Table 5.B Major Program Features and Requirements of Managed Care Authorities
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Authorities for Managed Care |
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| Feature | Section 1115 | Section 1915(a) | Section 1915(b) | Section 1932(a) |
| Defined Network of Providers | Yes | Yes | Yes | Yes |
| Limited Number of Qualified Contractors | Yes | No | Yes (at least 2 options usually required) |
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| Capitated Payments | Yes | Yes | Yes | Yes |
| Mandatory Enrollment | Yes | No | Yes | Yes |
| Limited Geographic Area | Yes | Yes | Yes | Yes |
| Targeted Population | Yes | Yes | Yes | Yes |
| Expand Eligibility | Yes | No | No | No |
| Additional Benefits | Yes | Yes | Yes | Yes |
| Budget Test | Budget neutral | None | Cost Effective | None |
| Approval Mechanism | Descretion of HHS and subject to negotiations | Managed care contract approved by CMS | Waiver application approved by CMS; managed care contract approved by CMS | State plan amendment and managed care contract approved by CMS |
(Click here for a pdf version of Table 5.B)
