Emerging Practices in Medicaid Primary Care Case Management Programs. Appendix C

06/01/2001

Case Study States' Enrollment Policies
  Alabama Florida Iowa Maine North Carolina Oklahoma Texas Virginia
Patient 1st MediPass MediPASS Maine Prime-Care Maine-NET/ Partnership ACCESS I ACCESS II ACCESS III SoonerCare Choice PCCM Model Texas Health Network STAR+ PLUS MEDALLION
Populations included in mandatory enrollment (in managed care) TANF1, SOBRA children, SSI, Aged, CHIP TANF, SSI, foster care children, CHIP TANF, CHIP TANF & related, CHIP (Medicaid expan-sion) --- TANF, SSI, ABD TANF, SSI, Aged, CHIP (Medicaid expansion) TANF SSI children, certain MH/MR TANF, SSI, Aged, CHIP
Populations included in voluntary enrollment Exemp-tions for medical reasons are granted case-by-case Have other insurance, enrolled in another mgd care prgm, "grand-fathered" SSI (enrolled pre-1993) Special needs American Indian/ Alaska Natives, hospice, Medicaid pregnant women, special needs SSI, Aged Dual eligibles, foster care children, subsidized adoption, American Indian/Alaska Natives, Medicaid pregnant women --- American Indian/ Alaska Natives, ABD   Special needs
Populations not eligible Medicare, reside in nursing facility or ICF/MR or thera-peutic group home, SOBRA adults, enrolled in another mgd care prgm., foster care children, retro-active eligibility/ eligibility less than 3 mos. Aged, reside in nursing facility or ICF/MR, participate in HCBS waiver, medically needy, incar-cerated SSI, dual eligibles foster care children, subsidized adoption, reside in nursing facility or ICF/MR, participate in HCBS waiver, have other insurance, enrolled in another mgd care prgm, short-term medical, long-term medical in com-munity, spend down SSI, dual eligibles, foster care children, subsidized adoption, other insurance, enrolled in another mgd care prgm, long-term mental health, participate in HCBS waiver, special needs adults Reside in nursing facility or ICF/MR CHIP, reside in nursing facilities or ICF/MR, long-term medical in the community, long-term mental health, retroactive eligibility/eligibility under 3 mos., refugees, spend down Medicare, foster care children, reside in nursing facility or ICF/MR, enrolled in another mgd care prgm, participate in HCBS waiver, travel more than 45 miles or 45 minutes, children in custody, subsidized adoption Medicare, foster care children, reside in nursing facility or ICF/MR, hospice, medically needy TANF, foster care children, CHIP, partici-pate in HCBS waiver, QMB, SLMB, participate in nursing facility waiver Medicare, foster care children, subsidized adoption, other insurance, enrolled in another mgd care prgm, reside in nursing facility or ICF/MR, participate in HCBS waiver, long term medical in community, long-term mental health, retro-active elig./elig. under 3 mos., refugees, hospice, spend down

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