State Switching to Managed Care for Medicaid Services
AT ISSUE:  How will managed care affect people with disabilities and their families?

January 15, 2013: Although no official start date has been announced, the Dept of Health & Human Services has laid out the procedural timeline for expected upcoming Step 1 switchover to Medicaid Managed Care. DHHS outlines details and updates including:
   * Upcoming changes to our Medicaid program
   * How the new program is different from what we have today
   * Timelines for enrollment
Click here to access the January 2013 DHHS presentation.

Per the January 2013 DHHS report to the Centers for Medicaid Services (CMS), the Managed Care Organizations’ progress is slow in signing up doctors, hospitals and specialists to participate in the Managed Care plan. Some headway has been made with pharmacies. DHHS provides monthly updates to CMS, and posts these reports on their Care Management website page.
Click here to access the January DHHS update report to CMS.

December 27, 2012:  The National Center for Policy Analysis reports on Robert Wood Johnson Foundation's synthesis report (Sep 2012) on the topic of Medicaid Managed Care, and concludes that Medicaid managed care did not improve access to care and in some cases, access was worse. Of particular interest is that many of the cost gains that other states have found for people with developmental disabilities is in the closing of institutions.
Click here to read the article, "Even RWJ Is Pessimistic About Medicaid Managed Care".

November 7, 2012: DHHS Commissioner Toumpas has sent a letter to all Medicaid recipients telling them that there will be a delay in the start of the new Managed Care program. Because he can’t make an estimate of when at this point, he is not announcing a new start date.* 
Click here to see the letter, dated November 7, 2012.

*The start date was most recently set at January 1, 2013, but that is no longer valid.

The primary reason for this continued delay is that the three Managed Care vendors (Boston Medical Health, Centene and Meridian) are behind in setting up the provider network. Anyone with questions should call 800-852-3345 ext 4344, or 603-271-4344. You can also send them an email at This email address is being protected from spambots. You need JavaScript enabled to view it..

Commissioner Toumpas has also provided updates to the Centers for Medicare and Medicaid services (CMS) in Boston (click here to read) and to the Medical Care Advisory Committee (click here to read) which conveys to the group why DHHS will not be able to start the program on the January 1, 2013.

DHHS Comm. Toumpas’ Letter to Medicaid Recipients (Nov 7, 2012)

Comm. Toumpas' Update to Regional CMS Office (Nov 1, 2012)

Comm. Toumpas’ Update to Medical Care Advisory Committee on the Medicaid Care Management program (Oct 31, 2012)

For further updates, visit the CSNI website and the Care Management page on the DHHS website.

November 2, 2012:  NH Business Review reported on the delays in getting Managed Care started in its article: "Hospitals, other providers withhold participation in Medicaid managed care program, puputting state in a bind." Click here to read article.

October 29, 2012:  Gubernatorial Candidate Maggie Hassan weighs in on NH's Managed Care. Earlier this month Community Support Network, Inc. (CSNI) sent a letter to gubernatorial candidates Maggie Hassan and Ovide LaMontagne asking them to weigh in on the state's approach to managed care and on the Step 2 implementation for long term services and supports for people with disabilities and seniors in need of care.

Maggie Hassan has responded.  Click here to view the questions and Hassan's responses at the CSNI website, under Friday Morning Message October 26, 2012.

Once Ovide LaMontagne responds, we will put that information on line as well. Please check back in.

August 31, 2012:  This week the state of New Hampshire received confirmation that Center for Medicaid/Medicare Services (CMS) has approved the State Plan Amendment (SPA) re: the initiation of Medicaid Managed Care. It is important to note that this does not mean that CMS has approved the Managed Care contract itself. The above-mentioned reflects approval of the State Plan Amendment (SPA) only, not the contracts or the rates.

August 2012:  Six candidates for NH governor spent two hours talking about NH Disabilities Issues at the July 29th Governors Candidate Forum.
Click here to find out what they each had to say.

July 2012: DHHS has recently modified the dates for implementing Step 1 of Medicaid Managed Care, extending the schedule by a month. This update has happened since the Care Management Information Sessions. Step 1 relates only to the enrollment for acute medical care services through Medicaid, as of early July:

    • Initial letter mailed          Mid September

    • Info packets on MMCs   Mid October

    • Enrollment begins           November 1

    • Step 1 start date              January 1, 2013

The date for moving the long-term care system for people who experience disabilities has similarly been extended by one month to January 2014.

These dates could very well change again. We will keep you updated.

