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2004 Medicaid Managed Care Enrollment Report
Page(s) 2 3 4 5 6-7 8-9 10 11 12 13 14-20 21-54 55-56

Introduction Managed Care Trends 1996-2004 National Breakout of Managed Care Entities Medicaid Managed Care Penetration Rates by State 2004 Enrollment Fact Sheet Managed Care Entity Type and Enrollment by State Prepaid Ambulatory Health Plans by State Prepaid Ambulatory Health Plans Enrollment by State Prepaid Inpatient Health Plans Enrollment by State Dual Eligible Enrollment by Managed Care Entity Type Dual Eligible Enrollment by Plans Medicaid Managed Care Program Summary Glossary

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2004 MEDICAID MANAGED CARE ENROLLMENT REPORT Summary Statistics as of June 30, 2004 This report is composed annually by the Finance, Systems, and Budget Group (FSBG) of the Centers for Medicare & Medicaid Services (CMS). The Enrollment Report profiles Medicaid managed care programs on a planspecific basis as of June 30, 2004. The information was collected from State Medicaid agencies and the CMS Regional Offices. Questions regarding this report should be directed to: Carolyn Lawson - (410) 786-0704 or [email protected] Loan Swisher – (410) 786-4650 or [email protected] Joseph Del Pilar – (410) 786-0081 or [email protected]

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MANAGED CARE TRENDS
   YEAR  TOTAL MEDICAID   MANAGED CARE  POPULATION  POPULATION  OTHER  POPULATION  % MANAGED CARE  ENROLLMENT 

2004  44,355,955  26,913,570  17,442,385  60.68%  2003  42,740,719  25,262,873  17,477,846  59.11%  2002  40,147,539  23,117,668  17,029,871  57.58%  2001  36,562,567  20,773,813  15,788,754  56.82%  2000  33,690,364  18,786,137  14,904,227  55.76%  1999  31,940,188  17,756,603  14,183,585  55.59%  1998  30,896,635  16,573,996  14,322,639  53.64%  1997  32,092,380  15,345,502  16,746,878  47.82%  1996  33,241,147  13,330,119  19,911,028  40.10%  The Total Medicaid population for 1996-2004 was collected by States at the same time the managed care enrollment numbers were collected instead of using 2082 data as in previous years. These figures represent point-in-time enrollment as of June 30th for each reporting year. The unduplicated managed care enrollment figures include enrollees receiving comprehensive benefits and limited benefits. This table also provides unduplicated national figures for the Total Medicaid population and Other population. The statistics also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards

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NATIONAL BREAKOUT OF MANAGED CARE ENTITIES    AND ENROLLMENT AS OF JUNE 30, 2004     MANAGED CARE ENTITY TYPE        # OF PLANS                 # OF ENROLLEES    

Health Insuring Organization  Commercial Managed Care Organization  Medicaid‐only Managed Care Organization  Primary Care Case Management  Prepaid Inpatient Health Plan  Prepaid Ambulatory Health Plan  Program of ALL‐inclusive Care for the Elderly  Other     TOTAL 

5  156  131  36  121  34  31  9     523 

                             

513,255  9,680,307  7,841,591  5,891,174  7,961,643  3,799,313  9,999  213,113     35,910,395 

This table provides duplicated figures by plan type.  The total number of enrollees include 8,996,825  individuals who were enrolled in more than one managed care plan.  It also includes individuals enrolled  in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility  standards. 

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MEDICAID MANAGED CARE ENROLLMENT AS OF JUNE 30, 2004
ROW NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 STATE  MEDICAID  ENROLLMENT MANAGED CARE  ENROLLMENT PERCENT IN  MANAGED CARE

800,569 439,832 54.94% Alabama 0 0.00% 96,630 Alaska 904,658 806,193 89.12% Arizona 386,395 65.02% 594,264 Arkansas 3,258,787 50.36% 6,471,239 California 378,416 369,270 97.58% Colorado 402,286 303,404 75.42% Connecticut 135,224 99,598 73.65% Delaware 138,637 88,452 63.80% Dist. of Columbia 1,450,117 65.69% 2,207,375 Florida 1,273,133 96.23% 1,323,036 Georgia 190,381 148,580 78.04% Hawaii 131,693 79.29% 166,088 Idaho 158,869 9.13% 1,740,488 Illinois 509,732 63.42% 803,786 Indiana 262,487 92.13% 284,918 Iowa 153,395 57.02% 269,032 Kansas 678,529 625,807 92.23% Kentucky 723,837 78.76% 919,079 Louisiana 154,785 59.84% 258,686 Maine 696,097 469,998 67.52% Maryland 581,520 61.39% 947,297 Massachusetts 1,255,067 89.02% 1,409,832 Michigan 361,381 63.54% 568,761 Minnesota 637,910 73,445 11.51% Mississippi 432,339 44.37% 974,310 Missouri 58,030 67.12% 86,452 Montana 149,405 72.28% 206,701 Nebraska 89,846 53.06% 169,334 Nevada 96,188 0 0.00% New Hampshire 798,132 541,820 67.89% New Jersey 420,935 273,018 64.86% New Mexico 2,341,733 58.22% 4,022,544 New York 788,943 70.93% 1,112,341 North Carolina 33,065 63.03% 52,458 North Dakota 507,337 30.83% 1,645,454 Ohio 518,926 354,110 68.24% Oklahoma 426,905 345,410 80.91% Oregon 1,265,891 79.14% 1,599,570 Pennsylvania 842,827 96.52% 873,211 Puerto Rico 180,528 124,921 69.20% Rhode Island 69,791 8.25% 845,870 South Carolina 95,577 97.75% 97,774 South Dakota 1,345,131 100.00% 1,345,131 Tennessee 1,150,773 42.75% 2,692,012 Texas 167,338 88.61% 188,839 Utah 130,782 86,263 65.96% Vermont 0 0.00% 10,900 Virgin Islands 398,871 65.66% 607,493 Virginia 1,080,738 834,883 77.25% Washington 156,468 52.49% 298,093 West Virginia 374,003 47.21% 792,177 Wisconsin 58,939 0 0.00% Wyoming TOTALS 44,355,955 26,913,570 60.68% The unduplicated Medicaid enrollment figures include individuals in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards. The unduplicated managed care enrollment figures includes enrollees receiving comprehensive and limited benefits. Page 4

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2004 PROGRAM AND ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2003 – 6/30/2004) Alabama – Patient First3 program has been restructured. As of June 30, 2004, there were no enrollees, therefore, it is not included in this report. The Partnership Hospital Program4 converted from 1915(a) voluntary to 1932(a). Arizona – CIGNA Community Choice1 and Family Health Plan of North Eastern Arizona2 no longer participate in the Medicaid program. California – Managed Care Network3 and Primary Care Case Management program5 were terminated. UCSD Health Plan1, Placer County Managed Care Network3, Sonoma County Partners for Health Managed Care Network3, and Care 1st Health Plan7 no longer participate in the Medicaid program. Center for Elders Independence8, On Lok Senior Health Services8, and Sutter Senior Care Sacramento LTC8 converted from 1115(a) to PACE. Colorado – Access Behavioral Care6 – The number of enrollees were incorrectly reported for 2003. The number of enrollees should have been 95,967 instead of 60,593. Delaware – First State Health Plan1 no longer participates in the Medicaid program. District of Columbia – Americaid Community Care2 is now Amerigroup2. Florida – AVMed – St. Augustine Health Care2 and Neighborhood Health Partnership1 no longer participate in the Medicaid program. Indiana – The State Medicaid Enrollment increase was due to the rising health care costs and loss of jobs. Michigan – Botsford Health Plan2 and Community Care Plan2 no longer participate in the Medicaid program. Mississippi – For 2003, the State provided FY eligibles of 768,004 as the Medicaid Enrollment instead of June 30th eligibles of 584,728. Nevada – Voluntary Health Maintenance Program 1 was terminated. New Hampshire – No longer has managed care. New Mexico – Cimarron1 is now Molina1. New York – For 2003, NY’s managed care enrollment should have been reported as 2,200,384. North Carolina – Access II/III - 1915(b) 3, Carolina Access – 1915(b) 3, and Health Care Connection – 1915(b)1 programs have been terminated. Wellpath Select, Inc. dba Southcare – 1915(b)1 no longer participates in the Medicaid program. Page 6 of 56
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2004 PROGRAM AND ENROLLMENT FACTS SHEET (MAJOR CHANGES FROM 6/30/2003 – 6/30/2004) Oklahoma- Under the SoonerCare program, MCO was terminated and PCCM was converted to a Medical-only PAHP. Heartland2, Prime Advantage2 and UNICARE2 no longer participate in the Medicaid program. Ohio – Family Health Plan2 no longer participates in the Medicaid program. Oregon – Providence Health Plan1 no longer participates in the Medicaid program. Pennsylvania – Community – LIFE4 has been converted from a Medical-only PIHP to PACE. Texas – HMO Blue1 is now Evercare1. Tennessee – Xantus Health Care1 no longer participates in the Medicaid program. Utah – Molina Healthcare of Utah (AFC Plus) 4 is now Molina Healthcare of Utah (Molina Plus) 4. Molina Healthcare of Utah (AFC Utah) 4 is now Molina Healthcare of Utah (Molina) 4. The Voluntary PCP/PIHP program4 was terminated. Virginia – The Managed Care Enrollment was reported incorrectly for 2003. The number was reported as 262,961 instead of 343,757. Washington – Healthy Options1,3 converted from 1915(b) to 1932(a). Premera Blue Cross1 no longer participates in the Medicaid program. ___________________________ Commercial MCO 2 Medicaid-only MCO 3 PCCM 4 Medical-only PIHP 5 Medical-only PAHP 6 Mental Health PIHP 7 Dental PAHP 8 Other
1

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NUMBER OF MANAGED CARE ENTITY ENROLLEES BY STATE AS OF JUNE 30, 2004 MedicaidCommercial STATE
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont only

HIO
0 0 0 0 513,255 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

MCO
0 0 0 0 2,650,685 0 223,366 0 0 512,210 0 100,121 0 80,187 0 54,253 0 0 0 0 0 98,639 417,394 336,417 0 116,997 0 31,204 89,846 0 186,407 272,783 756,800 13,153 794 157,281 0 24,563 233,871 842,827 124,921 0 0 887,027 472,762 0 0

MCO
0 0 806,193 0 0 56,351 80,038 85,598 88,452 195,046 0 48,459 0 78,682 294,014 0 63,997 132,813 0 0 469,849 178,735 470,643 25,144 0 315,342 0 0 0 0 355,413 0 1,538,431 0 0 350,056 0 233,567 897,047 0 0 52,944 0 458,104 320,182 0 0

PCCM
0 0 0 332,473 0 57,561 0 0 0 688,109 840,002 0 131,693 0 326,484 102,434 89,287 339,003 723,837 154,785 0 304,146 0 0 0 0 58,030 37,636 0 0 0 0 20,335 775,790 32,271 0 5,572 11,414 140,668 0 0 0 74,264 0 357,097 44,898 86,263

PIHP
423,112 0 75,548 0 0 381,312 0 0 3,198 95,287 2,235 673 0 0 0 262,487 0 0 0 0 0 325,344 1,255,067 0 0 0 0 0 0 0 0 0 9,849 0 0 0 0 291,480 1,030,653 842,827 0 0 0 1,345,131 292,623 238,152 0

PAHP
0 0 0 386,395 297,180 0 0 0 0 88,698 1,273,133 0 0 0 0 0 0 625,807 0 0 0 0 0 0 73,445 0 0 0 0 0 0 0 6,725 0 0 0 348,538 303,495 0 0 0 16,480 95,577 0 0 154,730 0

PACE
0 0 0 0 1,665 830 0 0 0 55 0 0 0 0 0 0 111 0 0 0 149 1,310 0 0 0 176 0 0 0 0 0 235 1,967 0 0 458 0 530 437 0 0 367 0 269 732 0 0

OTHER
16,720 0 0 0 2,652 0 13,565 0 0 17,810 0 1,409 0 0 0 0 0 0 0 0 0 0 0 926 0 0 0 149,405 0 0 0 0 10,626 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming TOTALS

0 0 0 0 0 0 513,255

0 230,959 427,612 92,993 244,235 0 9,680,307

0 78,352 48,217 0 119,922 0 7,841,591

0 89,560 4,087 63,475 0 0 5,891,174

0 0 1,077,312 0 9,353 0 7,961,643

0 0 129,110 0 0 0 3,799,313

0 0 215 0 493 0 9,999

0 0 0 0 0 0 213,113

This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

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Number of Prepaid Ambulatory Health Plans (PAHPs) by State as of June 30, 2004
Medical only 2 Mental Health Substance Use Disorders Disease Management

State Arkansas California Florida Georgia Kentucky Mississippi New York Oklahoma Oregon South Carolina South Dakota Utah Washington
Totals

Dental 9

Transportation 1

4 1 1 1 1 1 1 1 1 1 2
4 1 1 17 4 7

7

A PAHP provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and does not provide, arrange for, or otherwise have responsibility for provision of any inpatient hospital or institutional services.

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Number of Enrollees in Prepaid Ambulatory Health Plans (PAHPs) by State as of June 30, 2004
Medical only 997 Mental Health Substance Use Disorders Disease Management

State Arkansas California Florida Georgia Kentucky Mississippi New York Oklahoma Oregon South Carolina South Dakota Utah Washington

Dental 296,183

Transportation 386,395

88,698 1,273,133 625,807 73,445 6,725 348,538 8,084 16,480 95,577 154,730 129,110 295,411

Totals 366,015 6,725 8,084 687,171 2,440,065 291,253 A PAHP provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and does not provide, arrange for, or otherwise have responsibility for provision of any inpatient hospital or institutional services.

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Number of Prepaid Inpatient Health Plans (PIHPs) and Enrollment by State as of 6/30/04 # of Mental Health (MH) PIHPs Long Term Care PIHPs Long Term Care Enrollees

State Alabama Arizona Colorado District of Columbia Florida Georgia Hawaii Iowa Massachusetts Michigan New York Oregon Pennsylvania Puerto Rico Tennessee Texas Utah Washington Wisconsin Totals

# of Medicalonly PIHPs 1 1 1

Medicalonly Enrollees 423,112 12,042 3,198

MH PIHP Enrollees

# of MH & SUD PIHPs 1

MH & SUD Enrollees 75,548

8 2 1 2

369,270 95,287 2,235 673 1 1 1 262,487 325,344 35,441 12 9,849

17 10 3 292

1,219,626 291,480

25 2 2 1 9 14 63 174,302 1,077,312 2

1,030,361 842,827 1,345,131 292,623

3

63,850

640 4,210,402

1 13

8,713 18,562

9

502,494

3,230,185

36

A PIHP provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and provides, arranges for, or otherwise have responsibility for provision of any inpatient hospital or institutional services. *Note: We did not include a separate column for Substance Use Disorders (SUD) PIHPs on this chart because there were 0 enrollees in this managed care entity as of 6/30/04.

