The insurance industry bulwark of Hartford, Conn., is the latest state capital to embrace Medicaid managed care.
On Nov. 15, the state gave notice of its intent to request a federal waiver that will enable it to move some 244,000 Medicaid recipients into HMOs by December 1996. A draft request for proposals describing the terms and conditions of the initiative is under review by a state advisory council. The program is expected to save $23.4 million-or 5% of what the state would have spent on fee-for-service benefits-over two years.
While details regarding plan design and administrative costs remain under discussion, managed-care plans are anxious to respond.
"It's been a long time in development and a number of HMOs have expressed interest in participating in such a program," said Joe Mike, executive director of the Association of Connecticut HMOs, which represents 10 of the state's 13 licensed HMOs.
Hospitals also are poised to hop on the managed-care bandwagon. Nearly 20 of the Connecticut Hospital Association's 35 member hospitals and their physicians have agreed to work together to develop a statewide managed-care network, said Dennis May, the CHA's president.
The state intends to pay hospitals the normal fee-for-service amount, while primary and specialty care will be capitated, Mr. May said. "The reason the state did that was to limit the risk for those provider groups that don't have a lot of experience with managed care," he explained.
However, it's unclear whether hospitals will receive capitated payments in the future. The CHA and its hospital members are embroiled in litigation with the state over the adequacy of Medicaid payments. The suit, filed in December 1990, could go to trial early next year.
But with a new Republican governor taking office in January 1995, a settlement also may be possible, Mr. May said.