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

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Table 20-3. Enrollment in <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong>, with Adjustments for Dental and
Behavioral Health Plans, 1995 (percentage)
Percent of <strong>Medicaid</strong> Beneficiaries Percent of <strong>Medicaid</strong> Beneficiaries
State Enrolled Before Adjustment Enrolled After Adjustment
Hawaii 5890/ 2985%
Washington 141 58
Oregon 117 71
Colorado 114 47
Utah 102 55
Massachusetts 101 48
Iowa 86 31
North Carolina 30 18
California 23 21
SOURCE: Physician Payment Review Commission analysis of Health <strong>Care</strong> Financing Administration data
(HCFA 1996a).
* Individuals who enrolled in managed-care plans under Hawaii's Section 1115 waiver are counted in enrollment
totals, but not in the denominator (total recipients).
below its corrected figure. Even with these adjustments, the pattern of enrollment over a six-year
period shows rapid growth, especially in the last two years (Figure 20-6).
<strong>Medicaid</strong> managed-care enrollment is concentrated among low-income adults and children." 5 If viewed
as a proportion of that population, the managed-care share would be about one-half in 1996. Putting
<strong>Medicaid</strong>'s managed-care penetration in context, the share of beneficiaries in managed care is roughly
comparable to the proportion of workers in large firms who are enrolled in HMOs. But this share still
lags behind the percentage of workers in any type of managed care.
Some 20 states, Puerto Rico, and the District of Columbia have more than 50 percent of beneficiaries
in any type of managed-care arrangement (Figure 20-7 and Table 20-4). This figure is more than
double the number of states at this level just one year earlier. These states include some (e.g., Arizona
and Oregon), where high managed-care penetration characterizes the commercial market and others
(e.g., North and South Dakota) that made policy decisions to move aggressively into <strong>Medicaid</strong>
managed care in spite of a low commercial presence. At the other extreme, 8 states (down from 15 in
1995) have fewer than 10 percent of <strong>Medicaid</strong> beneficiaries in such arrangements. They are mostly
small rural states (e.g., Mississippi and Vermont), but also include Texas.
According to data from the National Academy for State Health Policy, just over one million elderly and disabled
beneficiaries are in managed care (Horvath and Kaye 1997).
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