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DUAL ELIGIBLE ENROLLMENT BY MANAGED CARE ENTITY TYPES STATE
Arizona  California  Colorado  Florida  Georgia  Idaho  Indiana  Iowa  Kansas  Kentucky  Maryland  Massachusetts  Minnesota  Missouri  New Jersey  New Mexico  New York  North Carolina  Ohio  Oregon  Pennsylvania  Puerto Rico  South Carolina  South Dakota  Tennessee  Texas  Utah  Washington  Wisconsin  TOTALS 

HIO
   107,053                                                                                   107,053 

MCO
72,637 30,750 3,777 14,268           11,660     38,727   8,461         26,417 130,275 124,105     242,607 29,270     3,910 736,864

PCCM
    6,545   722 10,725 26,215                     246,182   3,566             3,951     297,906

PIHP
    49,199   1,841     23,920                       44,774 124,462 124,105     242,607 22,909 20,958 126,728   781,503

PAHP
  6,771     161,001                             48,677       11,258     13,616     241,323

PACE OTHER
   1,550  829  51              108     142  1,174     154     235  1,827     342  530  398     343     253  665     215  468  9,284    2,645   24     8,500                   8,781                       7,680 27,630

This table provides duplicated figures that include enrollees receiving comprehensive and limited benefits. Total number of enrollees includes those who were enrolled in more than one managed care plan. Figures also include individuals enrolled in State health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards.

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Dual Eligible Enrollment by Plans as of 6/30/2004
Dual Eligible Enrollment
18,483 1,874 762 3,453 3,136 5,979 3,433 5,723 13,512 3,311 4,558 2,141 3,013 907 1,419 933 287 1,356 1,746 207 37 1,181 168 4,784 56,143 279 17,768 1,507 1,215 591 1,712 291 100 3,751 665 13,590 2,665 175 1,188 749 753

State Plan
AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA AZ Physicians IPA (HP) Care 1st Health Plan Cochise Co. Dept. of Health Services (PC) Department of Economic Security/Division of Developmental Disabilities (PC) Evercare Select (PC) Health Choice Arizona (HP) Maricopa County Health Plan (HP) Maricopa County Health Plan (PC) Mercy Care Plan (HP) Mercy Care Plan (PC) Phoenix Health Plan/Community Connection (HP) Pima Health System (HP) Pima Health System (PC) Pinal County Long Term Care (PC) University Family Care (HP) Yavapai County Long Term Care (PC) Access Dental Plan-LA Access Dental Plan-Sacramento Alameda Alliance for Health AltaMed Senior BuenaCare-LA American Health Guard-Dental Plan-LA Blue Cross of California-Sacramento Blue Cross of California-San Diego Blue Cross of California-TPMP Caloptima-San Diego Centers for Elders Independence-Alameda Central Coast Alliance For Health Community Health Group-San Diego Contra Costa Health Plan Delta Dental Plan of California-Sacramento Foundation Care Health Net-Sacramento Health Net-San Diego Health Net-TPMP Health Plan of San Joaquin Health Plan of San Mateo Inland Empire Health Plan Kaiser Foundation (North) Kaiser Foundation-Sacramento Kaiser Foundation-San Diego Kern Family Health Care

Managed Care Entity
Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Dental PAHP Dental PAHP Commercial MCO PACE Dental PAHP Commercial MCO Commercial MCO Commercial MCO HIO PACE HIO Commercial MCO Commercial MCO Dental PAHP Dental PAHP Commercial MCO Commercial MCO Commercial MCO Commercial MCO HIO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO

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Dual Eligible Enrollment by Plans as of 6/30/2004
CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CO CO CO CO CO CO CO CO CO CO CO CO FL FL FL FL FL FL FL FL FL FL FL GA GA GA LA Care Health Plan Molina Medical Centers-Sacramento Molina Medical Centers-TPMP On Lok Senior Health-San Francisco Partnership Health Plan Positive Healthcare/AIDS Health Care-LA San Francisco Health Plan Santa Barbara Regional Health Authority Santa Clara Family Health Plan Senior Care Action Network (SCAN) Sharp Health Plan-San Diego Sutter Senior Care-Sacramento UHP Healthcare-Dental Universal Care-Dental-LA Universal Care-San Diego Western Dental Services-LA Western Dental Services-Sacramento Western Health Advantage-Sacramento Access Behavioral Care Behavioral Healthcare, Inc. Colorado Access Denver Health and Hospital Authority Jefferson Center for Mental Health Mental Health Center of Boulder Northeast Behavioral Health Primary Care Physician Program Rocky Mountain HMO SyCare-Options Colorado Health Networks Total Long Term Care West Slope-Options Colorado Health Networks Adult Day Health Care Amerigroup Citrus Healthcare Florida PACE Centers Health and Home Connection Healthease Healthy Palm Beaches Preferred Medical Plan Staywell Health Plan United Healthcare Plans of Florida Vista Georgia Better Health Care Non-Emergency Transportation Preadmission Screening and Annual Resident Review (PASARR) Commercial MCO Commercial MCO Commercial MCO PACE HIO Medical-only PAHP Commercial MCO HIO Commercial MCO Other Commercial MCO PACE Dental PAHP Dental PAHP Commercial MCO Dental PAHP Dental PAHP Commercial MCO Mental Health (MH) PIHP Mental Health (MH) PIHP Medicaid-only MCO Medicaid-only MCO Mental Health (MH) PIHP Mental Health (MH) PIHP Mental Health (MH) PIHP PCCM Provider Medical-only PIHP Mental Health PIHP PACE Mental Health PIHP Other Commercial MCO Commercial MCO PACE Commercial MCO Medicaid MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO PCCM Provider Transportation PAHP Mental Health PIHP 5,679 230 590 876 10,766 357 860 8,786 1,278 2,645 533 188 453 404 176 652 922 466 13,255 7,780 3,709 68 3,799 2,042 5,902 6,545 1,920 9,060 829 5,441 24 5,036 9 51 533 3,739 1 162 3,276 979 533 722 161,001 1,841

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Dual Eligible Enrollment by Plans as of 6/30/2004
IA ID IN IN KS KY MA MA MA MA MA MA MD MN MN MN MN MN MN MN MN MN MO NC NC NJ NJ NJ NJ NJ NM NY NY NY NY NY NY NY NY NY NY NY NY NY Iowa Plan For Behavioral Health Healthy Connections Disease Management PCCM Medicaid Select Via Christi Healthcare Outreach Programs for Elders Passport Health Plan Elder Service Plan at Fallon Community Health Plan - PACE Elder Service Plan of Cambridge Health Alliance Elder Service Plan of East Boston Neighborhood Health Center Elder Service Plan of Harbor Health Services Inc Elder Service Plan of the North Shore, Inc Uphams Elder Service Plan Hopkins Elder Plus Blue Plus First Plan Blue Health Partners Itasca Medical Care Medica Metropolitan Health Plan PrimeWest Health System South Country Health Alliance UCARE Alexian Brothers Community Services Access II/III Carolina Access AmeriChoice of New Jersey, Inc. AMERIGROUP New Jersey, Inc. Health Net Horizon NJ Health University Health Plans, Inc. Total Community Care (PACE) Comprehensive Care Management (CCCM) Elderplan Guildnet Health Advantage/Elant Choice Hebrew Hospital Home/CO-OP Care Plan HomeFirst PACE CNY Independent Care Systems Independent Living For Seniors Long Island Health Partners/Broadlawn Health Partners Mohawk Valley Network/Senior Network Health Partners In Community Care Eddy Senior Care MH/SUD PIHP PCCM Provider Other PCCM Provider PACE Medicaid MCO PACE PACE PACE PACE PACE PACE PACE Comprehensive MCO Comprehensive MCO Comprehensive MCO Medicaid MCO Comprehensive MCO Comprehensive MCO Medicaid MCO Medicaid MCO Comprehensive MCO PACE PCCM Provider PCCM Provider Commercial MCO Medicaid MCO Medicaid MCO Medicaid MCO Commercial MCO PACE PACE Other Other Other Other Other PACE Other PACE Other Other Other PACE 23,920 10,725 8,500 26,215 108 11,660 171 100 296 184 316 107 142 8,671 792 3,483 501 12,081 1,268 1,999 2,098 7,834 154 172,327 73,855 1,935 959 746 3,928 893 235 1,189 466 1,827 73 410 889 250 302 312 408 325 116 76

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Dual Eligible Enrollment by Plans as of 6/30/2004
NY NY NY OH OH OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR PA PA PA PA PA PA Senior Health Partners Total Aging in Place VNS Choice Concordia Care TriHealth SeniorLink Accountable Behavioral Health Capitol Dental Care Inc. Care Oregon Cascade Comprehensive Care Central Oregon Independent Health Solutions Clackamas County Mental Health Deschutes County CDO Doctors of the Oregon Coast South Douglas County IPA FamilyCare (Mental Health) FamilyCare Health Plans Greater Oregon Behavioral Health, Inc. Hayden Family Dentistry Inter-Community Health Network Jefferson Behavioral Health Lane Care MHO Lane Individual Practice Association Managed Dental Care of Oregon Marion Polk Community Health Plan Mid Valley Behavioral Care Network Mid-Rogue Independent Practice Assoc. Multicare Dental Multnomah County Verity Northwest Dental Services Oregon Dental Service Oregon Health Management Service PCCM Providence Elder Care Providence Health Assurance Tuality Health Alliance (Mental Health) Tuality Health Care Washington County Health (Mental Health) Willamette Dental AmeriChoice of Pennsylvania AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL Community - LIFE County of Adams - Community Care Behavioral Health County of Allegheny - Community Care Behavioral Health Other Other Other PACE PACE Mental Health PIHP Dental PAHP Medicaid MCO Medicaid MCO Medicaid MCO Mental Health PIHP Substance Use Disorder PAHP Medicaid MCO Comprehensive MCO Mental Health PIHP Commercial MCO Mental Health PIHP Dental PAHP Medicaid-only MCO Mental Health PIHP Mental Health PIHP Medicaid MCO Dental PAHP Medicaid MCO Mental Health PIHP Medicaid MCO Dental PAHP Mental Health PIHP Dental PAHP Dental PAHP Medicaid MCO PCCM Provider PACE Medicaid MCO Mental Health PIHP Medicaid MCO Mental Health PIHP Dental PAHP Commercial MCO Medicaid MCO Medicaid MCO PACE MH/SUD PIHP MH/SUD PIHP 174 94 3,697 146 196 3,064 11,909 8,619 726 2,234 3,326 1,030 1,167 1,355 579 1,203 3,863 1,681 1,779 8,328 4,186 2,577 1,055 3,667 7,663 814 2,598 10,242 9,021 13,528 457 3,566 530 1,058 612 761 2,911 7,855 11,887 7,801 113 201 817 18,241

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Dual Eligible Enrollment by Plans as of 6/30/2004
PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PR PR PR PR PR PR PR SC County of Armstrong - Value Behavioral Health of PA County of Beaver - Value Behavioral Health of PA County of Berks - Community Care Behavioral Health County of Bucks - Magellan Behavioral Health County of Butler - Value Behavioral Health of PA County of Chester - Community Care Behavioral Health MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP 1,378 2,681 4,164 4,750 1,917 2,752 1,470 3,008 6,196 3,988 1,475 4,608 1,724 1,341 4,156 5,001 2,976 469 38,125 3,093 5,204 3,743 27,652 1,718 13,152 142 31,800 10 171 98 197 19,434 3,485 12,490 601 906 1,560 76,735 47,370 33,065 41,998 733 46,749 343

County of Cumberland - Community Behavioral Healthcare MH/SUD PIHP N t Countyk f PA I - Community Behavioral Healthcare Network of MH/SUD PIHP of Dauphin PA I of Delaware - Magellan Behavioral Health County MH/SUD PIHP County of Fayette - Value Behavioral Health of PA County of Indiana - Value Behavioral Health of PA County of Lancaster - Community Behavioral Healthcare Network f PA CountyI of Lawrence - Value Behavioral Health of PA MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP

County of Lebanon - Community Behavioral Healthcare Network of MH/SUD PIHP PA I of Lehigh - Magellan Behavioral Health County MH/SUD PIHP County of Montgomery - Magellan Behavioral Health County of Northampton - Magellan Behavioral Health County of Perry - Community Behavioral Healthcare Network of PA I of Philadelphia - Community Behavioral Health County County of Washington - Value Behavioral Health of PA County of Westmoreland - Value Behavioral Health of PA County of York - Community Care Behavioral Health Gateway Health Plan, Inc. Gateway Health Plan, Inc. -VOL Health Partners of Philadelphia ION Health Plan, Inc. - VOL Keystone Mercy Health Plan LIFE - Beaver County LIFE - Pittsburgh LIFE - St. Agnes LIFE - University of Pennsylvania Three Rivers Health Plans, Inc. / MedPLUS Three Rivers Health Plans, Inc./MedPlus - VOL UPMC Health Plan, Inc./UPMC for You UPMC Health Plan, Inc./UPMC for You - VOL Value Behavioral Health of PA (Greene County) Alianza de Medicos de Sur Este, Inc. APS Healthcare FHC Healthcare Humana Health Plans of Puerto Rico, Inc. MCS Health Management Options, Inc. San Judas Medical Services Triple-S, Inc. Palmetto SeniorCare (PACE) MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP Medicaid MCO Medicaid MCO Commercial MCO Medicaid MCO Medicaid MCO Medical-only PIHP Medical-only PIHP Medical-only PIHP PACE Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO MH/SUD PIHP Commercial MCO MH/SUD PIHP MH/SUD PIHP Commercial MCO Commercial MCO Commercial MCO Commercial MCO PACE

