is an Independent Practice Association for You?" Physician's Management. 19, no. 1: 42–6. 2002.
Introduced for Medicaid in 1989 and Medicare in 1990, this designation allowed HRSA-funded health centers to receive cost-based reimbursement rates. Covered services included those provided by physicians, physician assistants, nurse practitioners, certified nurse midwives, clinical psychologists, and clinical social workers.
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The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.