Alabama Medicaid officials have divided the state into five districts under a new care management plan that’s supposed to streamline the system.

The Legislature earlier this year approved a reorganization of Medicaid into districts around the state.

“The regions are the result of state legislation that passed this year and part of that legislation said that it was time to reform Medicaid by moving towards what we call, ‘affordable care,’ where the private companies or organizations assume the risk for the cost of the health care provided to the recipient — right now the state assumes that risk,” explained Robin Rawls, communications director of the Alabama Medicaid Agency. “What they want is to bring that closer to the community by having Regional Care Organizations.”

State Health Officer Don Williamson, the acting Medicaid director, said it was difficult to decide how to divide the counties, and added that some counties could be shifted before the map is finalized Oct. 1.

“What they tried to do in developing the regions was to honor the traditional doctor, hospital referral relationships, and they also were looking at keeping the health systems together,” Rawls said. “It would make no sense for someone in Dallas County to go to Mobile, they probably are more traditional referred to Tuscaloosa or Montgomery.”

Medicaid officials had been pushing for the district plan. Medicaid patients are encouraged but not required to get their health care from facilities within the district where they live.

Williamson said there’s nothing in the new plan to prevent patients from going to the same doctors they’ve always seen. He said one problem was that everybody wanted to be in the same district with a successful hospital, like UAB.

But he said every region will have ties to UAB.

“None of these districts are perfect,” Williamson said Monday at a briefing for Medicaid providers. “There’s nothing perfect about this. Everybody is not happy with it,” Williamson said.

The official notice of the new Medicaid districts was filed with the state Friday, and will be published next week.

“Then we’ll go into a public comment period for 35 days,” Rawls said. “During that time there will be a public hearing in Montgomery so people can give input on whether the think this is good or not good and whether they think changes need to be made.”

The public hearing will be July 15 in Montgomery. After going through the process Rawls said they should be ready for approval by Oct. 1.

“This is very much the first step,” she said. “They wanted to be very inclusionary and transparent so that they have the benefit of everyone’s input.”

The five regions are divided geographically and all counties are left intact.

Williamson said Chilton County was an example of a difficult county to place. Chilton is located halfway between Montgomery and Birmingham.

“We didn’t split any counties in half,” Williamson said.

Counties included in the five regions are:

Region A: Lauderdale, Limestone, Madison, Jackson, Colbert, Franklin, Laurence, Morgan, Cullman and Marshall.

Region B: DeKalb, Etowah, Cherokee, Calhoun, Cleburne, Clay, Randolph, Tallapoosa, Blount, Walker, Jefferson, St. Clair, Shelby Talladega and Coosa.

Region C: Marion, Winston, Fayette, Lamar, Pickens, Tuscaloosa, Greene, Hale, Bibb, Perry, Sumter, Marengo and Choctaw.

Region D: Chilton, Autauga, Elmore, Chambers, Lee, Macon, Russell, Bullock, Dallas, Lowndes, Montgomery, Macon, Butler, Crenshaw, Pike, Barbour, Coffee, Dale, Geneva. Houston and Henry.

Region E: Washington, Mobile, Baldwin, Monroe, Clarke, Conecuh and Escambia.

Republican State Rep. Greg Wren of Montgomery is chairman of the Legislature’s joint Medicaid committee. He said he likes the look of the districts. “It’s a starting point,” he said.

Rawls commented that just because there are new districts, doesn’t necessarily mean patients’ doctors or health care providers will change, especially not anytime soon.

“If you look at the time line — a lot of these changes won’t go into effect for two or three years,” she said. “There will certainly not be any changes in the immediate future, but there will be some changes as we moves towards those regional groups.”

— The Associated Press contributed to this report.