Thousands of Medicaid recipients in Northern Virginia are being enrolled in a managed-care program that state officials say will provide improved health care benefits while saving public tax dollars 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 the participants will be mostly women and children, as well as some people who are elderly, blind or 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.
Participants who do 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 recipients 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 primary-care physician appointments, a 24-hour nurse hotline, adult vision care, free membership in Boys & Girls Clubs for children ages 6 to 18, asthma and diabetes disease-management programs, and free sports physicals for children ages 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 were 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 states participating with managed care have historically reduced their total Medicaid spending by 2 to 19 percent, freeing up funds to provide health care to the uninsured.
"We're able to save them money," Nichols said. "That allows them to cover more people."
Virginia officials said managed care has cut about 5 percent from the state's Medicaid bill. The savings, they said, are applied to other programs.
"When we started managed care [in Virginia] in 1996, our big focus was saving taxpayer money," said Cheryl Roberts, deputy director of programs and operations for the state's Department of Medical Assistance Services. "The best part of the exercise is what the health outcomes look like. . . . We save money, but mostly we improve health."
Medicaid was established in 1965 as a federal- and state-financed program to pay for health care for those with low incomes.
The number of people enrolled in Medicaid has increased dramatically in recent years, from 28 million in 1991 to 44 million in 2004. The growth has fueled spending. Last year, the amount spent on Medicaid topped $311 billion, more than four times the amount spent in 1990.
Although states began exploring Medicaid managed care two decades ago, only recently has it been widely embraced. In 1991, about 9.5 percent of all people enrolled in Medicaid were covered by managed care. That number had grown to 59 percent by 2003.
Virginia is aggressively pursuing managed-care programs in an effort to contain growth in Medicaid spending while trying to maintain access to care for low-income residents.
According to data compiled by the state, last year 606,115 Virginians were enrolled in Medicaid, with 65 percent of those members participating in a managed care program.
Roberts said a large reason for the program is to provide recipients with "all the bells and whistles that we take for granted in commercial care."
In December, the state will bring managed care to Medicaid recipients in Winchester. Lynchburg will be added in May.