Item 6A

Authorize to enter into sole source contracts through amending the expiring existing individual agreements with the state’s two managed care health plans, Granite State Health Plan d/b/a New Hampshire Health Families, Bedford, NH, and Boston Medical Center HealthNet Plan d/b/a Well Sense Health Plan, Boston, MA (originally approved by G&C on 5-9-12, item #54A). The contract for FY 2019 synchronizes the existing Medicaid Care Management (MCM) Program re-procurement as legislatively required and adjusts for the delay in the initial MCM program start-up. It is impractical to contract with new Managed Care Organizations for one year given the lead time to procure and establish new MCOs. Also, with the planned transition under SB313 to the Granite Advantage Health Care Program from the NH Health Protection Program aside from a problematic procurement, it would require up to three transitions in a six month period for beneficiaries. The adjusted actuarially certified rate structure under the sole source contracts is $655,426,236.40, prospectively. The SFY capitation rate for SFY 19 increases by 3.72%, which approximates with experience over the preceding years of the MCM program, and is lower than the national trend of 4.9% under the President’s Medicaid budget projections. The pre-existing aggregate average administrative cost allowance of 8% remains in place as does the operating margin allowance of up to 1.5%. Effective upon G&C approval, the combined aggregate total is $3,557,921,400.41 all Medicaid Care Management program contracts. 50% Federal, 50% General Funds for the currently eligible Medicaid population except for the NH Health Protection Program services funds are 94% Federal, 6% Other for Calendar Year 2018; and 93% Federal, 7% Other for Calendar Year 2019.