Managed Care in Medicaid Touted as Money Saver

Thousands of Medicaid recipients in Northern Virginia are being enrolled in a managed-care program that state officials say will provide greater health-care benefits while saving public tax money that could be put into other health programs.

Starting Sept. 1, 23,000 additional Virginia Medicaid enrollees will be placed in a managed-care program. State officials said participants will be mostly women and children, as well as some people who are elderly or are blind or otherwise disabled.

They will be given a choice of two providers: UniCare, which already serves 43,000 Medicaid recipients in Northern Virginia, or Virginia Beach-based Amerigroup, which serves 1 million Medicaid recipients in nine states, including Maryland, and the District.

A member who does not make a selection will be assigned a provider. Amerigroup is the most recent addition to the roster of eight managed-care groups that operate in the state.

Officials with Amerigroup said they plan to provide Medicaid members with preventive medical benefits and other services that have not been available in the past.

Those benefits include up to 10 free round trips for people to take children to appointments with primary-care physicians, a 24-hour nurse hotline, adult vision care, free membership in boys and girls clubs for children 6 to 18, asthma and diabetes disease-management programs, and free sports physicals for children 10 to 18.

"We're letting people live healthier lives and lowering the cost of health care," said Amerigroup spokesman Kent Jenkins.

State governments have historically operated Medicaid as a "fee-for-service" program. But critics say that under that system, Medicaid recipients have not sought or received appropriate care, getting medical help only when they are acutely ill and creating a costly and inadequate cycle of care.

Under the managed-care system, officials said, members are encouraged to get preventive and early-stage care. Managed-care groups agree to provide services at a fixed monthly price, enabling states to better control Medicaid costs.

"Now, through a preventative care model, we're getting patients in earlier to get service," said Sandra Nichols, chief executive of Amerigroup in Virginia and the District.

Nichols said that states participating with managed care have historically reduced their total Medicaid spending by 2 to 19 percent, freeing up money to provide health care to the uninsured.

"We're able to save them money," Nichols said. "That allows them to cover more people."