The reason for the timing changes is that the Center for Medicaid and Medicare Services (CMS) has requested additional information from the State of NH before they will approve the application for transition to Managed Care. DHHS must provide the information requested within 90 days -- they are targeting early August for their reply. Once this reply is received, CMS will have another 90 days to respond in turn.
Click here to read the June 28 letter from CMS to DHHS.
Click here to see July 16 DHHS Leadership Team Stakeholder Briefing.

June 2012: Bob James, Executive Director of One Sky Community Services in Portsmouth, has written an article "Why Preserve Area Agencies?"
Click here to read the article on the CSNI website.

June 2012:  Medicare Managed Care Information Sessions are scheduled across the state in June and July. The Keene session is Tuesday, June 19th from 5:30 to 7:00 p.m. at the Keene Public Library. This is an information session only, NOT for signing people up for the new Care Management program. The 11 sessions across the state will cover the same information, so people need to attend only one. Meeting topics will include basic information about when the new program will start, what people will have to do when signing up for the program, how people can pick a Care Management health plan, and how the new program will work.  Registration is not required but appreciated.
Click here to register for an Information Session.

Click here to view presentation materials for June 19 session in Keene.
Click here to see updated Managed Care reports on the DHHS website.

May 9, 2012:  New Hampshire's Executive Council voted 3-2 to approve the $2.3 billion contract establishing a Managed Care system for the state's Medicaid recipients. These contracts still need to be approved by the Center for Medicaid Services in Baltimore.
Click here to read Concord Monitor story.
Click here to access WMUR-TV story.

May 8, 2012:  An advertisement "Open Letter to Executive Council and Governor Lynch from NH Families: Please Do Not Close Our Locally Controlled, Family Run Area Agency Network for Developmental Disability Care" runs in NH Union Leader and Concord Monitor.
Click here to read.

May 6, 2012: From the Concord Monitor, "State Should Reject Medicaid Contracts" by Betsy McNamara.
Click here to read article.

April 26, 2012: CSNI's Rich Crocker on "Managed Care for NH's Most Vulnerable Citizens?"
Click here to read article posted on the CSNI website.

April 25, 2012: KansasCity Star article on Managed Care situation in Kansas, another state in transition: "Kansas Governor Relents on Managed Health Care for Disabled".
Click here to read article from Kansas City Star online.

April 22, 2012:  Keene Sentinel editorial posted: "NH's Executive Councilors are wise to delay a move on Medicaid restructuring."
Click here to read article.

April 19, 2012: Executive Council once again delays decision on Medicaid Managed Care contract until Wed, May 9th.
Click here to read article in Concord Monitor.
Click here to read article in Union Leader.

April 16, 2012: Union Leader reports "Managed-Care Vote Likely But Exec Council Delays Cast Cloud".
Click here to read article.

April 12, 2012: CSNI presents a letter and supporting information to the Executive Council outlining the top five considerations for NH's Managed Care for people with developmental disabilities. The Executive Council is scheduled to vote on the contract on Wednesday, April 18th.
Click here to access these documents on the CSNI website.

April 12, 2012: DHHS Commissioner Toumpas provides to the Governor and Executive Council his response to questions from the previous hearing and an example of how Risk Management works.
Click here to access these documents on the DHHS website.

April 10, 2012: Senate Finance Committee public hearing on Wait List funding is Thursday, April 12 at 1:45 in Concord. Families are encouraged to attend and also call or send an email to their Senator.
Click here for details.

April 3, 2012: Monadnock Ledger Transcript on "State Tackles Medical Funding Option" and "House Spends Money on Waitlisted".
Click here to read both articles.

April 2, 2012: Concord Monitor Editorial Board asks: "Should Some Services Be Carved out of Managed Care Deal?
Click here to read Concord Monitor viewpoint piece.

March 28, 2012:  The Medicaid Managed Care contract presented to the Executive Councilors is tabled their vote to approve or disapprove until April 18th.
Click here to read Keene Sentinel editorial (3-28-2012), "Slow Down the Train to Private Medicaid Management".
Click here to access the contracts and minutes of meetings from the DHHS site.
Click here to read the Concord Monitor article (3-25-2012), "Council Puts Off Managed Care Decision".
Click here to read Nashua Telegraph article (3-25-2012), "Three Firms Recommended For Managing State's Medicaid Program"

March 21, 2012: From the Monadnock Ledger Transcript, a Rindge family has deep concerns about Medicaid Managed Care.
Click here to read the article.

March 2, 2012: The decision as to which companies will serve as Managed Care Organizations (MCOs) for all Medicaid services will be in the hands of the State of NH Executive Council on Wednesday, March 28th. This group will begin consideration on Friday, March 23rd.

