(P123) OPPORTUNITIES FOR MEDICAID MANAGED CARE PLANS TO ADDRESS BACTERIAL STIS

Background:
Medicaid is a dominant payer for STI services for lower-income Americans, and most enrollees are in managed care organizations (MCOs).  We previously investigated how Medicaid can better address the persistent epidemics of bacterial STIs, with specific attention to congenital syphilis; the role of community health workers; and social determinants of health.  The current project explores specific policy and program levers for Medicaid MCOs, specifically, to better address STIs.

Methods:
We reviewed all state contracts for Medicaid MCOs and provider manuals for the highest-enrollment plans. We conducted key informant interviews with national experts on Medicaid, STIs, and managed care; and with a geographically representative set of Medicaid MCOs.

Results:
STIs are not currently a top priority for most Medicaid MCOs, but they have many levers available to better address STIs. Medicaid MCOs have considerable flexibility to adapt their existing payment and service delivery approaches to better address STIs.  The majority of states require MCOs to have performance improvement projects, and plans are aggressively working to promote best practices, particularly in the prenatal and postpartum periods.  MCOs can offer incentives to providers to deliver STI care, and may also choose to provide patient incentives for receiving preventive, prenatal, or postpartum care, along with supports to address barriers to care.  MCOs may also be able to use their more flexible funding mechanisms to support nontraditional STI-related needs such as OTC condoms or STI tests, or to support non-clinical community-based organizations.  In addition, the recent expansion of the postpartum eligibility period to 12 months in nearly all states gives MCOs, along with broader state Medicaid programs, an opportunity to address STIs, sexual health, and other health needs in a more sustained way.

Conclusion:
Public health stakeholders and STI service providers can approach Medicaid MCOs in their state to identify opportunities for collaboration, service support, and performance improvement.