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

554
beneficiaries that belong to the population served by the program may choose a
health plan or remain in the fee-for-service system. (3) States may implement a
mandatory managed care program under which beneficiaries must select a health
plan or a primary care case management provider. 2 3 As shown by Chart C,24 states
appear to be divided as to which of the options to select-even within the same
state. For example, some states may have a voluntary HMO program and a
mandatory mental health carve-out program. Or, as in Utah, a program may be
voluntary in the rural areas of the state and mandatory in the urban areas.
90% 82%
n-31
23 As previously discussed states may currently establish voluntary programs without need
of a waiver. Also, Title IV-H of the Balanced Budget Act of 1997 will, as of October 1997, enable states to
establish mandatory programs without need of a federal waiver for all <strong>Medicaid</strong> beneficiaries except: dual
eligibles, certain children with special health care needs and (under most circumstances) American
Indians.
24 All charts in this Volume are based on information reported by states and reflect program
status as of June 30, 1996. For more information about an individual state's policies please refer to
Volume 1.
The National Academy for State Health Policy * © 8/97
Chart C
National Academy for State Health Policy
<strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong>
Enrollment Polides
Risk-Based Contracting
w 64% ~~68%
70 -16
leAFDC & E 551 * Elderly
Related no n=19
Ill ~~~~~~~~~~~~47%
0 I .' n-s
c 40%. . .,.,.,.,. - 36%
Fib 305 : . ...... 24% . - .24%
SD a~~~~~n9 e. 21
~20% 1% n
10% . Nsll~i{m
10%
Mandatory Voluntary Voluntary
Alternative to a
mandatory PCCM
Enrollment Structure
Note; The same state may opetate both . mandatory anda voluntary
pmngram.
IV-51