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

Addressing Concerns
Through Enrollment and
Related Programs
Client Enrollment
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Among states that offer prepaid managed care to disabled beneficiaries,
only those with mandatory enrollment have significant percentages of
their populations participating. The low participation in other states may
reflect, among other things, concerns of disabled individuals about relying
on a prepaid care system. When prepaid plan enrollment can be required
of beneficiaries, state decisions about enroUment-auch as who win enroll
recipients, what sorts of education programs wilt be involved, and how
beneficiaries will be assigned to a health plan if they do not choose
one-become more prominent among the concerns of disabled
beneficiaries, according to advocates in the states we visited. States we
contacted reported using various approaches to enrollment, assignments,
and exceptions to remain in the fee-for-service system.
Some states view the process of enrolling beneficiaries in <strong>Medicaid</strong>
managed care programs as an important opportunity to educate and
counsel beneficiaries-sometimes individually-about both managed care
and the need to choose from among participating health plans. The three
states we visited generally applied many of the steps they use for other
beneficiaries when they enrolled disabled beneficiaries.n' Other steps
included the following
tOregon sends disabled beneficiaries (I) a booklet that the state
developmental disabilities council created to educate beneficiaries about
managed care and (2) a chart comparing the features of available health
plans. The booklet contains worksheets to help beneficiaries identify their
health care needs and detail their existing provider network so that they
can better select an appropriate health plan.
In Massachusetts advocates were concerned that managed care might
disrupt the existing provider networks from which disabled beneficiaries
receive care." State staff and advocates adopted a health needs
assessment that enrollment staff use to help beneficiaries select existing
or other appropriate providers. The state also adopted a more flexible
approach allowing specialists to serve as primary care providers for their
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