Medicaid Managed Care - U.S. Senate Special Committee on Aging

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Table 20-2. Enrollment in <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong>, by Range of Services Covered, 1995
Number Percent Percent of
Range of Services of Enrollees of Beneficiaries <strong>Managed</strong>-<strong>Care</strong> Enrollees
Comprehensive Range of Services 9,640,309 26.6% 83.0%
Behavioral Health Services Only 1,535,780 4.2 13.2
Dental Services Only 443,840 1.2 3.8
Any <strong>Managed</strong> <strong>Care</strong>' 11,619,929 32.0 100.0
SOURCE: Physician Payment Review Commission analysis of Health <strong>Care</strong> Financing Administration data
(HCFA 1996a).
As noted by HCFA, this total includes duplicated counts of eligible beneficiaries enrolled in multiple plans.
The Commission has concluded that it is appropriate to eliminate enrollees in these carve-out plans
from the managed-care counts.-HCFA's solution, as shown in its most recent report, differs in that it
attempts to eliminate only those enrollees who are double-counted (i.e., enrolled in both a carve-out
plan and another managed-care plan) (HCFA 1997). The Commission's solution excludes carve-out
plans that offer substantially less than the full range of <strong>Medicaid</strong> services. Adjustments have also been
made to the 1994 and 1996 totals reported by HCFA using this approach." These adjustments
eliminate the double-counting of beneficiaries, reducing enrollment below 100 percent for five of the
six states identified above (Table 20-3).
There are also errors in the counts of total beneficiaries, the denominators for these calculations, for
several states. HCFA attempted to improve these data in its report on 1996 enrollment, noting that
<strong>Medicaid</strong> population counts were collected by states at the same time the managed-care enrollment
numbers were collected instead of using regular state data reports as in previous years.
An Accurate Count of Enrollment in Any Type of <strong>Managed</strong> <strong>Care</strong>. As previously noted, the
Commission estimates that enrollment in any type of <strong>Medicaid</strong> managed care in 1996 was 12.8 million
beneficiaries, accounting for 38.6 percent of all beneficiaries's This estimate is about 500,000 below
HCFA's published count. Total Commission-estimated managed-care enrollment in 1995 was
9.6 million. This count is about 2 million below the original count HCFA published and about 150,000
t HCFA's treatment of carve-out plans in 1994 was more consistent with the decisions described here. The 1994 data
tables showed various plans with zero enrollees (HCFA 1995). Actual enrollments were shown in footnotes, but were not
included in the totals. A few behavioral health plans in North Carolina and Washington, however, were not identified this
way. Adjustments to the 1994 data are, made to the tables reported later in this chapter. National enrollment is reduced by less
than I percent; enrollment for Washington is reduced from 71 percent to 56 percent; enrollment in North Carolina is reduced
from 20 percent to 9 percent.
'" The National Academy for State Health Policy recently estimated enrollment in any type of managed care as between
12 million and 13 million beneficiaries. This estimate, which was based on decisions about carve-out plans similar to the
Commission's, used data from a 1996 survey of the states (Horvath and Kaye 1997).
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