Medicaid

  • Managed Care
  • Enrollment
  • Reports & Data
  • DSH

This page will be updated as new resources become available.

Medicaid managed care was implemented May 1. The expansion applies to coverage of children and low-income parents in counties not in the “I-70” corridor, depicted on the map. The expansion is being implemented concurrent with a new set of Medicaid managed care vendors for the entire state. One of the three vendors is new to the market. A memorandum of understanding was negotiated between MHA Management Services Corporation and the managed care plans. The MOU sets standards and processes by which FRA-funded Medicaid direct “add-on” payments will flow from the managed care plans to hospitals. It also creates a process for distributing those payments that complies with federal standards, while maintaining hospitals’ financial stability. An amendment to the memorandum of understanding was incorporated May 8.MMC map

As this new system is implemented, there likely will be problems arising from unfamiliar managed care standards and processes, and a set of patients and providers new to Medicaid managed care. As these problems arise, MHA offers its assistance in working with state officials to resolve the problems.

We particularly are interested in hearing if your hospital or health system identifies patterns of events that affect multiple patients since this most likely signifies a problem that other hospitals will experience. Contact Brian Kinkade, Vice President of Children’s Health and Medicaid Advocacy, with questions or concerns. Brian can be reached at 573/893-3700, ext. 1338.

MHA Medicaid Managed Care Webinar - PowerPoint | Recording

2017 Medicaid Managed Care Provider Training

DHSS Provider Tips

Provider tips include Aetna inpatient care guidance, verifying participant eligibility and billing guidance.

MO HealthNet

MO HealthNet Managed Care: Your Guide to Enrollment

A managed care enrollment report was prepared April 21 and shows the number of participants that were projected to be enrolled in each plan, by region, on the first day of the expanded program.

MO HealthNet participants have 90 days from the date they selected or were auto-assigned a health plan to change plans for any reason.

Children who are in the state’s custody or children with certain disabilities are allowed to opt-out of managed care and receive care through a fee-for-service system.

Aetna Better Health

Consistent with the Medicaid managed care health plan contract, all participants enrolled with Aetna Better Health of Missouri will be transitioned to a new managed care health plan effective May 1. However, for Aetna participants in an inpatient hospital setting that will extend beyond Sunday, April 30, coverage will continue under Aetna until discharged. MO HealthNet is directing hospitals with Aetna Better Health inpatients to call the MO HealthNet Provider Communications Unit at 573/751-2896 with the date of admission and the date of discharge so the patient’s enrollment with Aetna can be extended through the date of discharge.

Advocates for Family Health Contact Information
Missouri's legal aid organizations will assist Medicaid participants who are having problems with eligibility or with managed care issues (denials, changing plans, etc.). A directory of county offices is available.

Data Book: Missouri Health and Health Care (July 2013)
MHA has published a data book that has information about the health of Missourians and the role of Medicaid in financing and delivering health services to 860,000 Missourians. the data book displays the components underlying Missouri’s ranking of 42nd among the states in health status and Medicaid spending data that shows 5 percent of Medicaid enrollees generated 52.3 percent of Medicaid hospital expenditures in fiscal year 2012. The data book also shows how disparities in health status are arrayed among Missouri’s counties and the top 10 causes of hospital emergency department use by Medicaid enrollees and the uninsured.

The following resources from MHA discuss Medicaid and DSH.