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

511
contrast, a state that excludes people with developmental disabilities from its
managed care initiative can pay less attention to network adequacy in mental
retardation. The following table identifies various ways to refine target groups.
Target Group Considerations
Criterion Options
1. Eligibility Status A. All Groups (SSL Medically Needy, TANF and Related,
including Dually Eligible for Medicare)
B. SSI Only
C. 551 and Medically Needy Only
D. Any of the Above, but Exclude Dually Eligible
2. Age A. 65 orOlder
B. Adults with Disabilities Under 65
C. Children with Disabilities
D. Combination of Above
3. Long Term Services Need A. Nursing Facility (NF) Certified Only
B. NF Certified and Others not Certified
C. NF Certified Excluded
4. Type of disability A. Physical
B. Developmental
C. Mental Illness
D. Combination of Above
E. Subcategory of Above
Eligibility Status
Perhaps the broadest way to think about a target group is to separate special
populations into eligibility categories. The options next to Criterion 1 in the table
have been oversimplified, but at a gross level, major eligibility categories include
TANF and related, SSI and related (which includes both older people and people
with disabilities) and Medically Needy. Dual eligibility for Medicare must also be
considered, given that 90 to 98% of older <strong>Medicaid</strong> beneficiaries also have Medicare
coverage, as do 30 to 50% of adults with disabilities under age 65. (Percentages of
dual eligibility have been found to vary considerably from state to state.)
Several states (including Arizona, parts of California, Oregon and Tennessee) have
included all eligibility groups in a single program. Perhaps the most important
lesson those states cite is that special populations take longer to enroll, and that
other states considering this approach should enroll eligibility groups in stages over
a two to three year period.
States including Medically Needy beneficiaries will face particular concerns around
rates, given that this group pays a portion of their own cost of care. A major
question becomes whether to pay the contractor a uniform rate and have
beneficiaries make their spenddown payments to the state, or whether to have the
The National Academy for State Health Poicy* @ 8/97 IV-8