RD556 - Operational Savings and Costs for Merging the Department of Medical Assistance Services Medicaid Managed Care Programs – October 1, 2021

Executive Summary:

DMAS will unify the contracts for the Commonwealth Coordinated Care Plus (CCC Plus) and Medallion 4.0 managed care programs effective July 1, 2022 through its Cardinal Care initiative. Consolidating the programs under one contract will enable the Department to ensure better continuity of care for members, eliminate redundancies, and improve the programs’ focus on the diverse and evolving needs of the populations served. Cardinal Care will require some upfront investment for systems, operational development, and communications costs. Over time, Cardinal Care is expected to bring administrative efficiencies, which will provide DMAS with enhanced capacity to focus on strengthening and refining its monitoring and oversight policies, processes, and systems. This report provides relevant background information and describes the anticipated costs, savings, and benefits associated with the Cardinal Care initiative. The report includes the following sections:

• Section 1 provides relevant background information describing the Department’s current and future managed care delivery models.

• Section 2 describes DMAS’s operational expenses.

• Section 3 describes MCO operational expenses.

• Section 4 examines benefits realized through Cardinal Care.

• Section 5 describes other recommended program alignment.

• Section 6 provides a summary conclusion and highlights next steps.