16 Page 18 of 56

Dual Eligible Enrollment by Plans as of 6/30/2004
SD TN TN TN TN TN TN TN TN TN TN TX TX TX TX TX UT UT UT UT UT UT UT UT UT UT UT UT UT UT WA WA WA WA WA WA WA WA WA WA WA WA WA WA Delta Dental Alexian Brothers Community Service Better Health Plan John Deere/Heritage National Health Plan Memphis Managed Care Corp. (TLC) Omnicare Health Plan Preferred Health Partnership/PHP Premier Behavioral Systems of TN Tennessee Behavioral Health, Inc. Volunteer State Health Plan (Bluecare) VUMC Care (VHP Community Care) Amerigroup- STAR+PLUS Bienvivir Senior Health Services Evercare- STAR+PLUS Jan Werner Adult Day Care Center ValueOptions Bear River Mental Health Central Utah Mental Davis Mental Health Four Corners Mental Health Healthy U IHC Health Plans Inc. Molina Healthcare of Utah (Molina Plus) Molina Healthcare of Utah (Molina) Non-Emergency Transportation Northeastern Counseling Center Southwest Mental Health Valley Mental Health Wasatch Mental Health Weber Mental Health Chelan/Douglas Regional Support Network Clark County Regional Support Network Grays Harbor Regional Support Network Greater Columbia Regional Support Network King County Regional Support Network North Central Washington Regional Support Network North Sound Regional Support Network Northeast Washington Regional Support Network Peninsula Regional Support Network Pierce County Regional Support Network Providence ElderPlace - Seattle Southwest Regional Support Network Spokane County Regional Support Network Thurston/Mason Regional Support Network Dental PAHP PACE Commercial MCO Commercial MCO Medicaid MCO Medicaid MCO Medicaid MCO MH/SUD PIHP MH/SUD PIHP Commercial MCO Commercial MCO Medicaid MCO PACE Commercial MCO PACE MH/SUD PIHP Mental Health (MH) PIHP Mental Health (MH) PIHP Mental Health (MH) PIHP Mental Health (MH) PIHP Medical-only PIHP PCCM Provider Medical-only PIHP Medical-only PIHP Transportation PAHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP PACE Mental Health PIHP Mental Health PIHP Mental Health PIHP 11,258 253 8,457 15,781 33,816 18,985 27,472 181,319 61,288 134,063 4,033 11,090 622 18,180 43 22,909 947 631 1,239 436 2,104 3,951 386 3,128 13,616 413 1,352 6,285 2,418 1,619 2,443 6,035 2,218 14,179 35,431 3,501 17,418 2,193 6,594 15,092 215 2,609 10,977 5,099

17 Page 19 of 56

Dual Eligible Enrollment by Plans as of 6/30/2004
WA WI WI WI WI WI WI WI Timberland Regional Support Network Community Care Organization - PACE Community Care Organization - Partnership Community Health Partnership -- Partnership Community Living Alliance -- Partnership Elder Care Of Dane County - Partnership Family Care Independent Care Health Plan (Voluntary, iCare) Mental Health PIHP PACE Comprehensive MCO Comprehensive MCO Comprehensive MCO Medicaid MCO Other Commercial MCO 2,939 468 359 476 170 426 7,680 2,479

18 Page 20 of 56

Medicaid Managed Care Program Summary
June 30, 2004 State
AL AL AR AR AZ

Plan
Maternity Care Program Partnership Hospital Program Connect Care Non-Emergency Transportation AZ Physicians IPA (Family Planning Extension) AZ Physicians IPA (HP)

Managed Care Reimbursement Entity Arrangement
*Contracted Global Fee Medical-only PIHP PCCM Transp PAHP Medicaid MCO Other Capitation FFS Capitation Capitation

Operating Authority
1932(a) 1932(a) 1915(b) 1915(b) 1115

Geographic Area Served
Statewide Statewide except Mobile County Statewide Statewide Apache, Cochise, Coconino, Graham, Greenlee, La Paz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yavapai, Yuma Apache, Cochise, Coconino, Graham, Greenlee, La Paz, Maricopa, Mohave, Navajo, Pima, Santa Cruz, Yavapai, Yuma Maricopa Maricopa Cochise, Graham, Greenlee Statewide

Number of Enrollees
16,720 423,112 332,473 386,395 2,259

AZ

Medicaid MCO

Capitation

1115

264,468

AZ AZ AZ AZ

Care 1st Health Plan Care 1st Health Plan (Family Planning Extension) Cochise Co. Dept. of Health Services (PC) Department of Economic Security/Childrens Medical and Dental Program (Family Planning Extension) Department of Economic Security/Childrens Medical and Dental Program (HP) Department of Economic Security/Division of Developmental Disabilities (PC) Department of Health Services (Behavioral Health) Evercare Select (PC) Health Choice Arizona (Family Planning Extension) Health Choice Arizona (HP)

Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO

Capitation Capitation Capitation Capitation

1115 1115 1115 1115

27,660 153 912 0

AZ

Medicaid MCO

Capitation

1115

Statewide

8,215

AZ

Medicaid MCO

Capitation

1115

Statewide

15,803

AZ

MH/SUD PIHP

Capitation

1115

Apache, Cochise, Coconino, Gila, Graham, Greenlee, LaPaz, Maricopa, Mohave, Navajo, Pima, Pinal, Santa Cruz, Yavapai, Yuma Apache, Coconino, La Paz, Maricopa, Mohave, Navajo, Yuma Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pima, Pinal

75,548

AZ AZ AZ

Medicaid MCO Medicaid MCO Medicaid MCO

Capitation Capitation Capitation

1115 1115 1115

3,706 760 94,253

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 21 of 56

1

AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ AZ CA CA CA CA CA CA CA CA CA CA CA CA

Maricopa County Health Plan (Family Planning Extension) Maricopa County Health Plan (HP) Maricopa County Health Plan (PC) Mercy Care Plan (Family Planning Extension) Mercy Care Plan (HP) Mercy Care Plan (PC) Phoenix Health Plan/Community Connection (Family Planning Extension) Phoenix Health Plan/Community Connection (HP) Pima Health System (Family Planning Extension) Pima Health System (HP) Pima Health System (PC) Pinal County Long Term Care (PC) University Family Care (Family Planning Extension) University Family Care (HP) Yavapai County Long Term Care (PC) Access Dental Plan-LA Access Dental Plan-Sacramento Alameda Alliance for Health AltaMed Senior BuenaCare-LA American Health Guard-Dental Plan-LA Blue Cross of California-Sacramento Blue Cross of California-San Diego Blue Cross of California-TPMP Caloptima-San Diego Centers for Elders Independence-Alameda Central Coast Alliance For Health Community Health Group-San Diego

Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Dental PAHP Dental PAHP Commercial MCO PACE Dental PAHP Commercial MCO Commercial MCO Commercial MCO HIO PACE HIO Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1115 1915(a) 1915(b) 1915(b) PACE 1915(a) 1915(b) 1915(b) 1915(b) 1915(b) PACE 1915(b) 1915(b)

Maricopa Maricopa Maricopa Cochise, Graham, Greenlee, La Paz, Maricopa, Pima, Yavapai, Yuma Cochise, Graham, Greenlee, La Paz, Maricopa, Pima, Yavapai, Yuma Maricopa Gila, Maricopa, Pinal Gila, Maricopa, Pinal Pima, Santa Cruz Pima, Santa Cruz Pima, Santa Cruz Pinal Pima Pima Yavapai Los Angeles Sacramento Alameda Los Angeles Los Angeles Sacramento San Diego Alameda, Contra Costa, Fresno, Kern, San Francisco, San Joaquin, Santa Clara, Stanislaus, Tulare Orange Alameda, Contra Costa Monterey, Santa Cruz San Diego

222 39,032 6,655 2,324 199,215 4,517 750 89,708 170 23,917 3,840 1,087 112 15,415 1,040 54,457 49,137 80,113 253 2,435 78,038 16,938 370,947 294,145 299 59,746 73,300

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 22 of 56

2

CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA CA

Contra Costa Health Plan Delta Dental Plan of California-Sacramento Foundation Care Health Net-Sacramento Health Net-San Diego Health Net-TPMP Health Plan of San Joaquin Health Plan of San Mateo Inland Empire Health Plan Kaiser Foundation (North) Kaiser Foundation-Sacramento Kaiser Foundation-San Diego Kern Family Health Care LA Care Health Plan Molina Medical Centers-Sacramento Molina Medical Centers-TPMP On Lok Senior Health-San Francisco Partnership Health Plan Positive Healthcare/AIDS Health Care-LA San Francisco City & CO/Family Mosiac San Francisco Health Plan Santa Barbara Regional Health Authority Santa Clara Family Health Plan Senior Care Action Network (SCAN)

Commercial MCO Dental PAHP Dental PAHP Commercial MCO Commercial MCO Commercial MCO Commercial MCO HIO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO PACE HIO Medical-only PIHP Medical-only PIHP Commercial MCO HIO Commercial MCO *Social HMO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(a) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(a) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) PACE 1915(b) 1915(b) 1915(a) 1915(b) 1915(b) 1915(b) 1115

Contra Costa Sacramento Los Angeles, Riverside, San Bernardino Sacramento San Diego Fresno, Los Angeles, Tulare San Joaquin San Mateo Riverside, San Bernardino Marin, Sonoma Sacramento San Diego Kern Los Angeles Sacramento Riverside, San Bernardino Alameda, San Francisco Napa, Solano, Yolo Los Angeles San Francisco San Francisco Santa Barbara Santa Clara Los Angeles, Riverside, San Bernardino

43,342 44,420 35,803 32,007 9,656 517,523 57,533 47,996 238,468 1,411 19,965 8,039 76,900 732,581 20,065 92,729 917 58,083 828 169 31,582 53,285 71,790 2,652

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 23 of 56

3

CA CA CA CA CA CA CA CA CO CO CO

Sharp Health Plan-San Diego Sutter Senior Care-Sacramento UHP Healthcare-Dental Universal Care-Dental-LA Universal Care-San Diego Western Dental Services-LA Western Dental Services-Sacramento Western Health Advantage-Sacramento Access Behavioral Care Behavioral Healthcare, Inc. Colorado Access

Commercial MCO PACE Dental PAHP Dental PAHP Commercial MCO Dental PAHP Dental PAHP Commercial MCO Mental Health PIHP Mental Health PIHP Medicaid MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(b) PACE 1915(a) 1915(a) 1915(b) 1915(a) 1915(b) 1915(b) 1915(b) 1915(b) 1915(a)

San Diego Sacramento, Yolo Los Angeles, San Bernardino LA San Diego Los Angeles, Riverside, Sacramento, San Bernardino Sacramento Sacramento Denver East Metro Denver Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Clear Creek, Conejos, Costilla, Crowley, Custer, Denver, Douglas, El Paso, Elbert, Fremont, Gilpin, Huerfano, Jefferson, Kiowa, Larimer, Lincoln, Logan, Mineral, Morgan, Otero, Park, Phillips, Prowers, Pueblo, Rio Grande, Saguache, Sedgewick, Teller, Washington, Weld, Yuma

49,836 196 13,160 20,098 13,700 23,331 53,342 14,222 107,979 76,698 55,254

CO CO CO CO CO CO CO CO CO CO CT CT

Denver Health and Hospital Authority Jefferson Center for Mental Health Mental Health Center of Boulder North Range Behavioral Northeast Behavioral Health Primary Care Physician Program Rocky Mountain HMO SyCare-Options Colorado Health Networks Total Long Term Care West Slope-Options Colorado Health Networks Anthem Blue Care Family Plan Community Health Network of Connecticut

Medicaid MCO Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP PCCM Medical-only PIHP Mental Health PIHP PACE Mental Health PIHP Commercial MCO Medicaid MCO

Capitation Capitation Capitation Capitation Capitation FFS Capitation Capitation Capitation Capitation Capitation Capitation

1915(a) 1915(b) 1915(b) 1915(b) 1915(b) 1905(t) 1915(a) 1915(b) PACE 1915(b) 1915(b) 1915(b)

Adams, Arapahoe, Denver, Jefferson Jefferson Boulder Northern Colorado Northern Colorado Statewide Delta, Mesa, Montrose, Ouray, Rio Blanco, San Miguel Southern Colorado Adams, Arapahoe, Denver, Jefferson Western Colorado Statewide Statewide

1,097 26,455 13,697 16,150 40,053 57,561 12,042 51,895 830 36,343 126,981 54,388

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 24 of 56

4

CT CT DC DC DC DC DC DE DE FL FL FL

FirstChoice Health Plan - Preferred One HealthNet - Healthy Options Advantage Health, Incorporated AMERIGROUP DC Chartered Health Plan, Incorporated Health Right Incorporated Health Services For Children with Special Needs Delaware Physicians Care, Inc Diamond State Partners Access Behavioral Health, Inc. Adult Day Health Care AIDS Healthcare Foundation

Medicaid MCO Commercial MCO Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO Medical-only PIHP Medicaid MCO *Enhanced Fee for Service Model Mental Health PIHP *Adult Day Health Care Facility Disease Management PAHP Commercial MCO Commercial MCO Disease Management PAHP Mental Health PIHP PACE

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation FFS Capitation Other Other

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(a) 1115 1115 1915(b) 1915(b) 1915(b)

Statewide Statewide Statewide Statewide Statewide Statewide Statewide Statewide Statewide Escambia, Okaloosa, Santa Rosa, Walton Lee, Palm Beach Statewide

25,650 96,385 3,796 37,200 36,089 11,367 3,198 85,598 13,565 32,133 24 8,212

FL FL FL

Amerigroup Citrus Healthcare DiabetikSmart

Capitation Capitation Other

1915(b) 1915(b) 1915(b)

Broward, Dade, Hillsborough, Lee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole Statewide Broward, Miami-Dade

157,567 629 3,763

FL FL

Florida Health Partners, Inc. Florida PACE Centers

Capitation Capitation

1915(b) PACE

Hardee, Highlands, Hillsborough, Manatee, Polk 33125, 33127, 33128, 33129, 33130, 33131, 33132, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33147, 33150, 33154, 33161, 33167, 33168, 33181 Statewide

63,154 55

FL

Florida: A Healthy State

FL FL

Health and Home Connection Healthease

Disease Management PAHP Commercial MCO Medicaid MCO

Other

1915(b)

72,599

Capitation Capitation

1915(b) 1915(b)

Brevard, Orange, Osceola, Seminole Alachua, Baker, Brevard, Broward, Citrus, Clay, Dade, Dixie, Duval, Escambia, Gadsden, Gilchrist, Highlands, Hillsborough, Jefferson, Lake, Leon, Levy, Madison, Manatee, Marion, Martin, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, Union, Volusia, Wakulla

550 195,046

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 25 of 56

5

FL FL

Healthy Palm Beaches Humana Family Health Plan

Commercial MCO Commercial MCO

Capitation Capitation

1915(b) 1915(b)

