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

Table 1.2: Comparison of <strong>Managed</strong>
Cars Flexibillty Undwr Program and
Demonstration Walvam
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Brpeod
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Program waivers
General characterlstics
Demonstration waivens
Allows for waier of a limited set of <strong>Medicaid</strong> Allows for waiver of nearly asy provision in
requirements <strong>Medicaid</strong> law
Approval is generally based on meeting Approval is based on the discretion of the
certain established conditions Secretary of HHS
Waivers can be renewed for 2- to 5-year Generally not renewableperiods
Generally used to establish primary care More recenty used to establish broad
case management programs and home and changes in <strong>Medicaid</strong> programs
community-based service programs
Chlacterlstics pertaining to prepald managed cars
Prepaid plans must still meet federal Prepaid plans may enroll <strong>Medicaid</strong>
requirement tor 25% or more private pabents exclusively
enrollment
Full range of mandatory services must be Benefit package may ba modiied'
offered
Prepaid plan enrollment 'lock-in limited to Prepaid plan enrollment "lock-in" may be
1 monthr exntended to 12 months
No restrictions on access to family planning Access to family planning providers may
prowiders be restricted
Th.e Congres has auisnrzed renewal of some demnstrason waivers.
'To date. oney Oregon has been permind to modify tie baneits package or traditiorna Medeaid
benelficianes. Other states have been permined to offer a modiried package only to lhane tnsy
eligible far Medicad coverage undar the deonstratpn.
'Lock-in is 6 months tor prepaid plans meesng certain tederal requirerent.
The use of prepaid managed care to provide health care for disabled
beneficiaries is also affected by the statutory requirements of other
programs besides <strong>Medicaid</strong>. Specifically, because many disabled <strong>Medicaid</strong>
beneficiaries are simultaneously eligible for one or more other federal
programs-most notably Medicare"-state prepaid programs must
accommodate requirements of these other programs. The Medicare
statute, in particular, contains a number of provisions that cannot be
waived and that directly affect basic features of <strong>Medicaid</strong> prepaid care.
For example, the Medicare statute requires participating health plans to
have an enrollment mix with no more than 50 percent publicly insured
i"M.&-, xuthrhed by rthe XlV ofstIr Ol Srd Semiry AM, i a federad heudrh irse perflvas
tdis onrrs me -pesple aged 6s or tader, all people who rerelve Sodnia S-riy dsabiaty b-enota tar
24 encth, s- , and ness peeple who softer ftem kidey raune. Medi-are r aors of tswo pa
pass A, ebbSh rnrem bipadest hbspisaL, skoted nasing rar, h.ome he.It, and hnapi- e#rvices, aid
pan 10 whkihn osee phyisin r a wide r-mte o other wntAes, isicaddig physical trempy
reg is
GeC8ES 4-1a-ni Medbeid <strong>Care</strong> C ra the OCh leiesd