Emerging Practices in Medicaid Primary Care Case Management Programs. Maine: MaineNET/Partnership

06/01/2001

MaineNET is a voluntary PCCM program for Maine's elderly and disabled adults. A second component of the program, the MaineNET/Partnership, serves Medicaid beneficiaries who are receiving long-term care at home through the state's Home and Community-based Waiver (HCBS) program. MaineNET/Partnershipis a program of the Maine Department of Human Services (DHS), but it is a complex program that involves multiple agencies, both state and private, in its administration.

Within DHS, the Medicaid agency is responsible for the overall administration of the program and the state unit on aging is responsible for policy development and implementation. The enrollment broker under contract with the Medicaid agency conducts enrollment, as it does for Maine PrimeCare. The state unit on aging administers two separate contracts for services related to Medicaid members who are eligible for long-term care services, including those beneficiaries who are eligible for the Partnership component of MaineNET. One contract is responsible for the determination of medical eligibility for long-term care services; the other arranges long-term care services for those found eligible. In the case of Partnership members, this contractor (the Health Care Coordinating Agency [HCCA]) provides a care coordinator who manages the member's home- and community-based long-term care services.

The Medicaid agency contracts with selected physician practices to participate as MaineNET/Partnership PCPs. These practices are selected based on the high number of patients in the Home and Community Based Services (HCBS) waiver program. The practices develop collaborative agreements with HCCA so that a care coordinator can be located at the MaineNET/Partnership practice.

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