Palm Beach Alachua, Baker, Bradford, Broward, Citrus, Clay, Columbia, Dade, Dixie, Duval, Flagler, Gilchrist, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Levy, Marion, Martin, Nassau, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Seminole, St. Johns, Union, Volusia Broward, Dade Area 1, Area 2, Area 3, Area 4, Area 5, Area 6, Area 7 Statewide Broward, Dade Broward, Dade Brevard, Broward, Citrus, Dade, Escambia, Hernando, Hillsborough, Lee, Manatee, Marion, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Lucie, Volusia Alachua, Bradford, Brevard, Broward, Charlotte, Clay, Collier, Columbia, Dade, DeSoto, Duval, Escambia, Flagler, Hernando, Highlands, Hillsborough, Lake, Lee, Manatee, Marion, Nassau, Okaloosa, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Seminole, St. Johns, Suwannee, Union, Volusia

5,481 56,174

FL FL FL FL FL FL

JMH Health Plan LifeMasters Medipass Preferred Medical Plan Provider Service Network Staywell Health Plan

Commercial MCO Disease Management PCCM Commercial MCO *Hospital Based Network Commercial MCO

Capitation Other FFS Capitation FFS Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b)

15,544 4,124 688,109 15,482 17,786 178,339

FL

United Healthcare Plans of Florida

Commercial MCO

Capitation

1915(b)

43,374

FL

Vista

Commercial MCO

Capitation

1915(b)

Alachua, Bradford, Broward, Calhoun, Columbia, Dade, Dixie, Escambia, Franklin, Gadsden, Gilchrist, Hamilton, Hillsborough, Jefferson, Lafayette, Leon, Levy, Liberty, Madison, Marion, Martin, Palm Beach, Pasco, Pinellas, Santa Rosa, St. Lucie, Suwannee, Union, Wakulla Statewide Statewide Statewide Hawaii, Kauai, Maui, Oahu Statewide

39,070

GA GA GA HI HI

Georgia Better Health Care Non-Emergency Transportation Preadmission Screening and Annual Resident Review (PASARR) Aloha Care Child & Adolescent Mental Health Division, Department of Health

PCCM Transp PAHP Mental Health PIHP Medicaid MCO Mental Health PIHP

FFS Capitation Capitation Capitation Capitation

1932(a) 1915(b) 1915(b) 1115 1115

840,002 1,273,133 2,235 48,459 516

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 26 of 56

6

HI

Early Intervention Programs, Department of Health

*Target Case Management for Mental Health Services Mental Health PIHP Commercial MCO Commercial MCO Commercial MCO Commercial MCO

Capitation

1115

Statewide

1,409

HI HI HI IA IA

HMSA-Behavior Health for SMI HMSA-Medical Kaiser Permanente Coventry Health Care Iowa Health Solutions

Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1932(a) 1932(a)

Statewide Island Maui, Oahu Black Hawk, Butler Benton, Boone, Buchanan, Calhoun, Clayton, Clinton, Des Moines, Dubuque, Hamilton, Hardin, Henry, Jackson, Lee, Linn, Lucas, Mahaska, Marion, Marshall, Muscatine, Polk, Scott, Story, Tama, Van Buren, Warren Statewide Benton, Black Hawk, Bremer, Buchanan, Butler, Cedar, Clayton, Dallas, Davis, Delaware, Dubuque, Fayette, Floyd, Grundy, Jackson, Jasper, Jefferson, Jones, Linn, Madison, Marion, Muscatine, Polk, Scott, Wapello, Warren

157 80,880 19,241 5,301 38,383

IA IA

Iowa Plan For Behavioral Health John Deere Health Plan, Inc.

MH/SUD PIHP Commercial MCO

Capitation Capitation

1915(b) 1932(a)

262,487 10,569

IA

Medipass

PCCM

FFS

1932(a)

Adair, Adams, Allamakee, Appanoose, Audubon, Benton, Black Hawk, Boone, Bremer, Buchanan, Buena Vista, Butler, Calhoun, Carroll, Cass, Cedar, Cerro Gordo, Cherokee, Chickasaw, Clarke, Clay, Clayton, Clinton, Crawford, Dallas, Davis, Decatur, Delaware, Dickinson, Dubuque, Emmet, Fayette, Floyd, Franklin, Fremont, Greene, Grundy, Guthrie, Hamilton, Hancock, Hardin, Harrison, Hnery, Howard, Humboldt, Ida, Jackson, Jasper, Jefferson, Johnson, Jones, Keokuk, Kossuth, Lee,. Linn, Lucas, Lyon, Madison, Mahaska, Marion, Marshall, Mills, Mitchell, Monona, Monroe, Montgomery, Muscatine, O'Brien, Osceola, Page, Palo Alto, Plymouth, Pocahontas, Polk, Pottawattamie, Sac, Scott, Shelby, Sioux, Story, Tama, Taylor, Union, Van Buren, Warre, Wayne, Webster, Winnebago, Winneshiek, Woodbury, Worth, Wright

102,434

ID IL IL

Healthy Connections Amerigroup Illinois Inc. Family Health Network

PCCM Commercial MCO Medicaid MCO

FFS Capitation Capitation

1915(b) 1915(a) 1915(a)

Statewide Cook Cook

131,693 33,860 20,080

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 27 of 56

7

IL IL IL IN

Harmony Health Plan Humana Health Plan United HealthCare of Illinois Disease Management PCCM

Medicaid MCO Commercial MCO Commercial MCO *Disease Management PCCM Medicaid MCO Medicaid MCO Medicaid MCO PCCM PCCM Medicaid MCO

Capitation Capitation Capitation FFS

1915(a) 1915(a) 1915(a) 1915(b)

Cook, Franklin, Jackson, Madison, Perry, Randolph, St. Clair, Washington, Williamson Cook Cook Statewide

58,602 18,712 27,615 47,515

IN IN IN IN IN KS

Harmony Health Plans of Indiana Managed Health Services (MHS) MDwise Medicaid Select PCCM (PrimeStep) FirstGuard Health Plan Kansas, Inc.

Capitation Capitation Capitation FFS FFS Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1932(a)

Northern Statewide North & South Regions Central All Counties Except Marion and Allen Allen, Anderson, Atchison, Barber, Brown, Butler, Chautauqua, Cloud, Coffey, Cowley, Crawford, Dickinson, Doniphan, Douglas, Elk, Ellis, Ellsworth, Ford, Franklin, Geary, Greenwood, Harper, Jefferson, Jewell, Johnson, Kingman, Labette, Leavenworth, Lincoln, Logan, Lyon, Marshall, McPherson, Miami, Mitchell, Morris, Morton, Nemaha, Neosho, Osage, Ottawa, Phillips, Pottawatomie, Pratt, Rawlins, Riley, Rooks, Rush, Russell, Saline, Sedgwick, Seward, Shawnee, Sheridan, Smith, Summer, Thomas, Wabaunsee, Washington, Wilson, Woodson, Wyandotte

35,658 135,247 123,109 63,251 215,718 63,997

KS KS KY KY KY LA MA MA

HealthConnect Kansas Via Christi Healthcare Outreach Programs for Elders Human Service Transportation Kentucky Patient Access and Care (KenPAC) Passport Health Plan Community Care Program Boston Medical Center HealthNet Plan Elder Service Plan at Fallon Community Health Plan - PACE

PCCM PACE Transp PAHP PCCM Medicaid MCO PCCM Medicaid MCO PACE

FFS Capitation Capitation FFS Capitation FFS Capitation Capitation

1932(a) PACE 1915(b) 1932(a) 1115 1915(b) 1115 PACE

Statewide Sedgwick Statewide Statewide Jefferson County (Louisville) Kentucky and 15 surrounding counties Statewide Boston/Greater Boston Region, Southern Region, Western Region Worcester county

89,287 111 625,807 339,003 132,813 723,837 117,732 177

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 28 of 56

8

MA MA MA MA MA MA MA MA

Elder Service Plan of Cambridge Health Alliance Elder Service Plan of East Boston Neighborhood Health Center Elder Service Plan of Harbor Health Services Inc Elder Service Plan of the North Shore, Inc Fallon Community Health Plan - MCO MA Behavioral Health Partnership Neighborhood Health Plan Network Health

PACE PACE PACE PACE Commercial MCO MH/SUD PIHP Commercial MCO Medicaid MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

PACE PACE PACE PACE 1115 1115 1115 1115

Allston, Cambridge, Somerville East Boston Greater Boston Northeastern MA Central Region Statewide Boston/Greater Boston Region, Central/Western Region, Northeast/Southeast Region Boston/Greater Boston Region, Central Region, Nothern Region, Western Region Statewide Greater Boston Anne Arundel, Baltimore City, Baltimore County, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Harford, Howard, Kent, Montgomery, Prince George's, Queen Anne's, Somerset, St. Mary's, Talbot, Wicomico Baltimore City, Baltimore County, Cecil, Harford Anne Arundel North, Baltimore City, Baltimore County, Harford 21052, 21202, 21205, 21206, 21213, 21214, 21218, 21219, 21220, 21221, 21222, 21224, 21227, 21231, 21237 Baltimore City, Baltimore County Statewide except for Prince George's county Statewide Statewide Statewide Arenac, Bay, Huron, Montcalm, Shiawassee, Tuscola Macomb, Oakland, Washtenau, Wayne Benzie, Clinton, Eaton, Gratiot, Ingham, Ionia, Manistee, Newago

116 310 193 388 8,629 325,344 90,010 61,003

MA MA MD

Primary Care Clinician Plan Uphams Elder Service Plan AMERIGROUP Maryland Inc.

PCCM PACE Medicaid MCO

FFS Capitation Capitation

1115 PACE 1115

304,146 126 128,007

MD MD MD

Coventry Diamond Plan Helix Family Choice Hopkins Elder Plus

Medicaid MCO Medicaid MCO PACE

Capitation Capitation Capitation

1115 1115 PACE

1,737 19,685 149

MD MD MD MD ME MI MI MI

JAI Medical System Maryland Physicians Care Priority Partners MCO United Health Care MaineCare Primary Care Case Management Bay Arenac CMH Cape Health Plan CEI CMH

Medicaid MCO Medicaid MCO Medicaid MCO Medicaid MCO PCCM Mental Health PIHP Medicaid MCO Mental Health PIHP

Capitation Capitation Capitation Capitation FFS Capitation Capitation Capitation

1115 1115 1115 1115 1932(a) 1915(b) 1915(b) 1915(b)

6,860 88,436 117,129 107,995 154,785 46,489 78,975 72,729

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 29 of 56

9

MI MI

Central Michigan CMH Children's Choice of Michigan

Mental Health PIHP Medicaid MCO

Capitation Capitation

1915(b) 1915(a)

Clare, Gladwin, Isabella, Mecosta, Midland, Osceola Agemaw, Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickenson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Grand Traverse, Gratiot, Hillsdale, Houghton, Huron, Ingham, Ionia, Iosco, Iron, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Keeweenaw, Lake, Lapeer, Lelanau, Livingston, Luce, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Menominee, Midland, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ononagon, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawasee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenau, Wayne, Wexford/Missaukee

34,485 2,489

MI

Community Choice Michigan

Medicaid MCO

Capitation

1915(b)

Alcona, Allegan, Alpena, Antrim, Berrien, Calhoun, Cass, Charleviox, Emmett, Genesee, Gladwin, Grand Traverse, Iosco, Kalamazoo, Kalkaska, Kent, Leelanau, Manistee, Mason, Mecosta, Monroe, Montmorency, Newaygo, Osceola, Presque Isle, Roscommon, Saginaw, St. Joseph, Van Buren, Wexford/Missaukee Wayne Genesee Berrien, Calhoun, Cass, Hillsdale, Huron, Jackson, Lapeer, Lenawee, Livingston, Macomb, Oakland, Saginaw, Saint Clair, Sanilac, Tuscola, Van Buren, Wayne

49,119

MI MI MI

Detroit-Wayne CMH Genesee County CMH Great Lakes Health Plan

Mental Health PIHP Mental Health PIHP Commercial MCO

Capitation Capitation Capitation

1915(b) 1915(b) 1915(b)

380,301 75,167 99,786

MI

Health Plan of Michigan

Medicaid MCO

Capitation

1915(b)

Allegan, Barry, Berrien, Branch, Calhoun, Cass, Eaton, Genesee, Hillsdale, Huron, Jackson, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Manistee, Monroe, Montcalm, Muskegon, Newago, Oakland, Oceana, Ogemaw, Oscoda, Ottawa, Roscommon, Sanilac, St. Clair, St. Joseph, Tuscola, Van Buren Bay, Genesee, Lapeer, Oakland, Saginaw, Shiawassee, Tuscola Allegan, Cass, Kalamazoo, St. Joseph

84,886

MI MI

HealthPlus Partners, Inc. Kalamazoo County CMH

Commercial MCO Mental Health PIHP

Capitation Capitation

1915(b) 1915(b)

59,264 55,343

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 30 of 56

10

MI MI

Kent County CMH Kid's Care of Michigan

Mental Health PIHP Medicaid MCO

Capitation Capitation

1915(b) 1915(a)

Kent Agemaw, Alcona, Alger, Allegan, Alpena, Antrim, Arenac, Baraga, Barry, Bay, Benzie, Berrien, Branch, Calhoun, Cass, Charlevoix, Cheboygan, Chippewa, Clare, Clinton, Crawford, Delta, Dickenson, Eaton, Emmet, Genesee, Gladwin, Gogebic, Grand Traverse, Gratiot, Hillsdale, Houghton, Huron, Ingham, Ionia, Iosco, Iron, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Keeweenaw, Lake, Lapeer, Lelanau, Livingston, Luce, Mackinac, Macomb, Manistee, Marquette, Mason, Mecosta, Menominee, Midland, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ononagon, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Schoolcraft, Shiawasee, St. Clair, St. Joseph, Tuscola, Van Buren, Washtenau, Wayne, Wexford/Missaukee Hillsdale, Jackson Macomb Livingston, Washtenaw, Wayne Arenac, Bay, Clinton, Eaton, Genesee, Gratiot, Ingham, Lapeer, Ogemaw, Oscoda, Roscommon, Saginaw, Shiawassee Macomb, Oakland, Washtenaw, Wayne Alcona, Allegan, Alpena, Arenac, Bay, Crawford, Genesee, Gladwin, Gratiot, Huron, Ionia, Iosco, Kent, Lake, Macomb, Manistee, Mason, Mecosta, Midland, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Tuscola, Wayne, Wexford/Missaukee Muskegon, Ottawa Crawford, Grand Traverse, Lake, Leelanau, Mason, Missaukee, Oceana, Roscommon, Wexford Alcona, Alpena, Antrim, Charlevoix, Cheboygan, Emmet, Iosco, Kalkaska, Montmorency, Ogemaw, Oscoda, Otsego, Presque Isle Oakland

72,789 2,361

MI MI MI MI

Lifeways CMH Macomb County CMH M-Caid HMO McLaren Health Plan

Mental Health PIHP Mental Health PIHP Commercial MCO Medicaid MCO

Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) 1915(b)

