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

Table 1: Characteristics of <strong>Managed</strong>
<strong>Care</strong> Programs Under Program and
DemonstratIon Walver
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eligibility to uninsured populations. Table I compares various
characteristics of the two waiver types.
Program waivers Demonstration waivers
Gantl characterIslcs
Allow for warver of certain <strong>Medicaid</strong> Allow for warver of a broader range of
requirements. <strong>Medicaid</strong> requirements _
Waivers renewed for 2- to 5-year periods. Generally not renewed
Generally used to establish primary care More recently used to establish broad
case management programs and home-and changes in <strong>Medicaid</strong> programs.
communitybased service programs.
Characterlstcs pertaining to capitatad managed care
Plans must comply with 25% requirement for Plans may enroll <strong>Medicaid</strong> patients
private enrollment. exclusively.
Full range of mandatory services must be Benefit package may be modified D
offered.
Beneficiaries may be mandated to enroll in Beneficiaries may be locked in for up to 12
plan and can be lacked in for no longer than months.
1 month.t
-The Congress has auth-cizet reimuiai of some demonsiration waivers
'To date. only Oregon has been pernmied te modfy the benefit package for adilonal <strong>Medicaid</strong>
benefcianes Other states have been permetted te ofte a modified package only to those newly
eligible for <strong>Medicaid</strong> covewnge nder, he d nemonsutron
Lack.in is up Lo 6 months f1O capiated plans meeting cenain fedetal reqoirements
At the time of our review, Arizona and Tennessee had demonstration
waivers for their mandatory statewide programs, which served both AFDC
and sst populations. Wisconsin had a program waiver for its mandatory
program, which served only the AFDc populations in 5 of its 72 counties. In
contrast, Pennsylvania had voluntary and mandatory managed care
programs. The voluntary program-the larger program at the time of our
review-served both AFTc: and sst populations In 13 of its 90 countiest This
program required no federal waiver.
To ensure that states comply with statutory and HctA requirements, HCFA
reviews state contracts with managed care plans. It also monitors state
programs through Independent evaluations and periodic reviews of
state-submitted Information on expenditures, medical services, and
rAt dtrenne of our retview 475fict00 beortadru were vomited In P-nayl-natas colantay managed
rnp ogrm. With Lte FebO ay 1997 vup-on oatn meodatory progran. t77f00it b-enficiades vere
partiulpatlng in the voluonty progan of April .f997:2 6tbODO -re projecd to rbe in the uatontary
oatin by tO9B.
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