Outreach, Marketing, Enrollment and Disenrollment Policies in Medicaid Managed Care: A Summary of a 1996 Survey of Medicaid Agencies

The focus of this paper is on enrollment and disenrollment policy and practice in Medicaid managed care. Specifically, this paper examines policies and practices in risk-based programs with attention to Primary Care Case Management (PCCM) program policies only as they specifically interact with risk-based enrollment policies. In risk-based managed care, a Medicaid agency contracts with an entity (the contractor) to provide or arrange for the provision of an agreed upon set of services in exchange for a set fee per person enrolled per month where the prepaid fee does no vary month to month based on services used by the individual enrollee. In other words, in risk-based managed care the contractor assumes some level of financial risk for providing care to enrollees. A PCCM program in this discussion refers to a fee-for-service system where Medicaid pays a nominal amount per PCCM enrollee per month to the provider/care manager in addition to per service fees.

1997.Dec_.outreach.marketing.enrollment.policies.medicaid.managed.care_.survey.1996.pdf

710 KB