26,446 62,347 15,878 34,161

MI MI

Midwest Health Plan Molina Healthcare of Michigan

Medicaid MCO Medicaid MCO

Capitation Capitation

1915(b) 1915(b)

53,005 90,343

MI MI MI

Muskegon County CMH Northern Lakes CMH Northern Michigan CMH

Mental Health PIHP MH/SUD PIHP Mental Health PIHP

Capitation Capitation Capitation

1915(b) 1915(b) 1915(b)

47,469 35,441 38,474

MI

Oakland County CMH

Mental Health PIHP

Capitation

1915(b)

75,971

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 31 of 56

11

MI MI

Omnicare Health Plan Pathways CMH

Commercial MCO Mental Health PIHP Medicaid MCO Commercial MCO

Capitation Capitation

1915(b) 1915(b)

Wayne Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keeweenau, Luce, Mackinac, Marquette, Menominee, Ontonagan, Schoolcraft Ingham Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren Allegan, Kent, Lake, Mecosta, Montcalm, Osceola, Ottawa

62,772 40,405

MI MI

Physicians Health Plan of Mid-Michigan Family Care Physicians Health Plan of Southwest Michigan Priority Health

Capitation Capitation

1915(b) 1915(b)

16,925 31,661

MI

Medicaid MCO

Capitation

1915(b)

32,415

MI MI MI MI MI

Saginaw County CMH St. Clair County CMH Summit Pointe Total Health Care Upper Penninsula Health Plan

Mental Health PIHP Mental Health PIHP Mental Health PIHP Commercial MCO Medicaid MCO

Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1915(b)

Saginaw Lapeer, Sanilac, St. Clair Barry, Berrien, Branch, Calhoun, VanBuren Genesee, Macomb, Oakland, Wayne Alger, Baraga, Chippewa, Delta, Dickinson, Gogebic, Houghton, Iron, Keewenaw, Luce, Mackinac, Marquette, Menominee, Ontonagon, Schoolcraft Lenawee, Livingston, Monroe, Washtenaw Genesee, Lapeer, Macomb, Muskegon, Oakland, Oceana, Wayne Aitkin, Anoka, Becker, Beltrami, Benton, Big Stone, Blue Earth, Brown, Carver, Cass, Chippewa, Chisago, Clay, Clearwater, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Houston, Hubbard, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Lac Qui Parle, Lake of the Woods, LeSueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mcleod, Meeker, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Trail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rook, Rouseau, Scott, Sherburne, Sibley, Stearns, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Wadena, Waseca, Washington, Watonwan, Wilkin, Winona, Wright, Yellow Medicine

36,256 33,073 71,200 49,657 25,964

MI MI

Washtenaw County CMH Wellness Plan

Mental Health PIHP Commercial MCO

Capitation Capitation

1915(b) 1915(b)

50,682 98,376

MN

Blue Plus

Commercial MCO

Capitation

1115

92,048

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 32 of 56

12

MN

Consolidated Chemical Dependency Treatment Fund (CCDTF) First Plan Blue Health Partners

*County and Tribal Case Managers Commercial MCO Commercial MCO

FFS

1915(b)

Statewide

926

MN MN

Capitation Capitation

1115 1115

Carlton, Cook, Koochiching, Lake, St. Louis Anoka, Benton, Carver, Chisago, Dakota, Hennepin, McLeod, Meeker, Mille Lacs, Morrison, Ramsey, Rice, Scott, Sherburne, Stearns, Washington, Wright Aitkin, Cass, Itasca, Koochiching Aitkin, Anoka, Becker, Benton, Carlton, Carver, Cass, Chisago, Clay, Crow Wing, Dakota, Hennepin, Isanti, Koochiching, Lake, Mahnomen, Mille Lacs, Morrison, Norman, Otter Tail, Pine, Ramsey, Scott, Sherburne, St. Louis, Stearns, Todd, Wadena, Washington, Wilkin, Wright

6,596 40,341

MN MN

Itasca Medical Care Medica

Medicaid MCO Commercial MCO

Capitation Capitation

1115 1115,1915(a)

4,246 111,532

MN MN

Metropolitan Health Plan PrimeWest Health System

Commercial MCO Medicaid MCO

Capitation Capitation

1115,1915(a) 1115

Anoka, Carver, Hennepin, Scott Big Stone, Douglas, Grant, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, Traverse Brown, Dodge, Freeborn, Goodhue, Kanabec, Sibley, Steele, Wabasha, Waseca Aitkin, Anoka, Benton, Big Stone, Blue Earth, Brown, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Douglas, Faribault, Fillmore, Freeborn, Goodhue, Grant, Hennepin, Houston, Isanti, Jackson, Kanabec, Kandiyohi, Kittson, Lac Qui Parle, Lake, LeSueur, Lincoln. Lyon, Marshall, Martin, Mcleod, Meeker, Millie Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Pipestone, Polk, Pope, Ramsey, Red Lake, Redwood, Renville, Rice, Rock, Roseau, Scott, Sherburne, Sibley, St. Louis, Steams, Steele, Stevens, Swift, Todd, Traverse, Wabasha, Waseca, Washington, Watonwan, Winona, Wright, Yellow Medicine

15,263 8,940

MN

South Country Health Alliance

Medicaid MCO

Capitation

1115

11,958

MN

UCARE

Commercial MCO

Capitation

1115,1915(a)

70,637

MO MO MO

Alexian Brothers Community Services Blue Cross Blue Shield of Kansas City, Blue Advantage+ Plus Community Care Plus

PACE Commercial MCO Medicaid MCO

Capitation Capitation Capitation

PACE 1115,1915(b) 1115,1915(b)

St. Louis City, St. Louis County Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair Franklin, Jefferson, Lincoln, St. Charles, St. Francois, St. Genevieve, St. Louis, St. Louis City, Warren, Washington

176 33,903 44,703

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 33 of 56

13

MO MO MO

Family Health Partners FirstGuard HealthCare USA

Medicaid MCO Commercial MCO Medicaid MCO

Capitation Capitation Capitation

1115,1915(b) 1115,1915(b) 1115,1915(b)

Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, Ray, St. Clair Audrain, Boone, Callaway, Camden, Cass, Chariton, Clay, Cole, Cooper, Franklin, Gasconade, Henry, Howard, Jackson, Jefferson, Johnson, Lafayette, Lincoln, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Platte, Randolph, Ray, Saline, St. Charles, St. Clair, St. Francois, St. Genevieve, St. Louis, St. Louis City, Warren, Washington Franklin, Jefferson, Lincoln, St. Charles, St. Francois, St. Genevieve, St. Louis, St. Louis City, Warren, Washington

49,587 40,784 187,613

MO

Mercy Health Plans

Commercial MCO

Capitation

1115,1915(b)

42,310

MO

Missouri Care

Medicaid MCO

Capitation

1115,1915(b)

Audrain, Boone, Callaway, Camden, Chariton, Cole, Cooper, Gasconade, Howard, Miller, Moniteau, Monroe, Montgomery, Morgan, Osage, Pettis, Randolph, Saline Statewide

33,439

MS

McKesson

MT NC

Passport to Health Access II/III

Disease Management PAHP PCCM PCCM

Capitation

1932(a)

73,445

FFS FFS

1915(b) 1932(a)

Statewide Alamance, Beaufort, Buncombe, Burke, Carbarrus, Catawba, Chatham, Cleveland, Craven, Davidson, Durham, Edgecombe, Gaston, Guilford, Haywood, Henderson, Lenoir, Mecklenburg, Moore, Onslow, Orange, Pitt, Robeson, Sampson, Scotland, Surry, Wayne, Wilson

58,030 539,917

NC NC ND ND NE NE NE NJ

Carolina Access Wellpath Select, Inc. dba Southcare AltruCare North Dakota Access and Care Program Magellan Behavioral Health Primary Care Plus Share Advantage AmeriChoice of New Jersey, Inc.

PCCM Commercial MCO Commercial MCO PCCM *Specialty Physician Case PCCM Commercial MCO Commercial MCO

FFS Capitation Capitation FFS FFS FFS Capitation Capitation

1932(a) 1932(a) 1932(a) 1932(a) 1915(b)

Statewide Mecklenburg Grand Forks County, Pembina County, Walsh County Statewide Statewide

235,873 13,153 794 32,271 149,405 37,636 31,204 140,863

1915(b),1932(a) Douglas, Lancaster, Sarpy 1915(b),1932(a) Douglas, Lancaster, Sarpy 1915(b),1932(a) Statewide

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 34 of 56

14

NJ

AMERIGROUP New Jersey, Inc.

Medicaid MCO

Capitation

1915(b),1932(a) Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren 1915(b),1932(a) Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Mercer, Middlesex, Ocean, Passaic, Salem, Somerset, Union 1915(b),1932(a) Statewide 1915(b),1932(a) Atlantic, Bergen, Burlington, Camden, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Sussex, Union, Warren 1915(b) 1915(b) 1915(b) PACE 1932(a) 1932(a) 1115 1115 Statewide Statewide Statewide Zip Code Clark, Washoe Clark, Washoe Bronx, New York Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk, Westchester Bronx, Kings, Queens, Richmond Broome Erie Albany, Broome, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Tioga, Washington Kings, New York, Putnam, Queens, Richmond

87,435

NJ

Health Net

Medicaid MCO

Capitation

36,887

NJ NJ

Horizon NJ Health University Health Plans, Inc.

Medicaid MCO Commercial MCO

Capitation Capitation

231,091 45,544

NM NM NM NM NV NV NY NY

Lovelace Molina (formerly Cimarron) Presbyterian Salud Total Community Care (PACE) Health Plan of Nevada NevadaCare DBA Nevada Health Solutions ABC Health Plan Affinity Health Plan

Commercial MCO Commercial MCO Commercial MCO PACE Commercial MCO Commercial MCO Medicaid MCO Medicaid MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

68,284 65,616 138,883 235 40,728 49,118 8,340 176,042

NY NY NY NY

Americhoice Broome County MC Buffalo Community Health/Univera Community Health Capital District Physicians Health Plan

Commercial MCO PCCM Medicaid MCO Commercial MCO

Capitation FFS Capitation Capitation

1115 1115 1115 1115

104,401 5,491 16,717 56,871

NY

CarePlus Health Plan

Medicaid MCO

Capitation

1115

85,655

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 35 of 56

15

NY

Catholic Services Health Plan/Fidelis

Medicaid MCO

Capitation

1115

Albany, Bronx, Broome, Cattauragus, Chautauqua, Clinton, Columbia, Cortland, Erie, Essex, Greene, Hamilton, Herkimer, Kings, Nassau, New York, Niagara, Oneida, Onondaga, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Warre, Washington, Westchester

209,547

NY NY NY NY NY NY

Community Choice Health Plan Community Premier Plus Comprehensive Care Management (CCCM) Eddy Senior Care Elderplan Excellus

Medicaid MCO Medicaid MCO PACE PACE Long Term Care PIHP Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation

1115 1115 PACE PACE 1915(a) 1115

Bronx, Rockland, Westchester Bronx, New York New York City, Westchester Schenectady New York City Herkimer, Livingston, Monroe, Oneida, Onondaga, Ontario, Orleans, Oswego, Seneca, Wayne, Yates Brooklyn, New York Statewide Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Greene, Kings, Manhattan, Montgomery, Orange, Otsego, Putnam, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Sullivan, Ulster, Warren, Washington, Westchester New York City Orange Allegany Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk Albany, Allegany, Cattauragus, Chautauqua, Clinton, Columbia, Erie, Essex, Fulton, Genesee, Greene, Montgomery, Niagara, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming Bronx, Brooklyn, Manhattan, Queens New York City

14,555 63,454 1,321 78 523 76,281

NY NY NY

FidelisCare HeatherLife SN GHI GHI HMO Select

Medicaid MCO *PPO Commercial MCO

Capitation Capitation Capitation

1115 1115 1115

6 10,626 4,410

NY NY NY NY

Guildnet Health Advantage/Elant Choice Health Choice Health First

Long Term Care PIHP Long Term Care PIHP PCCM Medicaid MCO

Capitation Capitation Capitation Capitation

1915(a) 1915(a) 1115 1115

2,313 81 402 237,964

NY

Health Now

Commercial MCO

Capitation

1115

59,094

NY NY

HealthFirst PHSP SN Hebrew Hospital Home/CO-OP Care Plan

Medicaid MCO Long Term Care PIHP

Capitation Capitation

1115 1915(a)

68 454

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 36 of 56

16

NY

HIP Combined

Commercial MCO

Capitation

1115

Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, Westchester New York City New York City Erie, Niagara Monroe Bronx, Kings, New York, Queens, Richmond Nassau Bronx, Kings, New York, Queens, Richman Bronx, Kings, New York, Queens, Richmond Bronx, Kings, New York, Queens Bronx, Brooklyn, Manhattan, Queens Herkimer, Oneida Dutchess, Ulster Bronx, Kings, New York, Queens, Richmond Bronx, Kings, New York, Queens Bronx, Brooklyn, Manhattan, Queens, Staten Island Albany, Allegany, Bronx, Broome, Cattaraugus, Cayuga, Chautaugua, Chemung, Chenango, Columbia, Cortland, Dutchess, Erie, Fulton, Greene, Herkimer, Jefferson, Kings, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Oswego, Otsego, Putnam, Queens, Rensselaer, Richmond, Rockland, Schenectady, Schoharie, Schuyler, Seneca, St. Lawrence, Steuben, Suffolk, Sullivan, Ulster, Wayne, Westchester, Yates

237,078

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

HomeFirst Independent Care Systems Independent Health/Hudson Valley&WNY Independent Living For Seniors LMC/Health Care Plus Long Island Health Partners/Broadlawn Health Partners Managed Health Inc/A+ Health Plan Manhattan PHSP/Centercare MetroPlus Health Plan MetroPlus Health Plan SN Mohawk Valley Network/Senior Network Health MVP Health Plan Neighborhood Health Providers NY Hospital Community PHSP NYPS Select Health SN OMH/Partial Capitation

Long Term Care PIHP Long Term Care PIHP Commercial MCO PACE Medicaid MCO Long Term Care PIHP Commercial MCO Medicaid MCO Medicaid MCO Medicaid MCO Long Term Care PIHP Commercial MCO Medicaid MCO Medicaid MCO Medicaid MCO Mental Health PAHP

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(a) 1915(a) 1115 PACE 1115 1915(a) 1115 1115 1115 1115 1915(a) 1115 1115 1115 1115 1915(a)

942 596 29,980 314 212,541 446 1,383 80,058 196,658 231 331 1,165 84,794 53,354 344 6,725

