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

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services when needed. This is true regardless of the decisions states have made
regarding the voluntary or mandatory nature of enrollment into the program.
The first step toward <strong>Medicaid</strong> managed care is eligibility for <strong>Medicaid</strong> but
enrollment in a health plan is generally agreed to be a discrete function in which
beneficiaries learn about managed care and how to use it and select a plan that best
suits their individual needs. These processes are particularly important-and
particularly difficult for older persons and persons with disabilities.
Some states have allowed health plans to conduct their own marketing and
enrollment. However, abuses and concerns that beneficiaries were not aware of the
full range of available plan options led many of those states to use state employees
or independent enrollment brokers to conduct these functions.25 Those states that
enroll special populations have been especially concerned that members of these
populations receive complete and understandable information during the
enrollment process. This is supported by the fact that 62% of the 16 states that enroll
SSI beneficiaries use an enrollment broker while 47% of the 38 states that enroll
AFDC beneficiaries use a broker.
Arizona does not allow plans to conduct any marketing or provide incentives for
people to enroll. Plans are allowed to conduct outreach activities or market
incentives that change care seeking behavior.
Addressing Continuity
When vulnerable populations enroll in a managed care program, a process that
identifies services currently being provided and/or assesses risk helps promote
continuity of care. The identification of members with ongoing care needs can be
accomplished by counselors or brokers during the enrollment process or by plans.
Tools to identify members who are at risk that are used by the health plans may be
designed by the state agency and included in the contract or designed by the plan,
subject to state agency approval. The Framework for the Development of <strong>Managed</strong>
<strong>Care</strong> Contacting Specifications for Dually Eligible Adults26 recommends
development of a form and a process to identify complex needs. State contracts
might require that beneficiaries who are at risk be seen by a primary care physician
within a specified period after enrollment e.g., five days. Possible indicators of a
25 Readers should note that probably due to similar concerns on the part of the federal
government, Title IV-H, §4707 of the Balanced Budget Act of 1997 prohibits both direct and indirect 'cold
call' marketing by managed care entities. This prohibition applies to contracts entered into or renewed
after October 1, 1997.
26 This document was produced by The National Academy for State Health Policy in
conjunction with HCFA 's <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong> Technical Advisory Group.
The National Academy for State Health Policy e 8/97 IV-53