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

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Will the Program Be Voluntary or Mandatory?
An important and emotional issue states must face is whether to make participation
of special populations voluntary or mandatory. States are divided on this question.
About half of those enrolling special populations in risk-based programs do so on a
mandatory basis. The following table provides examples of voluntary and
mandatory programs serving special populations.
<strong>Medicaid</strong> Choice in Selected State Programs
(Program Status as of May 1997)
Program Eligible Populations <strong>Medicaid</strong> Choice
Arizona All Mandatory for all
California County Organized All Mandatory for all
Health Systems
(5 counties)
California Geographic All, though emphasis is on Mandatory for TANF;
<strong>Managed</strong> <strong>Care</strong> (2 counties) TANF Voluntary for all others
Minnesota Prepaid Medical Elderly and TANF Mandatory
Assistance Plan (PMAP)
Minnesota Senior Health Dually eligible elderly Voluntary
Options (MSHO)
Nebraska HMO Program All Mandatory for all
New Jersey HMO Program All Mandatory for TANF in most
counties;
Voluntary for all others
Oregon Health Plan All Mandatory for all
Tenn<strong>Care</strong> All Mandatory for all
Wisconsin I<strong>Care</strong> People with disabilities Voluntary
Wisconsin Partnership Elderly and people with Voluntary
disabilities who qualify for
long term care
The issue of mandatory or voluntary enrollment is more complicated for older
people and people with disabilities than it is for TANF beneficiaries, for a number of
reasons.
* Untested Nature. As the introduction to this chapter notes, managed
care is still a relatively new concept for special populations, and some
early research has given us reason to proceed cautiously. Some believe
The National Academy for State Health Policy+ ©3 8/97 IV-5