NY NY NY

PACE CNY Partners In Community Care Physician Case Management Program

PACE Long Term Care PIHP PCCM

Capitation Capitation Capitation

PACE 1915(a) 1115

Lewis, Onondaga, Oswego Orange, Rockland Erie

254 124 5,117

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 37 of 56

17

NY NY NY NY NY NY NY NY NY NY NY NY NY NY NY

Preferred Care Primary Health Senior Health Partners Southern Tier Pediatrics St. Barnabas/Partners in Health Suffolk Health Plan Syracuse PHSP/Total Care Total Aging in Place Twin Tier/ Southern Tier Priority United Healthcare of NY United Healthcare of Upstate VidaCare Inc. SN VNS Choice Vytra Wellcare

Commercial MCO PCCM Long Term Care PIHP PCCM Medicaid MCO Medicaid MCO Medicaid MCO Long Term Care PIHP PCCM Commercial MCO Commercial MCO Medicaid MCO Long Term Care PIHP Commercial MCO Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1115 1115 1915(a) 1115 1115 1115 1115 1915(a) 1115 1115 1115 1115 1915(a) 1115 1115

Genesee, Livingston, Monroe, Ontario Chautauqua New York City Chemung, Steuben Bronx Suffolk Onondaga, Oswego, Tompkins Erie Chemung, Schuyler, Steuben Bronx, Kings, Nassau, Queens, Richmond, Suffolk Cayuga, Herkimer, Madison, Oneida, Onondaga, Oswego Bronx, Brooklyn, Manhattan, Queens, Staten Island New York City Nassau, Suffolk Albany, Bronx, Columbia, Delaware, Dutchess, Greene, Kings, New York, Orange, Queens, Rensselaer, Rockland, Saratoga, Sullivan, Ulster Orange, Rockland, Sullivan, Ulster, Westchester Lucas Butler, Clark, Clermont, Cuyahoga, Franklin, Greene, Hamilton, Lorain, Montgomery, Pickaway, Stark, Summit, Warren Cuyahoga Stark Lucas, Wood Cuyahoga Summit Butler, Clermont, Hamilton, Warren Statewide

16,293 687 208 3,100 24,952 13,429 20,905 103 5,538 72,786 28,135 105 3,728 9,793 59,130

NY OH OH

Westchester PHSP/Hudson Health Plan Buckeye Community Health Plan CareSource

Medicaid MCO Commercial MCO Medicaid MCO

Capitation Capitation Capitation

1115 1915(b) 1915(b)

38,712 23,767 337,108

OH OH OH OH OH OH OK

Concordia Care MediPlan Paramount Health Care Qualchoice Health Plan Summacare TriHealth SeniorLink SoonerCare American Indian PCCM

PACE Medicaid MCO Commercial MCO Commercial MCO Commercial MCO PACE PCCM

Capitation Capitation Capitation Capitation Capitation Capitation FFS

PACE 1915(b) 1915(b) 1915(b) 1915(b) PACE 1115

225 12,948 32,537 60,975 40,002 233 5,572

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 38 of 56

18

OK OR OR

SoonerCare PAHP Accountable Behavioral Health Capitol Dental Care Inc.

Medical-only PIHP Mental Health PIHP Dental PAHP

Capitation Capitation Capitation

1115 1115 1115

Statewide Benton, Crook, Deschutes, Jefferson, Lincoln Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Klamath, Lane, Lincoln, Linn, Marion, Multnomah, Polk, Umatilla, Wasco, Washington, Yamhill Clackamas, Clatsop, Columbia, Coos, Douglas, Jackson, Klamath, Marion, Morrow, Multnomah, Polk, Umatilla, Washington, Yamhill Klamath Crook, Deschutes, Grant, Harney, Hood River, Jefferson, Klamath, Lake, Sherman, Wasco, Wheeler Clackamas, Gilliam, Hood River, Marion, Multnomah, Sherman, Wasco, Washington Deschutes Coos Douglas Clackamas, Multnomah Clackamas, Jackson, Josephine, Morrow, Multnomah, Umatilla, Washington Baker, Clatsop, Columbia, Grant, Harney, Lake, Malheur, Morrow, Umatilla, Union, Wallowa, Wheeler Benton, Coos, Deschutes, Douglas, Gilliam, Grant, Klamath, Lake, Lane, Lincoln, Linn, Marion, Morrow, Multnomah, Umatilla, Wheeler Benton, Linn Coos, Curry, Douglas, Jackson, Josephine, Klamath Lane Benton, Lane, Linn Benton, Clackamas, Clatsop, Columbia, Hood River, Jackson, Josephine, Linn, Marion, Multnomah, Polk, Tillamook, Washington, Yamhill Clackamas, Linn, Marion, Polk, Yamhill

348,538 20,346 89,731

OR

Care Oregon

Medicaid MCO

Capitation

1115

95,099

OR OR OR OR OR OR OR OR

Cascade Comprehensive Care Central Oregon Independent Health Solutions Clackamas County Mental Health Deschutes County CDO Doctors of the Oregon Coast South Douglas County IPA FamilyCare (Mental Health) FamilyCare Health Plans

Medicaid MCO Medicaid MCO Mental Health PIHP Substance Use Disorders PAHP Medicaid MCO Commercial MCO Mental Health PIHP Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1115 1115 1115 1115 1115

7,038 18,026 20,024 8,084 7,721 9,815 8,713 14,748

OR OR

Greater Oregon Behavioral Health, Inc. Hayden Family Dentistry

Mental Health PIHP Dental PAHP

Capitation Capitation

1115 1115

24,274 16,814

OR OR OR OR OR

Inter-Community Health Network Jefferson Behavioral Health Lane Care MHO Lane Individual Practice Association Managed Dental Care of Oregon

Medicaid MCO Mental Health PIHP Mental Health PIHP Medicaid MCO Dental PAHP

Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1115 1115

16,187 51,786 27,534 29,125 9,951

OR

Marion Polk Community Health Plan

Medicaid MCO

Capitation

1115

35,428

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 39 of 56

19

OR OR OR OR OR

Mid Valley Behavioral Care Network Mid-Rogue Independent Practice Assoc. Multicare Dental Multnomah County Verity Northwest Dental Services

Mental Health PIHP Medicaid MCO Dental PAHP Mental Health PIHP Dental PAHP

Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1115 1115

Benton, Linn, Marion, Polk, Tillamook, Yamhill Douglas, Jackson, Josephine Clackamas, Multnomah, Washington Clackamas, Multnomah, Washington Baker, Coos, Crook, Curry, Deschutes, Douglas, Grant, Harney, Hood River, Jackson, Jefferson, Josephine, Klamath, Lake, Lane, Malheur, Sherman, Umatilla, Union, Wallowa, Wasco, Wheeler Baker, Benton, Clackamas, Clatsop, Columbia, Crook, Deschutes, Grant, Hood River, Jackson, Josephine, Lane, Lincoln, Linn, Malheur, Marion, Multnomah, Polk, Tillamook, Umatilla, Wasco, Washington, Yamhill Douglas, Jackson, Josephine Statewide 97009, 97010, 97014, 97019, 97024, 97030, 97034, 97035, 97056, 97060, 97080, 97124, 97133, 97201, 97202, 97203, 97204, 97205, 97206, 97209, 97210, 97211, 97212, 97213, 97215, 97216, 97217, 97218, 97219, 97220, 97221, 97222, 97225, 97227, 97229, 97230, 97231, 97232, 97233, 97236, 97239, 97258, 97266 Clackamas, Multnomah, Washington, Yamhill Washington Washington Clackamas, Washington Benton, Clackamas, Deschutes, Douglas, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington Bucks, Chester, Delaware, Montgomery, Philadelphia Adams, Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton, Perry, York Lackawanna, Luzerne, Monroe, Pike

55,587 5,759 23,825 58,204 55,934

OR

Oregon Dental Service

Dental PAHP

Capitation

1115

51,212

OR OR OR

Oregon Health Management Service PCCM Providence Elder Care

Medicaid MCO PCCM PACE

Capitation FFS Capitation

1115 1115 PACE

5,039 11,414 530

OR OR OR OR OR

Providence Health Assurance Tuality Health Alliance (Mental Health) Tuality Health Care Washington County Health (Mental Health) Willamette Dental

Medicaid MCO Mental Health PIHP Medicaid MCO Mental Health PIHP Dental PAHP

Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 1115 1115

7,951 5,636 6,194 19,376 47,944

PA PA PA

AmeriChoice of Pennsylvania AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan AmeriHealth HMO, Inc./AmeriHealth Mercy Health Plan - VOL

Commercial MCO Medicaid MCO Medicaid MCO

Capitation Capitation Capitation

1915(b) 1915(b) 1915(a)

97,769 73,551 1,057

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 40 of 56

20

PA

Community - LIFE

PACE

Capitation

PACE

15014, 15018, 15020, 15024, 15025, 15028, 15030, 15032, 15034, 15035, 15037, 15045, 15047, 15049, 15051, 15065, 15075, 15076, 15084, 15088, 15102, 15104, 15110, 15112, 15120, 15122, 15129, 15131, 15132, 15133, 15135, 15137, 15139, 15140, 15144, 15145, 15146, 15147, 15148, 15206, 15207, 15208, 15215, 15217, 15218, 15221, 15227, 15232, 15234, 15235, 15236, 15238, 15239

225

PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA PA

County of Adams - Community Care Behavioral Health County of Allegheny - Community Care Behavioral Health County of Armstrong - Value Behavioral Health of PA County of Beaver - Value Behavioral Health of PA County of Berks - Community Care Behavioral Health County of Bucks - Magellan Behavioral Health County of Butler - Value Behavioral Health of PA County of Chester - Community Care Behavioral Health County of Cumberland - Community Behavioral Healthcare Network of PA, Inc. County of Dauphin - Community Behavioral Healthcare Network of PA, Inc. County of Delaware - Magellan Behavioral Health County of Fayette - Value Behavioral Health of PA County of Indiana - Value Behavioral Health of PA County of Lancaster - Community Behavioral Healthcare Network of PA, Inc. County of Lawrence - Value Behavioral Health of PA County of Lebanon - Community Behavioral Healthcare Network of PA, Inc. County of Lehigh - Magellan Behavioral Health County of Montgomery - Magellan Behavioral Health County of Northampton - Magellan Behavioral Health

MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b)

Adams Allegheny Armstrong Beaver Berks Bucks Butler Chester Cumberland Dauphin Delaware Fayette Indiana Lancaster Lawrence Lebanon Lehigh Montgomery Northampton

6,460 132,480 9,380 21,506 39,772 29,456 13,436 18,817 10,088 27,483 53,078 29,546 9,625 39,276 13,909 10,998 34,376 33,088 20,903

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 41 of 56

21

PA PA PA PA PA PA

County of Perry - Community Behavioral Healthcare Network of PA, Inc. County of Philadelphia - Community Behavioral Health County of Washington - Value Behavioral Health of PA County of Westmoreland - Value Behavioral Health of PA County of York - Community Care Behavioral Health Family Care Network

MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP MH/SUD PIHP PCCM

Capitation Capitation Capitation Capitation Capitation FFS

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) 1915(b)

Perry Philadelphia Washington Westmoreland York Bedford, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clarion, Clearfield, Clinton, Columbia, Crawford, Elk, Erie, Forest, Franklin, Fulton, Huntingdon, Jefferson, Juniata, Lackawanna, Luzerne, Lycoming, McKean, Mercer, Mifflin, Monroe, Montour, Northumberland, Pike, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Wayne, Wyoming

3,835 378,538 21,225 34,993 30,900 140,668

PA

Gateway Health Plan, Inc.

Medicaid MCO

Capitation

1915(b)

Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York Blair, Cambria, Carbon, Clarion, Columbia, Erie, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Montour, Northumberland, Pike, Schuylkill, Somerset, Wyoming Bucks, Chester, Delaware, Montgomery, Philadelphia Blair, Cambria, Erie Bucks, Chester, Delaware, Montgomery, Philadelphia Beaver 15006, 15007, 15015, 15017, 15031, 15044, 15046, 15056, 15064, 15071, 15082, 15086, 15090, 15091, 15101, 15106, 15108, 15116, 15126, 15127, 15136, 15142, 15143, 15201, 15202, 15203, 15204, 15205, 15209, 15210, 15211, 15212, 15213, 15214, 15216, 15219, 15220, 15222, 15223, 15224, 15225, 15226, 15228, 15229, 15233, 15237, 15241, 15243 19106, 19107, 19111, 19114, 19115, 19116, 19123, 19124, 19125, 19134, 19135, 19136, 19137, 19145, 19146, 19147, 19148, 19149, 19152, 19154 19103, 19104, 19121, 19130, 19131, 19139, 19142, 19143, 19151, 19153

222,664

PA

Gateway Health Plan, Inc. -VOL

Medicaid MCO

Capitation

1915(a)

30,379

PA PA PA PA PA

Health Partners of Philadelphia ION Health Plan, Inc. - VOL Keystone Mercy Health Plan LIFE - Beaver County LIFE - Pittsburgh

Commercial MCO Medicaid MCO Medicaid MCO Medical-only PIHP Medical-only PIHP

Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(a) 1915(b) 1915(a) 1915(a)

136,102 1,470 281,395 15 172

PA

LIFE - St. Agnes

Medical-only PIHP

Capitation

1915(a)

105

PA

LIFE - University of Pennsylvania

PACE

Capitation

PACE

212

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 42 of 56

22

PA

Three Rivers Health Plans, Inc. / MedPLUS

Medicaid MCO

Capitation

1915(b)

Adams, Allegheny, Armstrong, Beaver, Berks, Butler, Cumberland, Dauphin, Fayette, Greene, Indiana, Lancaster, Lawrence, Lebanon, Lehigh, Northampton, Perry, Washington, Westmoreland, York Blair, Bradford, Cambria, Carbon, Clarion, Crawford, Erie, Franklin, Jefferson, Lackawanna, Luzerne, Mercer, Monroe, Pike, Schuylkill, Somerset, Sullivan, Susquehanna, Warren, Wyoming Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington, Westmoreland Bedford, Blair, Cambria, Clearfield, Crawford, Mercer, Somerset, Venango Greene Arroyo, Barranquitas, Coamo, Guayama, Juana Diaz, Maunabo, Orocovis, Patillas, Salinas, Santa Isabel, Villalba Aguas Buenas, Arecibo, Barceloneta, Bayamon, Caguas, Camuy, Canovanas, Carolina, Catano, Cayey, Ceiba, Ciales, Cidra, Comerio, Corozal, Culebra, Dorado, Fajardo, Florida, Guaynabo, Gurabo, Hatillo, Humacao, Juncos, Lares, Las Piedras, Loiza, Luquillo, Manati, Morovis, Naguabo, Naranjito, Quebradillas, Rio Grande, San Juan, San Lorenzo, Toa Alta, Toa Baja, Trujillo Alto, Utuado, Vega Alta, Vega Baja, Vieques, Yabucoa Adjuntas, Aguada, Aguadilla, Aibonito, Anasco, Arroyo, Barranquitas, Cabo Rojo, Coamo, Guanica, Guayama, Guayanilla, Hormigueros, Isabela, Jayuya, Juana Diaz, Lajas, Las Marias, Maricao, Maunabo, Mayaguez, Moca, Orocovis, Patillas, Penuelas, Ponce, Rincon, Sabana Grande, Salinas, San German, San Sebastian, Santa Isabel, Villalba, Yauco Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, Cayey, Cidra, Coamo, Guayama, Gurabo, Humacao, Juana Diaz, Juncos, Las Piedras, Maunabo, Naguabo, Orocovis, Patillas, Salinas, San Lorenzo, Santa Isabel, Villalba, Yabucoa

148,853

PA

Three Rivers Health Plans, Inc./MedPlus VOL

Medicaid MCO

Capitation

1915(a)

50,983

PA

UPMC Health Plan, Inc./UPMC for You

Medicaid MCO

Capitation

1915(b)

76,451

PA PA PR

UPMC Health Plan, Inc./UPMC for You - VOL Value Behavioral Health of PA (Greene County) Alianza de Medicos de Sur Este, Inc.

