DHHS Awards Medicaid Managed Care Contracts

The NH Department of Health and Human Services/Division of Medicaid Services is pleased to announce approvals of its Medicaid Care Management (MCM) managed care contracts at the Governor and Executive Council’s January 10, 2024 meeting. Managed care organizations (MCOs) AmeriHealth Caritas New Hampshire, Granite State Health Plan (d/b/a NH Healthy Families), and Boston Medical Center Health Plan (d/b/a WellSense Health Plan) were selected for 5-year contracts, September 1, 2024 through August 31, 2029, pending successful readiness review. 

The MCM Program elements in the new MCO contracts further support a primary care and prevention model of access to services through a more meaningful and holistic role of providers in the delivery of managed care services, including:

• Patient and Provider centric approach to care delivery and preventive services with introduction of a Primary Care and Preventive Services Care Model built on authentic patient/provider relationships and provider-delivered care coordination supported by MCO analytics;
• Increased focus on priority populations, including:
  • Individuals who have required an inpatient admission for a behavioral health diagnosis within the previous 12 months;
  • Infants, children and youth who are involved in the State’s child welfare system, Division for Children Youth and Families, including those in foster care and who have elected voluntary services;
  • Babies experiencing low birth weight and/or neonatal abstinence syndrome; and
  • Individuals who are incarcerated and eligible for participation in the Department’s Community Reentry demonstration program, pending CMS approval.
• Focused MCO-Delivered Care Management services for priority populations; 
• Safe and effective use of medications, while supporting appropriate access to new breakthrough drugs and gene therapies;
• Strengthened alignment of the State’s Community Mental Health Center funding with existing behavioral health investments;
• Improved reliability, quality and safety of Non-Emergency Medical Transportation services with elevated standards and remedies applied to the MCOs’ performance of broker and transportation provider oversight; and
• Expanded efforts to ascertain the full potential of program integrity functions with expanded use of MCO incentives and remedies tied to key quality and performance metrics.

The MCOs’ proposals demonstrated ways in which the plans will meet or exceed MCM Program requirements and the Department’s goals, offering innovative strategies for building on authentic patient/provider relationships with an emphasis on primary care prevention and provider-delivered care coordination to effectively reduce future illness burden and improve population health.

To learn more about the MCM Program and to view the current Contracts between DHHS and the MCOs, visit the Medicaid Care Management webpage.