Medicaid Managed Care Organizations

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Part
01

Medicaid Asthma Programs: FL, TX, MO

United Health, Centene, WellCare, and Anthem offer a range of pediatric asthma programs in Texas, Florida, and Missouri. These programs often include coverage for doctors visits and medications, but some salient features include Anthem's Missouri program called Condition Care that offers 24-hour phone access to registered nurses and United Health's Missouri program MO HealthNet Category of Assistance that supports an app called Airwaze for children with asthma. The Airwaze app offers medication scheduling alerts and training on the mobile phones of children between 5 and 18.

Unfortunately, we were not able to find specific mention of pediatric asthma care in any WellCare program in Texas, nor in any Anthem program in Texas or Florida. At least this latterissue may be the result of Anthem's close partnership with Blue Cross Blue Shield. Blue Cross Blue Shield provides many programs in partnership with other companies and may be the primary source for Anthem's pediatric asthma care in these two states. However, we could not find a clear indication that any particular pediatric asthma program in Texas or Florida was being provided on behalf of Anthem.

METHODOLOGY

We began our research by resolving clear definitions for the terms of the request, confirming that pediatric care tends to include any program that covers, whole or in part, age ranges from 0 to 18 or occasionally up to 21 such as in Medicaid's Early and Periodic Screening and Diagnosis and Treatment (EPSDT) program. We also confirmed that and that asthma care tends to be called just that, or occasionally, respiratory care.

With these definitions in hand, we discovered top-level sources, including the web presences of the named providers, for mentions of pediatric care and asthma care. This initial strategy proved highly successful and provided most of the information needed to answer this request. However, at this point, a few of the requested pieces of information were missing. We were unable to find mentions of pediatric asthma care programs under Anthem at all, nor under relevant WellCare programs in Missouri or Texas.

Thinking creatively, we searched the web presences of major healthcare providers and partnerships not named in this request, looking for signs that care may be provided under a partnership. This strategy proved fruitful, as we found the Anthem program in Missouri through information on a Blue Cross Blue Shield source. Still seeking the remaining information, we tried looking directly at doctors and other healthcare providers in the regions, as they often mention specific coverage programs on their websites. We used Zocdoc and other credible databases to perform this research. Unfortunately, no new information on Anthem or Wellcare pediatric asthma programs in the missing states emerged from this strategy.

Because health insurance is a highly regulated industry that often works in close partnerships with state and national governments, we turned our attention or major US government databases, such as those maintained by the Food and Drug Administration and the Health and Human Services department. While this research strategy did not reveal any new programs, it did confirm that many of Anthem's healthcare programs in the named states are administered through Blue Cross Blue Shield.

Since many asthma programs include people over the age of 18 and many pediatric programs cover asthma as part of a larger program, as a final strategy, we tried broadening the scope of our research. We returned to our primary sources and looked for programs that less obviously fulfilled the bounds of this request. This broader scope allowed us to find "Missouri Care," WellCare's program in Missouri that provided asthma coverage for patients down to the age of five. However, we were still unable to find specific mentions of asthma coverage for children in any WellCare program in Texas, nor in any Anthem program in Texas or Florida. The rest of the information is presented below.

Texas Star Kids Program (UNITED HEALTH IN TEXAS)

This program by United Health in Texas provides overall healthcare services such as well & sick care, care for conditions, vision, care, hearing care, dental care, and home care. The service covers some supplies, rides, and other value-added services and waiver programs. For children with chronic conditions, including asthma, diabetes and Chronic Obstructive Pulmonary Disease (COPD), this program offers access to a professional case manager and can provide additional services including individual care to help control symptoms.

The Florida Healthy Kids Program (UNITED HEALTH IN FLORIDA)

This program is meant for children and young adults up to age 19 whose families meet certain income requirements. Benefits include well and sick care, care for conditions, home care, supplies, and other assistance. Benefits focused upon pediatric asthma include asthma & allergy care, and support for exams, testing, and supplies.

MO HealthNet Category of Assistance (UNITED HEALTH IN MISSOURI)

This state program covers children and young adults up to 21 years of age. Its asthma care programs are administered by United Health. Benefits of the Asthma program include coverage for supplies and equipment, including peak flow meters, spacers, nebulizers, and masks. Coverage also includes regular doctor visits and a meeting once a year with a certified asthma educator. One noteworthy additional service is the Airwaze app. This mobile app includes asthma self-management tools as well as tailored asthma medication reminders, and ongoing asthma education. It is available to program members between the ages of 5 and 18.

Ambetter (CENTENE, TEXAS, FLORIDA, AND MISSOURI)

This Health Insurance Marketplace program insurance plan is part of a larger program called Healthy Solutions for Life. These programs are available in all three markets and have the same promoted benefits and coverage in each. Benefits include telephonic outreach, education, and support. Ambetter offers coverage for children with asthma. Among its promoted offers is the offer of a three-month supply of maintenance medications by mail or through in-network pharmacies, as well as other support for medication costs.

Florida Healthy Kids (WELLCARE IN FLORIDA)

Under the auspices of WellCare's subsidiary Staywell Kids, the company offers this comprehensive health insurance coverage to children between the ages of 5 and 18. Asthma benefits under this program include up to $100 in hypoallergenic bedding for qualified members. Eligibility requirements for this program include being ineligible for Medicaid or coverage through Children's Medical Services.

Missouri care (WELLCARE IN MISSOURI)

WellCare's program in the state of Missouri is called "Missouri Care." One part of Missouri Care is the Medication Management for People with Asthma program. This program focuses on supporting people who have been diagnosed with asthma and who need to receive a persistent supply of medication to control symptoms. This program covers patients between the ages of 5 and 64 years old.

Condition Care (ANTHEM IN MISSOURI)

The aim of this program is to improve patient health and enhance well-being for patients with chronic conditions. Asthma is one of the qualifying conditions. Benefits include education, 24-hour telephone support from a registered nurse, and guidance from nurse coaches and other healthcare professionals.
Sources
Sources

Quotes
  • "Airwaze is a smartphone app that provides tailored asthma education, medication reminders and other self-management tools. This care management app is available for members age 5–18 who have and need help maintaining control of their asthma (page 41)"
Quotes
  • "For years, Superior HealthPlan has delivered healthcare solutions to Texas residents. And now, it’s easier to stay covered with our Health Insurance Marketplace insurance plan: Ambetter."
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  • "With quality healthcare solutions, Sunshine Health helps residents of Florida live better. And now, it’s easier to stay covered with our Health Insurance Marketplace insurance plan: Ambetter."
Quotes
  • "Pediatric Age Range Pediatric age range is defined as ages 0-18 (birth to 18 years of age). Note, this definition does not imply that pediatricians may not provide services to individuals who are beyond 18 years of age (e.g., young adults). ** Federal and State Plans are required to provide early and periodic screening and diagnosis and treatment (EPSDT) of eligible Medicaid recipients under age 21. This document has been classified as public information."