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

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and some beneficiaries were enrolled in a plan other than the one they
chose or were assigned to a plan that was not an option for them. State
assignments of beneficiaries who did not choose a plan were not always
timely, which meant that plans lost capitation revenue. The situation
worsened when Benova lost its bid for the enrollment broker contract and
began losing significant numbers of staff.
HCFA and managed care plans agree that Medi-Cal's enrollment process has
begun to function more smoothly. Maximus has more resources to process
and track enrollments, and the state has begun to implement long-needed
fixes, such as improved monitoring of the enrollment broker. However,
problems have continued to occur. For example, in April 1997, thousands
of beneficiaries in Riverside County were sent letters with dates that
implied beneficiaries had already been assigned to a plan. The state
remaded the letters with corrected dates.
Because of continuing concerns, IICF'A slowed enrollment in several
counties earlier this year. According to itcrA, it would not approve the
February 1997 full implementation in Santa Clara and San Joaquin
counties because it had found, during its preimplementation reviews,
deficiencies in the education process that 'grossly violated" the ICO
process and the conditions of California's waiver. For example, enrollment
packets sent to beneficiaries were incomplete, and the state could not
verify whether a subsequent mailing was sent
At the end of March 1997, IICFA decided to slow enrollment in Los Angeles
County, prior to full implementation. HCFA took this action, in part,
because the enrollment broker had not yet demonstrated an ability to send
timely or accurate mailings to beneficiaries or to properly train tCXi
counselors to make accurate and informative presentations to
beneficiaries. Adequately educating beneficiaries in Los Angeles about
their plan options is especially difficult, since there are multiple plans
from which beneficiaries can choose. Furthermore, with over I million
beneficiaries who will be mandatorily enrolled, and another 400,000
voluntarily eligible, the consequences of enrollment errors in Los Angeles
County could be significant
Potential Impact of Based on anecdotal evidence from Hct'A, advocates, and managed care
Education and Enrollment plans, the problems with the education and enrollment processes
Problems on Beneficiaries throughout the implementation of the two-plan model have affected
and Plans beneficiaries and plans alike. Officials from one plan said that
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