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

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member with complex needs might include:
* poor self-reported health status;
* use of long term care services;
* chronic health conditions;
* functional impairment in activities of daily living;
* cognitive or emotional impairments;
* recent hospitalizations or admissions to a nursing facility or assisted
living facility;
* use of prescription drugs; and
* recent significant life event (death, relocation).
State Strategies for Transferring Information About Health Services Upon
Enrollment
During the open enrollment period in Arizona, transition coordinators at each plan
monitor rosters of people entering and leaving the plan. Information is shared
among plans that identifies members who are hospitalized, those who have recent
or scheduled surgeries, chemotherapies underway, durable medical equipment that
has been ordered and members who are receiving care management or who are
noncompliant.
Choice counselors in Oregon complete a Continuity of <strong>Care</strong> Referral (CCR) form
when members have special or complex medical or social needs requiring the
immediate attention of the health plan. The CCR is sent to the <strong>Managed</strong> <strong>Care</strong>
Organization (MCO) and alerts ENCCs to the services being received by members or
needs which must be addressed. The form is reviewed by the ENCC for potential
medical needs and sent to the primary care.physician.
Who Enrolls Beneficiaries
In general, enrollment can be performed by several different groups: state income
maintenance workers who are responsible for determining welfare and <strong>Medicaid</strong>
eligibility (Missouri), <strong>Medicaid</strong> employees (Utah), interagency agreements with
another state agency (in Oregon, the Senior and Disabled Services Division enrolls
aged and disabled beneficiaries through its field offices and Area Agencies on
Aging), county employees (Minnesota) or staff of a private contractor (New Jersey,
New York City, Ohio). If state or county employees are used as brokers, states
recommended that training, supervision and management be conducted by the
<strong>Medicaid</strong> agency rather than by cash assistance eligibility workers. Eligibility
workers have had competing responsibilities which makes it more difficult for
those workers to master the complexities of <strong>Medicaid</strong> and the choices of managed
care plans.
An additional complication states face in reaching older persons and persons with
disabilities is that most members of these groups apply for assistance with the
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