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

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needs. For example, women who are HIV positive should have PAP smears every
six months. Unless a primary care provider is familiar with the needs of this group
of women, this test may not be performed that often. Primary care providers with
geriatric training may recognize the signs of some conditions, such as Alzheimer's
disease, earlier than other providers.
States have responded to this need for primary care providers with knowledge and
experience serving members of special populations in several ways. First some
states allow plans to designate specialists as primary care providers to serve
members of special populations. For example, the plans participating in
Massachusetts' program for dual eligibles 4 will be able to use physicians with board
certification in geriatric medicine or gerontology, as well as those with certifications
in family practice or internal medicine. New York uses a similar approach and
specifies that specialists may serve as primary care physicians for enrollees with
complex needs.
Other states focus on ensuring that the primary care provider, regardless of specialty,
has knowledge and experience treating persons that belong to special groups. For
example, Pennsylvania requires plans to "...consider the special medical needs of
each member when assigning a PCP to ensure that the member's PCP is trained and
experienced in treating the members special needs." Similarly, the contra cor for
Wisconsin's Independent <strong>Care</strong> Program must "subcontract with providers with
knowledge and experience relevant to the needs of the disabled population."
Wisconsin <strong>Medicaid</strong> staff then prepared a report identifying providers that served
many persons with disabilities in the plan's service area and reviewed a list of
subcontracted providers submitted by the plan against that list.
In Oregon, members of health plans who are <strong>Medicaid</strong> beneficiaries must have the
same access to providers as other plan members. In addition to meeting the
community standard, contractors must also be able to meet the needs of the enrolled
population. Under the administrative rules, contractors provide evidence that
vulnerable populations have access to providers with expertise to treat the full
range of medical conditions experienced.
Oregon's rules go beyond a generic access requirement. Plans are also required to
develop plans anc procedures for identifying members in need of interpreter
services, members needing accommodations under the Americans with Disabilities
Act (ADA), and to monitor, improve and manage risk in times of reduced provider
capacity.
4 Dual Eligibles' are those beneficiaries who have both <strong>Medicaid</strong> and Medicare coverage.
Most elderly <strong>Medicaid</strong> beneficiaries are dual eligibles as are many <strong>Medicaid</strong> beneficiaries with disabilities.
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