ME LD1878

Department of Health and Human Services must contract with 3 managed care organizations (MCOs) to deliver MaineCare services statewide, covering physical health, behavioral health, pharmacy, and dental services through monthly per-enrollee capitation payments rather than fee-for-service

TANF recipients, children's health insurance program participants, Medicaid expansion enrollees under 65 with income up to 138% of federal poverty level, and dual Medicare-Medicaid eligible individuals must enroll in the managed care program

MCOs must be enrolled by February 1, 2029 for most populations, with dual-eligible individuals enrolled by July 1, 2030; contracts are 5 years with possible 3-year extensions

Department must submit implementation report to Legislature by December 3, 2025 and file all necessary federal waivers and Medicaid plan amendments by April 1, 2026

MCO selection criteria include national accreditation, quality measures, fraud prevention policies, provider network accessibility, and capability to address social determinants of health such as food insecurity and housing instability