Medicaid MCO MH/SUD PIHP Commercial MCO

Capitation Capitation Capitation

1915(a) 1915(b) 1915(a)

10,244 7,193 11,717

PR

APS Healthcare

MH/SUD PIHP

Capitation

1915(a)

517,757

PR

FHC Healthcare

MH/SUD PIHP

Capitation

1915(a)

325,070

PR

Humana Health Plans of Puerto Rico, Inc.

Commercial MCO

Capitation

1915(a)

212,441

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 43 of 56

23

PR

MCS Health Management Options, Inc.

Commercial MCO

Capitation

1915(a)

Aguada, Aguadilla, Anasco, Cabo Rojo, Canovanas, Carolina, Ceiba, Culebra, Fajardo, Hormigueros, Isabela, Lajas, Las Marias, Loiza, Luquillo, Maricao, Mayaguez, Moca, Rincon, Rio Grande, Sabana Grande, San German, San Juan, San Sebastian, Trujillo Alto, Vieques Canovanas, Carolina, Ceiba, Culebra, Fajardo, Loiza, Luquillo, Rio Grande, San Juan, Trujillo Alto, Vieques Adjuntas, Arecibo, Barceloneta, Bayamón, Camuy, Cataño, Ciales, Comerio, Corozal, Dorado, Florida, Guanica, Guayanilla, Guaynabo, Hatillo, Jayuya, Lares, Manati, Morovis, Naranjito, Penuelas, Ponce, Quebradillas, Toa Alta, Toa Baja, Utuado, Vega Alta, Vega Baja, Yauco

279,303

PR

San Judas Medical Services

Commercial MCO

Capitation

1915(a)

5,155

PR

Triple-S, Inc.

Commercial MCO

Capitation

1915(a)

334,211

RI RI RI SC SC

Coordinated Health Partners Neighborhood Health Plan of Rhode Island United HealthCare of NE Palmetto SeniorCare (PACE) Physicians Enhanced Program (PEP)

Commercial MCO Commercial MCO Commercial MCO PACE Medical-only PIHP

Capitation Capitation Capitation Capitation Capitation

1115 1115 1115 PACE 1915(a)

Statewide Statewide Statewide Lexington, Richland Anderson, Beaufort, Berkeley, Charleston, Chester, Chesterfield, Darlington, Florence, Greenville, Hampton, Horry, Laurens, Newberry, Orangeburg, Pickens, Richland, Spartanburg, Sumter, Williamsburg Aiken, Allendale, Bamberg, Berkeley, Calhoun, Charleston, Chesterfield, Clarendon, Darlington, Dillon, Dorchester, Fairfield, Florence, Greenville, Horry, Lee, Lexington, Marion, Marlboro, Newberry, Orangeburg, Richland, Saluda, Union, Williamsburg Statewide Statewide Hamilton Lake, Obion, Weakley, Henry, Dyer, Crockett, Gibson, Carroll, Benton, Lauderdale, Haywood, Madison, Henderson, Decatur, Tipton, Fayette, Hardeman, Hardin, Chester, McNair, Shelby

12,780 72,994 39,147 367 16,480

SC

Select Health of South Carolina, Incorporated

Medicaid MCO

Capitation

1915(a)

52,944

SD SD TN TN

Delta Dental PRIME Alexian Brothers Community Service Better Health Plan

Dental PAHP PCCM PACE Commercial MCO

Capitation FFS Capitation Capitation

1915(a) 1932(a) PACE 1115

95,577 74,264 269 45,506

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 44 of 56

24

TN

John Deere/Heritage National Health Plan

Commercial MCO

Capitation

1115

Anderson, Bledsoe, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Franklin, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hawkins, Jefferson, Johnson, Knox, Loudon, Marion, McMinn, Meigs, Monroe, Morgan, Polk, Rhea, Roane, Scott, Sequatchie, Sevier, Sullivan, Unicoi, Union, Washington Benton, Carroll, Chester, Crockett, Decatur, Dyer, Fayette, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Lake, Lauderdale, Madison, McNairy, Obion, Shelby, Tipton, Weakley Lake, Obion, Weakley, Henry, Dyer, Crockett, Gibson, Carroll, Benton, Lauderdale, Haywood, Madison, Henderson, Decatur, Tipton, Fayette, Hardeman, Hardin, Chester, McNair, Shelby Anderson, Bledsoe, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Franklin, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hawkins, Jefferson, Johnson, Knox, Loudon, Marion, McMinn, Meigs, Monroe, Morgan, Polk, Rhea, Roane, Scott, Sequatchie, Sevier, Sullivan, Unicoi, Union, Washington Statewide Statewide Anderson, Bledsoe, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Franklin, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hawkins, Jefferson, Johnson, Knox, Loudon, Marion, McMinn, Meigs, Monroe, Morgan, Polk, Rhea, Roane, Scott, Sequatchie, Sevier, Sullivan, Unicoi, Union, Washington Davidson Harris Brazoria, Collin, Dallas, Denton, Ellis, Fort Bend, Galveston, Harris, Hood, Hunt, Johnson, Kaufman, Montgomery, Navarro, Parker, Rockwell, Tarrant, Waller, Wise 79901, 79905, 79907, 79915, 79924, 79925, 79930, 79936, 79935 Bexar Service Area

80,695

TN

Memphis Managed Care Corp. (TLC)

Medicaid MCO

Capitation

1115

196,617

TN

Omnicare Health Plan

Medicaid MCO

Capitation

1115

130,947

TN

Preferred Health Partnership/PHP

Medicaid MCO

Capitation

1115

130,540

TN TN TN

Premier Behavioral Systems of TN Tennessee Behavioral Health, Inc. Volunteer State Health Plan (Bluecare)

MH/SUD PIHP MH/SUD PIHP Commercial MCO

Capitation Capitation Capitation

1115 1115 1115

1,030,097 315,034 729,439

TN TX TX

VUMC Care (VHP Community Care) Amerigroup- STAR+PLUS Amerigroup Texas

Commercial MCO Medicaid MCO Medicaid MCO

Capitation Capitation Capitation

1115 1915(b) 1915(b)

31,387 22,501 297,681

TX TX

Bienvivir Senior Health Services Community First

PACE Commercial MCO

Capitation Capitation

PACE 1915(b)

672 46,567

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 45 of 56

25

TX

Community Health Choice

Commercial MCO

Capitation

1915(b)

Brazoria, Fort Bend, Galveston, Harris, Montgomery, Waller

48,226

TX TX TX TX

El Paso First Premier Evercare- STAR+PLUS First Care Jan Werner Adult Day Care Center

Commercial MCO Commercial MCO Commercial MCO PACE

Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) PACE

Culberson, El Paso, Hudspeth Harris Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry 79015, 79101, 79104, 79106, 79111, 79118, 79119, 79121, 79124 Denton, Hood, Johnson, Parker, Tarrant, Wise Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, Rockwall Culberson, El Paso, Hudspeth Harris, Harris Contiguous Atascosa, Bexar, Brazoria, Chambers, Comal, Crosby, Dallas County, Ellis, Floyd, Fort Bend, Galveston, Garza, Guadalupe, Hale, Hardin, Harris, Hockley, Jefferson County, Kendal, Lamb, Liberty, Lubbock, Lynn, Medina, Montgomery, Orange, Terry, Waller, Wilson Harris Collin County, Dallas County, Ellis County, Hunt County, Kaufman County, Navarro County, Rockwall County Box Elder, Cache, Rich Juab, Millard, Piute, Sanpete, Sevier, Wayne Davis Carbon, Emery, Grand Davis County, Salt Lake County, Utah County, Weber County Davis County, Salt Lake County, Utah County, Weber County Beaver, Box Elder, Cache, Garfield, Iron, Kane, Washington Davis, Salt Lake, Utah, Weber

26,299 30,393 16,652 60

TX TX TX TX TX

JPS Star Parkland Community Health Plan Superior Health Plan Texas Children's Health Plan Texas Health Network (STAR)

Commercial MCO Commercial MCO Commercial MCO Commercial MCO PCCM

Capitation Capitation Capitation Capitation FFS

1915(b) 1915(b) 1915(b) 1915(b) 1915(b)

13,580 86,653 140,549 63,843 346,543

TX TX

Texas Health Network (Star+Plus) ValueOptions

PCCM MH/SUD PIHP

FFS Capitation

1915(b) 1915(b)

10,554 292,623

UT UT UT UT UT UT

Bear River Mental Health Central Utah Mental Davis Mental Health Four Corners Mental Health Healthy U IHC Health Plans Inc.

Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Medical-only PIHP PCCM

Capitation Capitation Capitation Capitation Other FFS

1115,1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b)

10,764 7,166 14,081 4,949 23,913 44,898

UT UT

Molina Healthcare of Utah (Molina Plus) Molina Healthcare of Utah (Molina)

Medical-only PIHP Medical-only PIHP

Other Other

1115 1115,1915(b)

4,390 35,547

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 46 of 56

26

UT UT UT UT UT UT VA

Non-Emergency Transportation Northeastern Counseling Center Southwest Mental Health Valley Mental Health Wasatch Mental Health Weber Mental Health CareNet

Transp PAHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b) 1115,1915(b) 1915(b)

Statewide Daggett, Duchesne, Uintah Beaver, Garfield, Iron, Kane, Washington Salt Lake, Summit, Tooele Utah, Wasatch Morgan, Weber Amelia County, Caroline County, Charles City County, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Essex County, Goochland County, Hanover County, Henrico County, Hopewell City, King and Queen County, King William County, Lancaster County, Lunenburg County, Mathews County, Mecklenburg County, Middlesex County, New Kent County, Northumberland County, Nottoway County, Petersburg City, Powhatan County, Prince George County, Richmond City, Richmond County, Surry County, Sussex County, Westmoreland County

154,730 4,691 15,364 71,422 27,473 18,392 14,355

VA

Healthkeepers, Inc.

Commercial MCO

Capitation

1915(b)

Amelia County, Brunswick County, Caroline County, Charles City County, Chesterfield County, Colonial Heights City, Cumberland County, Dinwiddie County, Emporia City, Fredericksburg City, Goochland County, Greensville County, Halifax County, Hanover County, Henrico County, Hopewell County, King George County, Lunenburg County, Petersburg City, Powhatan County, Prince Edward County, Prince George County, Richmond City, Spotsylvania County, Stafford County, Sussex County, Westmoreland County

33,129

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 47 of 56

27

VA

MEDALLION

PCCM

FFS

1915(b)

Alexandria City, Alleghany County, Amherst County, Appomattox County, Arlington County, Bath County, Bedford City, Bedford County, Bland County, Botetourt County, Bristol City, Buchanan County, Buena Vista City, Campbell County, Carroll County, Charlotte County, Clarke County, Clifton Forge City, Covington City, Craig County, Culpeper County, Danville City, Dickenson County, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Floyd County, Franklin County, Frederick County, Galax City, Giles County, Grayson County, Henry County, Highland County, Lee County, Lexington County, Loudon County, Lynchburg City, Manassas City, Manassas Park City, Martinsville City, Montgomery County, Norton City, Page Country, Patrick Country, Pittsylvania County, Prince William County, Pulaski County, Radford City, Rappahannock County, Roanoke City, Roanoke County, Rockbridge County, Russell County, Salem City, Scott County, Shenandoah County, Smyth County, Tazewell County, Warren County, Washington County, Winchester City, Wise County, Wythe County

89,560

VA

Peninsula Health Care, Inc.

Commercial MCO

Capitation

1915(b)

Essex County, Gloucester County, Hampton City, Isle of Wight County, James City County, King and Queen County, King William County, Mathews County, Middlesex County, Newport News City, Northumberland County, Poquoson City, Richmond County, Surry County, Williamsburg City, York County Accomack County, Chesapeake City, Franklin City, Norfolk City, Northampton County, Portsmouth City, Southampton County, Suffolk City, Virginia Beach City

17,551

VA

Priority Health Care, Inc.

Commercial MCO

Capitation

1915(b)

22,884

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 48 of 56

28

VA

Sentara Family Care

Commercial MCO

Capitation

1915(b)

Accomack County, Albemarle County, Amelia County, Augusta County, Brunswick County, Buckingham County, Caroline County, Charles City County, Charlotte County, Charlottesville City, Chesapeake City, Chesterfield County, Colonial Heights City, Cumberland County, Danville City, Dinwiddle County, Emporia City, Essex County, Fluvanna County, Franklin City, Gloucester County, Goochland County, Greene County, Greensville County, Halifax County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Hopewell City, Isle of Wright County, James City County, King and Queen County, King William County, Lancaster County, Louisa County, Lunenburg County, Madison County, Matthews County, Mecklenburg County, Middlesex County, Nelson County, New Kent County, Newport News City, Norfolk City, Northampton County, Northumberland County, Nottoway County, Orange County, Petersburg City, Pittsylvania County, Poquoson City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Richmond City, Richmond County, Rockingham County, Southampton County, Staunto

99,077

VA

UniCare Health Plan of Virginia, Inc.

