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

States' Analyses of
Disenroliment Data Could
Help Identify Problem
Areas
&-70335
405
mental health care, and works with the plan and the state to correct the
problem. This can obviate the need for beneficiaries to register grievances.
Beneficiaries who disenroll from a managed care plan may do so because
of dissatisfaction with the care they receive through the plan. Therefore.
collecting a-d analyzing data on disenrofinments can provide important
insights into plan performance. In a voluntary program, such as the one we
visited in Pennsylvania. beneficiaries can switch plans or return to
fee-for-service care. In mandatory programs-such as those in Arizona,
Tennessee. and Wisconsin-beneficiaries can switch plans during open
seasons, which occur every 6 or 12 months. 2 The states we visited,
however, generally do not conduct routine disenrollment studies.
According to officials in these states, they would conduct a disenrollment
study if a significant number of disenrollments were detected.n They
believe that disenrollments-especially in low numbers-could signify a
number of occurrences other than beneficlary dissatisfaction or problems
with the plan. For example, in 1992, Arizona conducted a disenrollment
study and found that most of the beneficiaries who changed plans during
open enrollment-which was less than 5 percent of all beneficiaries in
managed care-did so for reasons other than plan dissatisfaction.
Specifically, the state found that some beneficiaries disenrolled because
they wanted to continue to see a provider who was no longer in their
plan's network. Others switched to have all family members in one plan.
and still others wanted to enroll in a plan where provider location was
more convenient. Unless It sees a substantial change in enrollment rates
during an annual open season, Arizona has no plans to conduct another
study.
More analyses of these disenroilment data-even If the rate at which
beneficiaries leave or switch plans is low-could reveal significant
problems. Disenroilments concentrated In an area or among people having
similar needs, such as people with mm, may indicate a potential problem
in a plan. Also, any plan having higher disenrollment rates than other plans
may merit scrutiny to determine the reason.
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