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

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Materials explaining the Oregon Health Plan (OHP)27 were printed in 17 languages.
Pamphlets listed primary care physicians with their plan affiliations and an
indication of which physicians had sign language capacity, the bus routes for access
to the physician and notations indicating whether the physician was open to
existing patients, accepted or limited new members, or was fully open. Individual
rather than group sessions were held to provide counseling and to enroll recipients
in a plan. Area Agency of Aging (AAA) staff often mailed materials and made
follow up calls to make sure the person received the materials and to respond to any
questions. Plans were not allowed to conduct their own marketing nor were they
allowed to work individually with AAAs or SDSD offices.
OMAP and SDSD anticipated that the counseling and enrollment process would
take 1 1/2 hours per person. However, the state used more in-person interviews
and fewer group sessions with elderly beneficiaries and people with disabilities and
the actual enrollment time averaged 2 1/4 hours per member. The amount of time
required varies with the number of plans available in each area.
All staff who have contact with beneficiaries-information and referral staff, case
managers and staff involved in the intake process-receive information about the
Oregon Health Plan. Oregon developed different procedures based on the status of
the beneficiary. SSI beneficiaries who do not receive <strong>Medicaid</strong> long term care
services contact the local Disability Services Office or Area Agency on Aging, receive
information and counseling about OHP and their MCO options, and complete an
enrollment form. The intake process is used to perform these functions for new
applicants. Existing <strong>Medicaid</strong> Home and Community Based Services (HCBS) clients,
or HCBS clients converting to <strong>Medicaid</strong> are enrolled by their case managers.
Counseling and enrollment tasks add to the workload of case managers and the
increased workload needs to be taken into consideration in projecting needed
staffing capacity.
<strong>Medicaid</strong> beneficiaries are encouraged to select a plan on their own after receiving
information on the plans, being invited to attend an orientation session or
receiving face to face counseling. While case managers have the authority to "auto
assign," or select a plan for recipients who have not done so within the allowable
time, auto assignment has been limited. OMAP distributes a list of beneficiaries
who are elderly or have disabilities and who have not selected a plan. SDSD case
managers then follow up by mail or visit the beneficiary at home to assist with
selection. OMAP and SDSD monitor the number of auto assignments to determine
whether additional training or other intervention is needed. Incidently, those
members of special populations that are dual eligibles (eligible for both <strong>Medicaid</strong>
and Medicare) are only assigned for OHP covered services since case managers
27 The Oregon Health Plan is Oregon's term for its <strong>Medicaid</strong> program that is made up entirely
of managed care options.
The National Academy for State Health Policy * D 8/97 IV-56