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Auto-Assignment and Enrollment in Medicaid Managed Care Programs

Published online by Cambridge University Press:  01 January 2021

Joel D. Ferber
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In the face of escalating Medicaid costs and anticipated reductions in federal Medicaid spending, states are increasingly converting from fee-for-service (FFS) to managed health care systems. The interrelated issues of enrollment and auto-assignment are fundamental to the overall success or failure of Medicaid managed care programs. The purpose of this article is to suggest how policy makers, consumer advocates, and providers should address these issues. My major premise is that implementation of managed care will proceed more smoothly if states adopt enrollment strategies that promote voluntary selection of health plans by Medicaid consumers, minimize the likelihood of auto-assignment, and mitigate the negative consequences of mandatory assignment of consumers to managed care organizations (MCOs).

States seeking to implement Medicaid managed care must apply for a waiver from the secretary of the Department of Health and Human Services (DHHS). Two different types of waivers are available to implement Medicaid managed care.

Type
Article
Information
Journal of Law, Medicine & Ethics , Volume 24 , Issue 2 , Summer 1996 , pp. 99 - 107
Copyright
Copyright © American Society of Law, Medicine and Ethics 1996

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References

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The Rhode Island Medicaid managed care program, RIteCare, developed an algorithm that cost over $100,000 to develop, but then the state manually auto-assigned recipients to the lowest bidding plan, United Health Care. Notably, this health plan had the most non-English-speaking members but no materials printed in any language other than English. Recipients enrolled in this plan experienced delays in primary care appointments of up to twenty months. The Rhode Island program also proposed to conduct auto-assignments of mailed applications if a choice had not been made within five days. The Rhode Island auto-assignment proposal was rejected by HCFA in response to consumer opposition. Rhode Island then revised the process to allow for two scheduled face-to-face appointments within a month, a mailed application, and a thirty day turn around time. See Perkins, J., “Memorandum to Persons Interested in Managed Care,” Aug. 17, 1995, at 11 (available from National Health Law Program, Washington, D.C.); and Presentation of Jane Perkins at “Evolving Medicaid: State Child Health Advocacy,” July 24, 1995, Washington, D.C.Google Scholar
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Enrollment materials should be made available in alternative formats, such as braille, when necessary to meet the special needs of Medicaid recipients.Google Scholar
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