Complete Managed Care Organization List and Guide

Managed care organizations (MCOs) are a crucial part of the US healthcare system, playing a significant role in shaping the way healthcare is delivered and financed. They're responsible for coordinating and managing the care of millions of Americans.

There are several types of MCOs, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans. These different types of MCOs offer varying levels of provider choice and out-of-pocket costs.

Some MCOs have a network of primary care physicians and specialists who work together to provide comprehensive care. For example, Kaiser Permanente's integrated care model brings together doctors, hospitals, and other healthcare professionals to deliver care.

MCOs often have a strong focus on preventive care, providing regular check-ups and screenings to help prevent illnesses and manage chronic conditions. This can be especially beneficial for individuals with chronic conditions, such as diabetes or heart disease.

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Managed care organizations play a crucial role in delivering services to enrolled members in the Georgia Families managed care program.

The State of Georgia contracts with private Care Management Organizations to deliver services to enrolled members, with the Department of Community Health responsible for administering the Medicaid program and CHIP.

The Department of Community Health employs a care management approach to organize its system of care and enhance access.

There are five Care Management Organizations that contracted with the Department of Community Health during SFY 2022–2023: Amerigroup, Amerigroup 360, CareSource, Peach State, and WellCare.

Amerigroup is a subsidiary of Anthem, Inc. and has been operating in Georgia since 2006.

Amerigroup 360 is also a subsidiary of Anthem, Inc. and started operating in Georgia in 2014.

CareSource was founded in 1989 and is a nonprofit model of managed care.

Peach State Health Plan is a subsidiary of the Centene Corporation and has been operating in Georgia since 2006.

WellCare of Georgia, Inc. is a subsidiary of WellCare Health Plans, Inc. and started operating in Georgia in 2006.

The Care Management Organizations have undergone accreditation by the National Committee for Quality Assurance (NCQA), with the following accreditation statuses: Amerigroup (Accredited through 09/22/2025 and Health Equity Accredited through 11/15/2025), Amerigroup 360 (Accredited through 09/22/2025 and Health Equity Accredited through 11/15/2025), CareSource (Accredited through 12/21/2024), Peach State (Accredited through 06/05/2026), and WellCare (Accredited through 09/18/2023).

Here is a list of the Care Management Organizations with their accreditation statuses:

Managed care organizations are structured differently across various regions in Pennsylvania. In the Lehigh/Capital Counties, there are five health plans: AmeriHealth Caritas Pennsylvania, Geisinger Health Plan, Health Partners Plans, Highmark Wholecare, and UPMC for You, Inc.

The phone numbers for member services and special needs units vary among the health plans in this region. AmeriHealth Caritas Pennsylvania can be reached at 888-991-7200 for member services, while Geisinger Health Plan's member services phone number is 855-227-1302.

In the Southeast Counties, the health plans and phone numbers differ from those in Lehigh/Capital Counties. The Southeast Counties in the HealthChoices Program include Bucks, Chester, Delaware, Montgomery, and Philadelphia.

The health plans in this region are Geisinger Health Plan, Health Partners Plans, Keystone First, UnitedHealthcare Community Plan, and UPMC for You, Inc. Each health plan has its own phone numbers for member services and special needs units.

Here's a breakdown of the health plans and phone numbers for the Southeast Counties:

Accreditation is a crucial factor to consider when evaluating managed care organizations. The National Committee for Quality Assurance (NCQA) awards accreditation status to organizations that meet their rigorous standards for consumer protection and quality improvement.

Several Care Management Organizations in Georgia have received NCQA accreditation status. Amerigroup, for example, has been accredited through 09/22/2025, while also holding a Health Equity Accreditation through 11/15/2025.

CareSource, on the other hand, has an accreditation status through 12/21/2024. Peach State Health Plan has been accredited through 06/05/2026.

WellCare, a subsidiary of Centene Corporation, has two accreditation statuses: one through 09/18/2023, and another that is still valid.

Here is a list of the Care Management Organizations and their accreditation statuses:

Amerigroup is a subsidiary of Anthem, Inc. and offers Medicaid and Medicare commercial services, among others.

Amerigroup 360°, on the other hand, is also a subsidiary of Amerigroup Corporation, but it does not have a separate accreditation status from Amerigroup.

CareSource was founded in 1989 and offers Medicaid, Marketplace, and Medicare Advantage programs as a nonprofit model of managed care.

CareSource's accreditation status is Accredited through 12/21/2024.

Peach State Health Plan is a subsidiary of the Centene Corporation and offers Medicaid, Medicare, and Exchange plans in some states.

Peach State's accreditation status is Accredited through 06/05/2026.

WellCare of Georgia, Inc. is a subsidiary of WellCare Health Plans, Inc. and offers Medicaid, Medicare Advantage, and other services.

WellCare's accreditation status is Accredited through 09/18/2023.

If you're looking for a specific organization to help with your healthcare needs, there are several types to consider.

Child Health Plus, or CHPlus, is a type of plan that focuses on children's health.

The Commercial plan, or Comm, is designed for individuals and families who purchase health insurance on their own or through their employer.

Health and Recovery Plans, or HARP, are specialized plans that provide intensive treatment and support for individuals with complex mental health needs.

Medicaid, or MCAID, is a government-funded program that provides health coverage to low-income individuals and families.

Here's a quick reference guide to help you navigate the different types of plans:

Amerigroup offers a range of resources to its members, including a drug formulary, which is a list of approved medications, and a provider directory, which helps members find in-network healthcare providers.

Their member handbooks are also a valuable resource, covering topics such as benefits, eligibility, and how to access care. The Georgia Families Member Handbook, Georgia Families 360° Member Handbook, PeachCare for Kids Member Handbook, and Planning for Healthy Babies Member Handbook are all available.

Amerigroup's resources can be a great starting point for navigating the healthcare system and understanding what's covered under their plans.

CareSource is a managed care organization that offers a range of resources to its members.

One of the resources available is the Drug Formulary, which is a list of covered medications that members can use to manage their health.

CareSource also provides a Georgia Families Member Handbook, which contains important information about the plan and its benefits.

Additionally, the Planning for Healthy Babies Member Handbook is available to members who are expecting a baby or have young children.

CareSource members can also find a list of in-network providers in their area by using the Provider Directory.