Medicaid Carve-Out Update

At the July meeting of the Medicaid Managed Care Council, DSS announced that letters were sent to offer contract negotiations for two vendors - UnitedHealth Group (and its dental unit, Dental Benefit Providers) and Doral - for the dental carve-out.

Under the DSS model, both vendors would be responsible for a statewide network, and clients could decide between the two vendors. As explained by DSS, that should allow the clients more choice and also give DSS more leverage that it would have with only one vendor. DSS explained that using two vendors would give the state the option of telling one vendor (if a problem arises), "We can always shift to just the other vendor." DSS reported that both organizations scored close to one another in the proposal ranking process and far ahead of the other RFP respondent.

One Council member raised the question of whether the use of two ASOs, rather than one, would mean a less cost-effective and efficient program. Another Council member responded that both providers already have extensive administrative infrastructures. A third Council member asked about the challenge faced by DSS in coordinating four general/medical providers with two dental providers.

The dental carve out is now slated to begin on February 1st, 2005.