On May 1, 250,000 additional 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.

Patients could fall through the cracks because of the confusion, say policy experts with the Missouri Foundation for Health.

“Serving this population is really hard, and you better plan for it carefully or there can be some real pain among the participants,” said Jeanette Mott Oxford, executive director of Empower Missouri.

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. In Missouri, Medicaid covers nearly half of all children and nearly half of all births.

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.

The confusion can benefit the insurance companies, Oxford said, because they are paid monthly for each person enrolled, even if no services are provided.

Missouri began contracting out management of Medicaid benefits in 1995 in an effort to cut costs. The managed care system is only for children, pregnant women and parents of children 18 and under who are also on the program.

The federal government hasn’t yet approved the state’s expansion of managed care to all of Missouri. The Department of Social Services, which applied for regulatory approval last month, did not respond to requests for comment.

Yancy Williams, executive director of the Missouri Health Plans Association, which represents the managed care companies operating in the state, said the plans “have been in constant communication with the Department of Social Services to ensure the successful implementation of the statewide expansion.”

The change is a big one, said Alan Freeman, CEO of Affinia Healthcare, a clinic that primarily serves low-income individuals.

“It is vitally important that enrollees and the more vulnerable in our population have easy access to health care,” he said, “and that the Medicaid managed care plans and (state) work together to ensure effective processes in this regard.”

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Advocates worry that patients will fall through cracks during Medicaid managed care rollout in Missouri – STLtoday.com