Update on Alaska’s Medicaid Coordinated Care Demonstration Project

Alaska’s Department of Health and Social Services issued a Request for Proposals at the end of 2016 for the implementation of coordinated care demonstration projects for Medicaid beneficiaries as part of the Health Alaska Medicaid reform under Senate Bill 74, which passed last year.

Proposals were due in April. The DHSS received nine proposals and at least one proposal for each of the three categories of models identified in the RFP.

The three different health care models in the RFP are

  • Managed Care Organizations (MCO), Prepaid Inpatient Health Plans (PIHP), and Prepaid Ambulatory Health Plans (PAHP)
  • Care Management Entities (CME)
  • Provider-Based Reform (PRB)

Under the MCO, PIHP, and PAHP model, DHSS would contact with a licensed health insurer to enroll Medicaid beneficiaries and provide Medicaid-covered services under a capitated per member per month payment arrangement.

Under the PAHP model, DHSS would contract with an administrative entity to perform care and disease management for Medicaid beneficiaries. The contractor would coordinate with Medicaid providers. The contractor’s payment would be per member per month fee, with incentives built in for demonstrated savings from their services.

Under the PRB model, DHSS would contract with a provider-sponsored organization to perform care and disease management for Medicaid beneficiaries through the organization’s provider network.

The list of organizations who responded will be release after the contracts are awarded in the fall. The contracts are scheduled to go into effect on January 1, 2018 and will last at least three years, which the option to renew the contracts up to three additional years.

Healthy Alaska has sixteen different initiatives as part of the redesign process.