The social health maintenance organization (SHMO) is an innovative prepaid program that integrates medical, social and long term care. The SHMO merges the HMO concepts of
capitation financing and provider risk sharing with the case management and support services
concepts of providers of long term care. The demonstration sites are financed through capitation
payments from Medicare and Medicaid, and member premiums and copayments.
In March of 1984, four plans initiated service delivery:
Elderplan, Inc., Brooklyn, NY; Group Health, Inc. and Ebenezer Society, Minneapolis, MN;
Kaiser-Permanente Center for Health Research, Portland, OR; and Senior Care Action Network
(SCAN), Long Beach, CA.
Section 4207 of Public Law 101-508 (Omnibus Budget Reconciliation Act of 1990) authorized
the approval of up to four additional SHMO targeting and financing methodologies and benefit
design.
Currently, only three of the original four SHMOs are operational. Three new contracts were
signed in August 1995 under the name EverCare in the states of Georgia, Maryland and
Massachusetts.
Attn: Margie Sharif
Office of Managed Care
Health Care Financing Administration
7500 Security Boulevard, Rm S3-02-1
Baltimore, Maryland 21244-1850
Comments/Corrections:
Plan Name:
Medicare Name:
Address:
Telephone:
Contract Number:
Counties:
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