Families are encouraged to make their concerns known to their Executive Councilors prior to those deliberations.
Click here to find out how you can make your concerns known.
Click here to find out what the NH Executive Council does.

February 17, 2012: Commission Toumpas writes to families in response to their letters about Managed Care.
Click here to read the letter.

February 19, 2012: From the Keene Sentinel
Editorial: "A Shift to Managed Care Has Some Medicaid Beneficiaries Worried"
Click here to read the article. 

February 17, 2012: From the Nashua Telegraph
"Approval Is Sought For New Health Care Initiative"
Click here to read the article

February 14, 2012:  From the Concord Monitor
"Managed Care Will Help Lower Medicaid Costs" by DHHS Commissioner Nick Toumpas
Click here to read the article.

February 13, 2012:  From the Keene Sentinel
"Medicaid Overhaul Leaves Questions"
Click here to read the article. 

February 5, 2012:  From the Concord Monitor
"Parents Like Us Are Watching and Worrying" by Betsy McNamara
Click here to read the article.
"Table Contracts to Manage Medicaid"
Click here to read the article.

February 2012:  The National Council on Disability publishes Guiding Principles for successfully enrolling people with disabilities in Managed Care Plans.
Click here to read the NCD's 20 Guiding Principles.

January 31, 2012:  Commissioner Nick Toumpas talks with Laura Knoy on NHPR's The Exchange about Medicaid Managed Care.
Click here to listen online at NHPR.

January 2, 2012: From the Union Leader
"State Reviewing Proposals for Massive Medicaid Contract"
Click here to access article. 

January 2012: Disabilities Rights Center presents panel discussion of what Managed Care is and what it means for NH.
Click here to watch online.

January 2012: National Leadership Consortium on Developmental Disabilities
"Reassessing the Impact of Managed Care in the DD Sector" by Robert Gettings
Click here to access the report.

January 2012: CSNI's Timeline of Managed Care in NH
Click here to access the timeline.

January 10, 2012 Update

The Care Management Review Committee received a number of bids from managed care organizations by the December 15th deadline. These proposals, currently under review, will be whittled down to a few by January 15th.

Meanwhile Connecticut, one of more than thirty states who switched to Managed Care for Medicaid, made the decision in late December 2011 to stop using private insurers for Medicaid. Why? 
Read article in USA Today...

Read article in the Hartford Courant...

Back to NH, the Review Committee hasn't released any information on this first round of bidders, and it's not yet clear if we'll find out who the finalists are in mid-January. We may have to wait until the contract is awarded to find out who will be the provider. Stay tuned on that...

Please note that any changes will not affect the DD system until at least July 2013. 

The DD community support system is part of the second phase of the program, and the start date for the second stage is somewhat ambiguous at this point. It is supposed to start one year following the actual completion of the first phase.

In the meantime, to stay informed, you can find the results of last fall's Stakeholder Feedback Process on the DHHS website. These feedback sessions included public forums, focus groups and an online survey, using input from program users, caregivers and providers. There's a lot of material in the report, but it's worth a look-through if you want to know what people across the state had to say about this issue.

New Hampshire is aggressively pursuing a switch from its current Medicaid system to a Managed Care Plan. Your input is needed as the state designs, develops and implements NH’s Care Management Program.

Currently, there are several steps for transition from the current arrangement for Medicaid services. The first phase will enroll all Medicaid recipients in a managed care program for acute care, that is, for their medical services. This will be similar to any of us who use an HMO or provider plan, and is expected to be implemented in July of 2012.

The second step will have much more serious impact on services on which individuals with Developmental Disabilities and Acquired Brain Disorder rely. These services include things like day and residential services, consumer-directed services, respite, and service coordination. The Request for Proposal (RFP), released in mid-October, includes DD services in the Managed Care program. The current timeline for this second phase sets its start in July 2013, a year after the first phase is enacted. The next 12 to 18 months will be critical to all of us involved in providing disabilities services. We must use this time to engage in discussion and give serious consideration to implications as options are evaluated.

Bob James, Executive Director of One Sky Services in Portsmouth (Region 8), wrote an article describing concerns and exploring what services might be like under a Managed Care scenario. Click here to read Bob James' piece.


Additional Background Materials and Resources:

NH DHHS Care Management Documents on the DHHS website

CSNI Updates

GSIL Medicaid Managed Care Primer (from GSIL website)

Choice (clear one-page summary from Bob James, OneSky Services, Region 8)

Concord Monitor Editorial Board asks: "Should Some Services Be Carved out of Managed Care Deal?
Click here to read Concord Monitor viewpoint piece.