Managed Care

Issue:           

The OPWDD system will transition to managed care in phases, beginning with an enhanced care coordination model through the development of regional Care Coordination Organizations (CCOs), before transitioning to a fully capitated rate structure. Beginning in 2018, CCOs are expected to begin operations and will be rolled-out on a regional basis. Enrollment on a voluntary basis in managed care is expected to begin in 2018, and the transition to managed care is planned to be completed within a five-year period.

The state budget applies ongoing DOH Global Cap resources to support the initial start-up costs of transitioning the OPWDD service delivery system from a fee-for-service payment structure to managed care. OPWDD is the last remaining Medicaid system to transition to managed care, which has shown enhanced quality outcomes and cost control for other Medicaid populations.

Position:     

As OPWDD begins transitioning to managed care by developing regional CCOs, we advocate for increased standardization, new models of care coordination, and investments at both the state agency and provider agency levels, including investing in information technology. Any savings resulting from the implementation of CCOs and managed care should be reinvested in the OPWDD system.