Primary Care Case Management (PCCM) is a Medicaid health care delivery system that lies between traditional fee-for-service and risk-based HMO managed care. Under PCCM, consumers are linked to a Primary Care Provider (PCP) who coordinates their health care. Providers are paid on a fee-for-service basis, and receive additional dollars to compensate for care management responsibilities. Providers are not at financial risk for the services they provide or authorize. Thirty states use PCCM in their Medicaid programs, either alone or parallel to HMOs.
Since 1995, Connecticut has provided Medicaid/HUSKY health coverage to over 300,000 residents, mainly children and families, through a fully-capitated HMO managed care system. The federal government reimburses Connecticut for about half the cost of the program. Connecticut does not have a PCCM program.
Connecticut’s HUSKY program is struggling – families have great difficulty getting care and the current HMOs in the program are resisting Freedom of Information court orders to explain how they spend over $700 million in state funds each year and how much care HUSKY members receive. In a recent secret shopper survey, trained surveyors posing as HUSKY clients were only able to secure an appointment for care with one in five listed providers. Only half of HUSKY children get a check up each year and very few of Connecticut physicians accept Medicaid or HUSKY. State policymakers are searching for an alternative, to give families and the state another option and they are looking at PCCM.
For more information on what PCCM is and how it works:
Primary Care Case Management: An Alternative for Medicaid in Connecticut – A survey across states with PCCM programs to answer questions posed by CT policymakers, providers, researchers, advocates and consumers. Conducted by four Yale School of Nursing graduate students, December 2000