Member Medicaid Loyalty Re-Assignment Initiative

Date: 09/16/25

What is this initiative?

MHS will now be reviewing Medicaid members’ PMP assignments to proactively assign members to providers based on loyalty. Member PMP assignments will be reviewed quarterly to align with where members are seeking care, provider availability, and appropriate proximity criteria more closely.

Who will be doing this and how frequently?

The MHS Provider Data Quality (PDQ) team will receive a report from Centene Corporation outlining potential members that qualify for reassignment. The report will be reviewed quarterly based on claims data.

Why is this being done?

To align members with a PMP that they are already seeing and/or an appropriate PMP in their area to establish a medical home.

Which members are being moved? (Medicaid).

• Members who have not visited their assigned PMP.
• Members with no claims on file.
• Members who have sought care from a different PMP, as indicated by three or more visits to another provider

What are the benefits?

Reassigning members to PMPs based on loyalty helps create a more patient-centered healthcare experience. This approach can build trust, improve health outcomes, and enhance the overall experience for both patients and providers.

How will members be notified?

Members will receive reassignment notices by mail.

Can members change their assigned PMP?

Yes, members can change their assigned PMP by following the normal protocol for selecting or changing a provider.

Will claims be impacted?

No, MHS Medicaid claims will not be affected by the assigned PMP. MHS operates an open network for Medicaid products, with the exception of Right Choice Program members.