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

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* the state should develop corrective action strategies to improve the
health plan's performance-perhaps through a corrective action plan
or the imposition of contract penalties.
This chapter is based primarily on information gathered during site visits and
interviews with state officials, managed care organizations and advocates in
Arizona, California, New Jersey, Oregon and Tennessee. All of these states enroll
some members of special populations into their <strong>Medicaid</strong> managed care programs.
Site Visit State Background
State Year Risk-Based SSI Enrollment as of Aged Enrollment as of
Iogram. Begar. jun^e 30, .996 Junre 30 ,1996
Arizona 1982 Acute care 57A412 33,690
1989 Long term care
(Both programs are
mandatory.)
California 1983 Mandatory 48,832 13,657
1972 Voluntary l
New Jersey 1985 Mandatory 5,387
198145 Voluntary l
Oregon 1995 11,799 (MH only) 7.871 (MH only)
31,311 (dental only) 20,909 (dental only)
31,671 (comprehensive) 16,759 (comprehensive)
Tennessee 1994 217.666 151.370
Accessl
Most states use multiple methods for ensuring access for <strong>Medicaid</strong> managed care
enrollees (see Volume II for details about many of these methods). But, there are
access issues that are of particular concern to members of special populations.
People with chronic conditions worry that they will be unable to access physicians
and specialists familiar with their health and functional needs or specialists with
whom they have a long standing relationship. Members of these groups also want
services that maintain their functional capacity in their own homes or in residential
I Readers should be aware that Title IV-H, § 4705 of the Balanced Budget Act of 1997
requires states to have access standards (and monitor plan compliance with these standards) 'so that
covered services are available within reasonable timeframes and in a manner that ensures continuity of
care and adequate primary care and specialized services capacity.' Title IV-H also specifies that these
standards 'shall be consistent with standards that the Secretary first establishes within 1 year after the
date of the enactment of this section." These new requirements will become effective on January 1,
1999.
The National Academy for State Health Policy * © 8/97 IV-22