Commercial MCO

Capitation

1915(b)

Albemarle County, Alexandria City, Arlington County, Buckingham County, Charlottesville City, Fairfax City, Fairfax County, Falls Church City, Fauquier County, Fluvanna County, Greene County, Loudoun County, Louisa County, Madison County, Manassas City, Manassas Park City, Nelson County, Orange County, Prince William County

43,963

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 49 of 56

29

VA

Virginia Premier

Medicaid MCO

Capitation

1915(b)

Accomack County, Albemarle County, Amelia County, Augusta County, Bedford City, Bedford County, Botetourt County, Brunswick County, Buena Vista City, Caroline County, Charles City County, Charlottesville City, Chesapeake City, Chesterfield County, Colonial Heights City, Culpeper County, Cumberland County, Dinwiddle County, Emporia City, Floyd County, Franklin City, Franklin County, Fredericksburg City, Giles County, Goochland County, Greene County, Greensville County, Hampton City, Hanover County, Harrisonburg City, Henrico County, Henry County, Hopewell City, King George County, King William County, Lexington City, Louisa County, Lunenburg County, Madison County, Martinsville City, Mecklenburg County, Montgomery County, New Kent County, Newport News City, Norfolk County, Northampton County, Nottoway County, Orange County, Patrick County, Petersburg City, Portsmouth City, Powhatan County, Prince Edward County, Prince George County, Pulaski County, Radford City, Richmond City, Roanoke City, Roanoke County, Rockbridge County, Rockingham County, Salem City, Southampton County, Spotsylvania County, Stafford County

78,352

VT WA WA WA WA WA WA

PC PLUS Asuris Northwest Health BHP Plus Chelan/Douglas Regional Support Network Clark County Regional Support Network Columbia United Providers Community Health Plans of Washington

PCCM Commercial MCO Medicaid MCO Mental Health PIHP Mental Health PIHP Commercial MCO Commercial MCO

FFS Capitation Capitation Capitation Capitation Capitation Capitation

1115 1932(a) 1932(a) 1915(b) 1915(b) 1932(a) 1932(a)

Statewide Spokane County Statewide Chelan, Douglas Clark Clark, Klickitat, Skamania Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Ferry, Franklin, Grant, Grays Harbor, Island, Jefferson, King, Kitsap, Klickitat, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, Skagit, Skamania, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Yakima Grays Harbor Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Klickitat, Skamania, Walla Walla, Whitman, Yakima

86,263 1,223 31,548 22,460 69,310 29,636 129,814

WA WA

Grays Harbor Regional Support Network Greater Columbia Regional Support Network

Mental Health PIHP Mental Health PIHP

Capitation Capitation

1915(b) 1915(b)

17,558 158,090

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 50 of 56

30

WA WA WA WA

Group Health Healthy Options/PCCM King County Regional Support Network McKesson Health Solutions LLC

Medicaid MCO PCCM Mental Health PIHP Disease Management PAHP Commercial MCO

Capitation FFS Capitation Capitation

1932(a) 1932(a) 1915(b) 1915(b)

King, Kitsap, Pierce, Spokane Statewide King Statewide

16,669 4,087 230,864 128,987

WA

Molina

Capitation

1932(a)

Adams, Benton, Chelan, Clallam, Columbia, Cowlitz, Douglas, Ferry, Franklin, Garfield, Grant, Grays Harbor, Island, King, Kitsap, Kittitas, Lewis, Lincoln, Mason, Okanogan, Pacific, Pend Oreille, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla, Whatcom, Whitman, Yakima Adams, Grant, Okanogan Island, San Juan, Skagit, Snohomish, Whatcom Ferry, Lincoln, Pend Oreille, Stevens Clallam, Jefferson, Kitsap Pierce King Clallam, Grays Harbor, Island, King, Pacific, Pierce, San Juan, Skagit, Snohomish, Yakima Statewide

233,504

WA WA WA WA WA WA WA WA

North Central Washington Regional Support Network North Sound Regional Support Network Northeast Washington Regional Support Network Peninsula Regional Support Network Pierce County Regional Support Network Providence ElderPlace - Seattle Regence Blue Shield Renaissance Health Care, Inc.

Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP PACE Commercial MCO Disease Management PAHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Mental Health PIHP Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1915(b) PACE 1932(a) 1915(b)

41,305 155,954 19,334 50,283 129,542 215 33,435 123

WA WA WA WA WI

Southwest Regional Support Network Spokane County Regional Support Network Thurston/Mason Regional Support Network Timberland Regional Support Network Atrium Health Plan -- BadgerCare SCHIP

Capitation Capitation Capitation Capitation Capitation

1915(b) 1915(b) 1915(b) 1915(b) 1115

Cowlitz Spokane Mason, Thurston Lewis, Pacific, Wahkiakum Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Jackson, Juneau, La Crosse, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn

22,526 92,764 44,863 22,459 9,380

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 51 of 56

31

WI

Atrium Health Plan -- Medicaid HMO

Commercial MCO

Capitation

1932(a)

Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Jackson, Juneau, La Crosse, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, Sawyer, St. Croix, Trempealeau, Vernon, Washburn Milwaukee Milwaukee, Racine Chippewa, Dunn, Eau Claire Dane Dane Dane, Dodge, Fond Du Lac, Jefferson, Lafayette, Rock, Sauk, Walworth Dane, Dodge, Fond Du Lac, Jefferson, Lafayette, Rock, Sauk, Walworth Dane Fond du Lac County, LaCrosse County, Milwaukee County, Portage County, Richland County Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Douglas, Dunn, Eau Claire, Jackson, Pepin, Pierce, Polk, Rusk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Clark, Douglas, Dunn, Eau Claire, Jackson, Pepin, Pierce, Polk, Rusk, Sawyer, St. Croix, Taylor, Trempealeau, Washburn Dane Dane Buffalo, Crawford, La Crosse, Monroe, Trempealeau, Vernon Buffalo, Crawford, La Crosse, Monroe, Trempealeau, Vernon Milwaukee

21,022

WI WI WI WI WI WI WI

Community Care Organization - PACE Community Care Organization - Partnership

PACE Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation

PACE 1115 1115 1115 1915(a) 1115 1932(a)

493 378 572 284 119 2,638 8,738

Community Health Partnership -- Partnership Commercial MCO Community Living Alliance -- Partnership Commercial MCO

Dane County Human Services Department -MH/SUD PIHP CCF Dean Health Plan -- BadgerCare SCHIP Commercial MCO Dean Health Plan -- Medicaid HMO Commercial MCO

WI WI WI

Elder Care Of Dane County - Partnership Family Care Group Health Cooperative Of Eau Claire -BadgerCare SCHIP

Medicaid MCO Long Term Care PIHP Commercial MCO

Capitation Capitation Capitation

1115 1915(b) 1115

448 8,713 4,211

WI

Group Health Cooperative Of Eau Claire -Medicaid HMO

Commercial MCO

Capitation

1932(a)

10,664

WI WI WI WI

Group Health Cooperative Of South Central WI -- BadgerCare SCHIP Group Health Cooperative Of South Central WI -- Medicaid HMO Health Tradition Health Plan -- BadgerCare SCHIP Health Tradition Health Plan -- Medicaid HMO Independent Care Health Plan (Voluntary, iCare)

Commercial MCO Commercial MCO Commercial MCO Commercial MCO

Capitation Capitation Capitation Capitation

1115 1932(a) 1115 1932(a)

385 2,485 1,562 4,196

WI

Commercial MCO

Capitation

1915(a)

6,082

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 52 of 56

32

WI

Managed Health Services -- BadgerCare SCHIP

Medicaid MCO

Capitation

1115

Brown, Calumet, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Marathon, Milwaukee, Outagamie, Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood Brown, Calumet, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Marathon, Milwaukee, Outagamie, Ozaukee, Racine, Rock, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood Dane, Green, Jefferson, Rock, Walworth Dane, Green, Jefferson, Rock, Walworth Milwaukee Brown, Calumet, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Marathon, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood Brown, Calumet, Dodge, Fond Du Lac, Green Lake, Jefferson, Kenosha, Manitowoc, Marathon, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara, Winnebago, Wood Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Rusk, Sawyer, Taylor, Vilas, Washburn, Waupaca, Wood Adams, Ashland, Barron, Chippewa, Clark, Eau Claire, Forest, Iron, Jackson, Juneau, Langlade, Lincoln, Marathon, Oneida, Portage, Price, Rusk, Sawyer, Taylor, Vilas, Washburn, Waupaca, Wood Brown, Calumet, Fond Du Lac, Green Lake, Marquette, Menominee, Oconto, Outagamie, Shawano, Waupaca, Waushara, Winnebago Brown, Calumet, Fond Du Lac, Green Lake, Marquette, Menominee, Oconto, Outagamie, Shawano, Waupaca, Waushara, Winnebago

22,847

WI

Managed Health Services -- Medicaid HMO

Medicaid MCO

Capitation

1932(a)

96,627

WI WI WI WI

MercyCare Insurance Company -BadgerCare SCHIP MercyCare Insurance Company -- Medicaid HMO Milwaukee County Human Services Department -- Wraparound Milwaukee Network Health Plan -- BadgerCare SCHIP

Commercial MCO Commercial MCO MH/SUD PIHP Commercial MCO

Capitation Capitation Capitation Capitation

1115 1932(a) 1915(a) 1115

2,031 7,014 521 9,962

WI

Network Health Plan -- Medicaid HMO

Commercial MCO

Capitation

1932(a)

37,857

WI

Security Health Plan -- BadgerCare SCHIP

Commercial MCO

Capitation

1115

7,093

WI

Security Health Plan -- Medicaid HMO

Commercial MCO

Capitation

1932(a)

15,552

WI

Touchpoint Health Plan -- BadgerCare SCHIP Touchpoint Health Plan -- Medicaid HMO

Commercial MCO

Capitation

1115

4,986

WI

Commercial MCO

Capitation

1932(a)

14,345

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 53 of 56

33

WI WI WI WI WI WI WV WV

UnitedHealthcare of WI -- BadgerCare SCHIP UnitedHealthcare of WI -- Medicaid HMO

Commercial MCO Commercial MCO

Capitation Capitation Capitation Capitation Capitation Capitation Capitation Capitation

1115 1932(a) 1115 1932(a) 1115 1932(a) 1915(b) 1915(b)

Milwaukee, Racine, Waukesha Milwaukee, Racine, Waukesha Dane Dane Barron Barron Boone, Clay, Kanawha, Pleasants, Putnam, Tyler, Wirt, Wood Brooke, Doddridge, Gilmer, Hancock, Harrison, Lewis, Marion, Marshall, Monongalia, Ohio, Pleasants, Preston, Ritchie, Taylor, Tyler, Upshur, Wetzel, Wirt, Wood Statewide Barbour, Boone, Braxton, Clay, Doddridge, Fayette, Gilmer, Greenbrier, Harrison, Jackson, Jefferson, Kanawha, Lewis, Lincoln, Logan, Marion, McDowell, Mercer, Monongalia, Monroe, Morgan, Nicholas, Pleasants, Pocahontas, Putnam, Raleigh, Randolph, Ritchie, Summers, Taylor, Tucker, Tyler, Upshur, Webster, Wetzel, Wirt, Wood, Wyoming

11,392 57,039 611 2,856 293 607 20,156 37,155

Unity Health Insurance -- BadgerCare SCHIP Commercial MCO Unity Health Insurance -- Medicaid HMO Valley Health Plan -- BadgerCare SCHIP Valley Health Plan -- Medicaid HMO Carelink Health Plan Health Plan of the Upper Ohio Valley Commercial MCO Commercial MCO Commercial MCO Commercial MCO Commercial MCO

WV WV

Physician Assured Access System Unicare Health Plan of WV

PCCM Commercial MCO

FFS Capitation

1915(b) 1915(b)

63,475 35,682

TOTAL NUMBER OF ENROLLEES

35,910,395

Blank or 0 "Number of Enrollees" indicates Plan had not been implemented as of 6/30/2004. *Indicates the sructure of the Managed Care Entity is "Other" and not considered a PCCM, MCO, HIO, PIHP, PAHP, or PACE. Page 54 of 56

34

Medicaid Managed Care Enrollment Report Glossary as of June 30, 2004
Terms used in "Managed Care Entity" column
• Primary Care Case Management (PCCM) Provider is a provider (usually a physician, physician group practice, or an entity employing or having other arrangements with such physicians, but sometimes with such physicians, but sometimes also including nurse practitioners, nurse midwives, or physician assistants who contracts directly with the State to locate, coordinate, and monitor covered primary care (and sometimes additional services). This category also includes those PIHPs that contract with the State as “primary care case managers.” Commercial Managed Care Organization (MCO) – A Commercial MCO is a health maintenance organization, an eligible organization with a contract under §1876 or a Medicare+Choice organization, a provider sponsored organization or any other private or public organization, which meets the requirements of §1902(w). A Commercial MCO provides comprehensive services to both Medicaid and commercial and/or Medicare. Medicaid-only Managed Care Organization (MCO) – A Medicaid-only MCO provides comprehensive services to only Medicaid beneficiaries, not to commercial or Medicare enrollees. Health Insuring Organization (HIO) – A HIO is a managed care entity which, by law, is exempt from certain rules governing MCO program operation such as the requirement for beneficiaries to have a choice of at least two managed care entities in mandatory programs. Prepaid Inpatient Health Plan (PIHP) – A PIHP is a prepaid inpatient health plan that provides less than comprehensive services on an at-risk or other than state plan reimbursement basis; and provides, arranges for, or otherwise has responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are define in 42 CFR 438.2} There are several types of PIHPs that States use to deliver a range of services. For example, a Mental Health (MH) PIHP is a managed care entity that provides only mental health services. Prepaid Ambulatory Health Plan (PAHP) – A PAHP is a prepaid ambulatory health plan that provides less than comprehensive services on an at-risk or other than state plan reimbursement basis, and does not provide, arrange for, or otherwise have responsibility for the provision of any inpatient hospital or institutional services. {Comprehensive services are defined in 42 CFR 438.2} There are several types of PAHPs that States use to deliver a range of services. For example, a Dental PAHP is a managed care entity that provides only dental services. Program for All-inclusive Care for the Elderly (PACE) – program that provides prepaid, capitated comprehensive, health care services to the frail elderly. Other – The structure of the managed care plan is not considered a PCCM, PIHP, PAHP, Commercial MCO, Medicaid-only MCO, HIO, or PACE.
Page 49











• •

Page 55 of 56

Terms used in "Reimbursement Arrangement" Column
• • Capitation –The managed care entity is paid for providing services to enrollees solely through capitation. Fee-For-Service (FFS) – The managed care entity is paid for providing services to enrollees solely through fee-for service payments plus in most cases, a case management fee. Other – The managed care entity is providing services to enrollees through means other than through capitation or fee-for-service reimbursements.



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