HEALTH CARE AUTHORITY

[Filed June 3, 2021, 8:13 a.m.]

Title or Subject: Medicaid State Plan Amendment (SPA) 21-0018 Managed Care Enrollment Process Updates.

Effective Date: July 1, 2021.

Description: The health care authority (HCA) intends to submit medicaid SPA 21-0018 in order to limit default assignment of medicaid beneficiaries who are not American Indian or Alaska Native (AI/AN) to a managed care organization (MCO) based on statewide market share. Default assignment means automated assignment to MCOs for non-AI/AN medicaid beneficiaries who do not choose an MCO themselves. Once an MCO reaches a level of statewide apple health market share that could adversely affect the ability of the other MCOs to meet network adequacy requirements, HCA will no longer include that MCO in the pool of MCOs for default assignment. This limit will apply to default assignments only; medicaid beneficiaries will continue to be able to choose any MCO regardless of this limit.

SPA 21-0018 is expected to have no effect on the annual aggregate per member per month payments made to MCOs.

SPA 21-0018 is in the development process; therefore a copy is not yet available for review. HCA would appreciate any input or concerns regarding this SPA. To request a copy when it becomes available, you may contact the person named below. To submit comments, please contact the person named below (please note that all comments are subject to public review and disclosure, as are the names of those who comment).

Contact Jessica Diaz, Medicaid Programs Division, 626 8th Avenue S.E., Olympia, WA 98501, phone 360-725-1177, TTY 711, email jessica.diaz@hca.wa.gov.