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Health Plans
Medicaid services can be delivered through Managed Care Organization (MCO) or Fee-For-Services (FFS). Under MCO, the State pays a capitation fee to a MCO health plans for each beneficiary enrolls in the health plan. In turn, the health plan pays providers for all of the eligible Medicaid services a beneficiary may require that are included in the health plans’ contract with the State. Under the FFS model, the State pays providers directly for each covered services received by a Medicaid beneficiary.
In Hawaii, most of the Medicaid services are delivered through MCO. There are five (5) MCO health plans: AlohaCare, HMSA, Kaiser Permanente, ‘Ohana Health Plan, and UnitedHealthcare Community Plan that provides medical and Long Term Services and Support (LTSS) benefits.
