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. This SPA is a relatively simple document, a small link in the transition chain. It informs the federal government that the state of NH intends to shift its Medicaid program from a fee-for-service reimbursement to a managed care program.

Again, approval of the SPA is not the same as review and approval of the contract. CMS still has to approve both this massive managed care contract and the capitated rates paid to the Managed Care Organizations (MCOs). These are not yet approved. In addition, the three MCOs are still trying to build robust provider networks, which will also require approval by CMS and the state.

According to CMS's letter, CMS is still reviewing the contracts and their associated rates, and has continuing questions for the Department about them. No federal financial participation (no federal dollars) will be available to NH for Managed Care until the contracts are approved by CMS.

This SPA (State Plan Amendment) has absolutely nothing to do with Step 2 (DD and long-term care) or Area Agency services. As of right now, Step 1 covering medical and acute care services is still scheduled to begin on January 1, 2013, but as that date approaches it appears less and less likely to be do-able. Step 2 is still scheduled to start one year after Step 1 is implemented.

FYI, a final report on this past summer’s meetings to discuss Managed Care can be found on the DHHS website. Details on how Managed Care might affect people served by MDS and their families can be found on our special Managed Care Info page.