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

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Medicare members are not typically enrolled retroactively. 3 0 As a result, recipients
who enroll in a plan for both Medicare and <strong>Medicaid</strong> are enrolled immediately for
<strong>Medicaid</strong> and the plan bills Medicare fee-for-service until the Medicare process is
completed, typically 30-60 days.
State Experience Enrolling Dual Eligibles
States that enroll dual eligibles have put different levels of effort into tracking the
Medicare enrollment decisions of dually eligible beneficiaries in order to coordinate
enrollment in <strong>Medicaid</strong> managed care program and the benefits available under
each program. Minnesota's Senior Health Options has had the most success in
coordinating the two programs. This program's waiver combines the <strong>Medicaid</strong> and
Medicare enrollment systems. County offices may complete the single enrollment
form. The form is submitted to the state <strong>Medicaid</strong> agency, verified and submitted to
HCFA. The streamlined process means that the enrollee only has to sign one form
and allows enrollment to be effective in the following month if the completed form
is submitted to HCFA six days prior to the end of the preceding month.
As previously mentioned, Oregon also places great importance on making every
effort to ensure that an individual that chooses a plan for Medicare services is
enrolled into that plan for <strong>Medicaid</strong> services. Of course, since Medicare freedom-ofchoice
takes precedence over <strong>Medicaid</strong>'s mandatory enrollment the choices are
complex and vary with the beneficiary's preference for receiving Medicare benefits.
The various choices and their effect on enrollment are identified below.
If the beneficiary is already enrolled in a Medicare HMO at the time of
<strong>Medicaid</strong> enrollment, the beneficiary may either:
- enroll in the plan for <strong>Medicaid</strong> services if the HMO is also an
Oregon Health Plan (OHP) contractor; or
- remain in the HMO for Medicare benefits and receive <strong>Medicaid</strong>
services on a fee-for-service basis if the HMO is not an OHP
contractor or if the HMO membership is a private, premiumbased
policy which the member wishes to retain.
* If the beneficiary is not currently enrolled in a Medicare HMO, but
chooses an OHP plan that is also a Medicare HMO, that beneficiary will
be enrolled in that HMO <strong>Medicaid</strong> and Medicare plans.
* If the beneficiary chooses an OHP plan that does not offer a Medicare
HMO, the beneficiary is enrolled in the OHP plan for <strong>Medicaid</strong> services
30 HCFA has indicated that retroactive Medicare enrollment will be considered.
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