Beginning July 1, certain Medicaid beneficiaries who live in seven eastern Kansas counties will choose one of the Health Maintenance Organizations (HMO) under contract with the state in the PrimeCare Kansas program for their health care needs. People in these programs and counties will no longer be able to choose the other SRS managed care program, HealthConnect.

Only Medicaid recipients in two public assistance programs -- Temporary Assistance to Families and the poverty-level eligible pregnant women and children program -- in Douglas, Leavenworth, Miami, Franklin, Atchison, Wyandotte and Johnson counties will be effected by this change. Medicaid recipients in other SRS programs, including children in the SSI program, are not effected by the change and remain in the HealthConnect program.

These seven counties currently have more than one HMO providing health care for Medicaid recipients, giving people in these programs a choice between HMOs in the PrimeCare Kansas program. Under PrimeCare Kansas, people in the program not only choose the HMO, but also the primary care provider within that HMO they wish to see.

In these seven counties, at least two of the following three HMOs are serving Medicaid clients: Blue Advantage Plus +, Horizon, and HealthNet.

With the change, the Department of Social and Rehabilitation Services is attempting to meet the intent of the Kansas Legislature for SRS to implement capitated managed care wherever possible.

Under a capitated managed care system such as PrimeCare Kansas, HMOs are paid a monthly fee in advance to provide health care to a Medicaid recipients. Recipients select a single primary care provider within the HMO such as a doctor or advance registered nurse practitioner. The primary care provider supplies preventive and primary medical services and refers the patient to specialists when necessary.

Medicaid recipients effected by this change were sent information about the change in May. The HMO selected by the Medicaid beneficiary provides a list of primary care providers within the HMOs.

Under PrimeCare Kansas, the HMOs act as insurance companies to provide most of the Medicaid recipient's health care needs. A major intent of the program is to build relationships between consumers of medical care and their health care provider in order to create a continuity of care and prevention.

People in the Medicaid program will have access to a number of preventive services in PrimeCare Kansas not available in HealthConnect. For example, smoking cessation, prenatal, and parenting classes are available. PrimeCare Kansas also pays for transportation for health care visits.

HMOs also offers Medicaid recipients more choice concerning a primary care provider. Physicians not enrolled in the Medicaid program are available to recipients when the physician is part of the HMO chosen .

As SRS contracts with multiple HMOs in other counties, this policy will also be implemented in these counties as well.

Page Last Updated: May 29, 2001