On May 1, an additional 250,000 Medicaid recipients in Missouri will be enrolled in a managed care system, and advocates and health policy experts say they are worried that not enough has been done to make them aware of the changes.
Currently, three companies provide managed care for most Medicaid recipients in 54 counties along Interstate 70. Beginning May 1, recipients in all of Missouri’s 115 counties will be under managed care. Seniors and disabled people are not affected by the change.
Medicaid is a government-funded health insurance program for low-income individuals, financed by both the state and federal government. There are two systems in Missouri to deliver Medicaid benefits: fee-for-service or managed care. In fee-for-service, participating health care providers are paid for each service performed. But nationwide, more states are moving to managed care, where private insurance companies are paid a set fee each month for each participant. This system provides an incentive for the insurance companies to actively monitor participants’ health care use in an attempt to keep costs below the monthly allotment.
Adding to the confusion this year, Aetna, which had been managing care for 55 percent of Medicaid recipients in Missouri, will no longer be an option.
UnitedHealthcare was awarded the contract, beginning May 1. The other companies with plans are WellCare and Home State Health Plan, a division of Clayton-based Centene. Recipients were to choose one of them, but less than 20 percent of the 750,000 people eligible have done so.
Those who didn’t choose were automatically enrolled in one of the three plans. Advocates said they worry that the low rate of enrollment is a sign that the word has not gotten to the people eligible for Medicaid managed care.
Read more: St. Louis Post-Dispatch