• [IMAGE: Services Delivery Capacity Pre and Post RFP (gif 4.2 K)] MCO Development. The State used its leverage as the largest purchaser of healthcare to stimulate the development of much-needed Medicaid managed care organizations (MCOs) in parts of the State where they previously did not exist. The issuance of an RFP for new and/or expanded Medicaid MCOs and the decision to no longer accept the fee-for-service (FSS) option resulted in a significant increase in MCOs throughout the State.

• Prior to the MIChild RFP for MCOs:
  • 38 counties had 0 Medicaid plans.
  • 37 counties had 1-3 Medicaid plans.
  • 8 counties had 4 or more Medicaid plans.

• After the MIChild RFP for MCOs:
  • 0 counties have 0 Medicaid plans.
  • 1 county has 1-3 Medicaid plans.
  • 82 counties have 4 or more Medicaid plans

• Service Delivery Incentives. Service delivery capacity was also addressed through incentives to physicians and health plans such as:
  • Adverse risk supplements for first 7 months.
  • Physician rates based on Medicare—these rates are 95 percent above Medicaid, which almost doubles the physician’s rates.
  • Maternity case rate of $4,000.
  • Vaccines supplied by the State.

• Hospital Service Delivery Issues. Hospitals in Michigan created a critical service issue when monopoly hospitals refused to negotiate hospital contracts with health plans. To address this issue, the State has taken the position that health plans are agents of Medicaid, and therefore cannot be charged higher prices than the Medicaid diagnosis-related group (DRG) in absence of a contract.

• Historic Medicaid Providers.  HMO’s are encouraged to include historic Medicaid providers, such as Indian Health Centers (IHCs), Adolescent Health Centers, and Family Planning Clinics, in their network.
  • [IMAGE: Historic Medicaid Providers Comparison Chart (gif 8.6 K)] IHCs and Adolescent Health Centers: MIChild to Medicaid comparison
  • [IMAGE: Historic Medicaid Providers Comparison Chart (gif 7.9 K)] Family planning and local health department: MIChild to Medicaid comparison

• Dental Services. Although there are over 6,000 licensed dentists in Michigan, only approximately 2,000 have participated in the Medicaid Dental Coverage program in past years. The MIChild Dental Coverage program has been successful in increasing the total number of participating dentists to over 4,000 and has instituted access standards to which participating dentists must adhere. All participating dentists must:
  • Accept new patients.
  • Provide an appointment within 3 weeks.
  • Provide emergency appointments within 24 hours.

• Overview of Service Delivery Statistics

• Medicaid Plans Advantages and Disadvantages

• Denise Holmes