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

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cannot enroll a person in a Medicare HMO without the signature of the member or
their guardian.
Through the enrollment process, beneficiaries who are receiving health or long
term care services that must be continued or who will require services at the time of
enrollment are identified. The SDSD case manager completes a Continuity of <strong>Care</strong>
Referral which identifies service needs prior to the beneficiary's enrollment in the
health plan. The form is sent to the MCO's ENCC (Exceptional Needs <strong>Care</strong>
Coordinator) who then makes appropriate follow up arrangements with the
beneficiary.
Other State Strategies for Enrollment
Utah uses state <strong>Medicaid</strong> workers as health program representatives to conduct
education, counseling, enrollment, disenrollment and to handle complaint
functions for members of special populations as well as TANF beneficiaries. The
representatives are located in welfare eligibility offices. Those beneficiaries who call
or visit the welfare office may view a video, receive information on each HMO and
have on-line access to review the list of providers in each HMO. The enrollment
staff have extended hours to make calling more convenient. In rural areas, the
volume of managed care enrollment was too low to use full time, dedicated staff. In
response, the Division of Health <strong>Care</strong> Financing contracted with local Health
Departments to explain the fee-for-service, primary care case management and
HMO options to beneficiaries. In addition to managed care enrollment, the Health
Departments were contracted to work with physicians to promote the program. This
arrangement was viewed as successful as evidenced by an 80% rate of voluntary
selection of managed care plans by Utah's managed care eligible <strong>Medicaid</strong>
beneficiaries.
In Tennessee, as in other states, <strong>Medicaid</strong> eligibility for SSI beneficiaries is
determined by the Social Security Administration (SSA). SSA sends a tape to
Tenn<strong>Care</strong> and SSI beneficiaries are randomly assigned to plans. Tenn<strong>Care</strong> then
sends each SSI beneficiary a letter notifying the individual of the assignment and
allowing 45 days to make a change. Plans assign primary care physicians for people
with disabilities and elderly beneficiaries who are not dually eligible; but, do not do
so for those that are dually eligible. This distinction is made because Tenn<strong>Care</strong>
plans have limited authority over services provided to dual eligibles and the plan is
responsible for providing dual eligibles only those services that are not covered by
Medicare.
Dual Eligibility and Enrollment
States that enroll elderly beneficiaries and people with disabilities into <strong>Medicaid</strong>
managed care programs must also address dual eligibility-at least to decide if they
will exempt dual eligibles from program participation or will find ways of
accommodating the complications dual eligibility brings to <strong>Medicaid</strong> managed care.
The National Academy for State Health Policy * C 8/97
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