Prepaid Health Plan

Acronym: PHP

PHPs provide either comprehensive or non-comprehensive benefits to Medicaid beneficiaries through a risk-based contract with a state Medicaid agency.34 Medicaid managed care organizations are comprehensive PHPs, while prepaid inpatient health plans and prepaid ambulatory health plans are non-comprehensive PHPs. The services most commonly provided by non- comprehensive PHPs are inpatient and outpatient behavioral health care, substance abuse treatment, dental care, nonemergency transportation, and prescription drugs. States may provide some these services through non-comprehensive PHPs, while most other services are provided through MCOs or primary care case management programs, or on a fee-for-service basis. Relevant Federal Legislation or Regulation: 42 C.F.R. Part 438. CMS regulations on Medicaid managed care.