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

Assignment
Active Management of a
Disabled Beneficiary's
<strong>Care</strong>
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States with mandatory enrollment programs for broader segments of the
population, such as low-income families, often develop systems that
automatically assign beneficiaries to a health plan if they do not select one
for themselves. This assignment is usually based on geographic proximity.
The three states we visited each took a different approach to assignung
disabled enrollees. Oregon decided against assigning disabled
beneficiaries, relying instead on each social services case worker selecting
a plan in consultation with beneficiaries or their families. In Arizona,
severely disabled recipients who receive both acute and long-term care do
not have a choice among providers because only one contract is awarded
in each county. Less severely disabled beneficiaries are assigned to plans,
when they do not choose from among those available, based on results of
the state's competitive bidding process, with the lowest-cost plans
receiving proportionately more assignments. In Massachusetts, nurse
review panels analyze beneficiaries' claims histories to determine the
health needs of those who do not choose health plans so that assigned
plans are more likely to have the capacity to meet their needs. Enrollment
staff try to contact beneficiaries after assignment to ask about their
satisfaction and help them select another provider if the relationship is
unsatisfactory.
Most of the nine states furthest along in tailoring their programs have also
taken steps to ensure that disabled beneficiaries receive coordination of
services through a process called 'case management" The four small-scale
programs aimed exclusively at disabled individuals have included specific
requirements for case management services. Examples of such
requirements are (1) coordination of a range of needed services, such as
transportation, community support services, and primary and specialty
care; (2) development of individual plans of care that ensure continuity
and coordination of care among various clinical and nonclinical settings;
and (3) stipulation that case managers be social workers or nurses with
specific training in working with disabled people. In Wisconsin's program,
if case managers do not perform a needs assessment within 55 days of
enrollment, the beneficiary is automatically disenrolled from the program.
Among the mandatory programs, Arizona and Delaware have also taken
steps regarding case management Arizona's program for the more
severely disabled requires contractors to provide case management
services, although no such requirement exists for health plans serving the
less disabled. Arizona requires case managers to perform a needs
assessment within 15 days and complete a plan of care within 30. Failure
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