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

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Chapter 2
States Are Moving Toward <strong>Managed</strong> <strong>Care</strong> for
Disabled <strong>Medicaid</strong> Recipients
17 States Have
<strong>Medicaid</strong> Prepaid
<strong>Managed</strong> <strong>Care</strong>
Programs for Disabled
Beneficiaries
Of the 17 states that enrolled some portion of their disabled <strong>Medicaid</strong>
beneficiaries in prepaid managed care plans, enrollment ranged from less
than I percent to all of a state's disabled beneficiaries. Six states have
programs that are mandatory for some or all disabled beneficiaries. Of the
remaining 11 states, 3 operate small-scale, voluntary programs focused
specifically on disabled beneficiaries; 7 allow disabled beneficiaries to
participate voluntarily wherever prepaid plans for the general <strong>Medicaid</strong>
population are available; and I does both.
Thirteen states exclude one or both of their more vulnerable disabled
populations-those in institutional care and those receiving home and
community-based long-term care-from prepaid plan enrollment
However, under certain circumstances, all 17 states include one or more
groups of 'dually eligible' beneficiaries, who are simultaneously eligible
for <strong>Medicaid</strong> and another federally fumded program, such as Medicare.
Coordinating enrollment and other requirements for this dually eligible
group is difficult, according to state officials.
In addition to the 17 states currently enrolling disabled beneficiaries, more
states have plans under way to include them in prepaid managed care.
Specifically, 10 additional states have waiver proposals either approved or
pending; three of these are for pilot programs to gain experience with the
approach.
As of February 1996, 17 states have implemented prepaid managed care
programs for disabled <strong>Medicaid</strong> beneficiaries (see fig. 2.1). Six of 17
mandate prepaid plan enrollment for most or all of their disabled <strong>Medicaid</strong>
beneficiaries. Three states designed small-scale programs specifically for
disabled individuals in which participation is voluntary. In seven states,
disabled beneficiaries may voluntarily enroll wherever prepaid health care
plans are available for the general <strong>Medicaid</strong> population The remaining
state operates both a small-scale program for disabled individuals and
allows beneficiaries to enroll wherever plans are available.
Pan 2
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