Emerging Practices in Medicaid Primary Care Case Management Programs. Enrollment Policies


States are increasingly mandating enrollment in PCCM for their Medicaid beneficiaries. As Chart C illustrates, in 1990, 63 percent of the 19 states with PCCM programs (a total of 12 states) mandated enrollment; 47 percent (nine states) made enrollment voluntary. (These add up to over 100 percent, as states may use both mandatory and voluntary enrollment, depending on geographic region, population group, or some other factor.) By 1998, 93 percent of the 29 states operating PCCM programs (a total of 27 states) mandated enrollment; 17 percent (five states) made enrollment voluntary.

Chart C:

Mandatory v. Voluntary Enrollment. See text for explanation of chart.

States have increasingly used enrollment brokers for their PCCM programs, from 10 states in 1996 to 16 in 1998 — a 40 percent increase. Five states (17 percent of the 29 states with PCCM programs) reported involving community-based organizations in informing and outreach for PCCM in 1998, although the most common venue for informing was the welfare/social service agency (used in 20 states). Other commonly used venues include: the beneficiary's home (18 states), point of service/provider locations (17 states), health fairs (14 states), and community-sponsored events (13 states). Brochures/flyers mailed directly to the beneficiary were the most common way to inform; phone calls were another common informing technique. In most states, beneficiaries were allowed to phone in their PCP selection in order to make enrollment more convenient

Chart D:

Allowable PCCM Provider types. See text for explanation of chart.

View full report


"report.pdf" (pdf, 314.91Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®