Emerging Practices in Medicaid Primary Care Case Management Programs. Enrollment of Special Needs Populations


A few of the case-study states have made specific accommodations in their enrollment processes for special needs populations. The practices of Alabama and Oklahoma are of particular interest.

Alabama pays close attention to the enrollment of individuals with special needs. As the state proceeds with enrollment county by county, it works with community agencies in the particular county to identify subpopulations of individuals with special needs. The state makes sure that specific providers who serve persons with special needs are recruited as PCPs before proceeding with mandatory enrollment. When bringing on a county with a fairly large population of Russian Medicaid beneficiaries, state agency staff contacted a physician in the community who speaks Russian and serves the population. The physician assisted the state by helping prospective members understand the program and how to enroll.

Oklahoma began enrolling the Aged, Blind, and Disabled (ABD) populations in its PCCM and MCO programs in January 2000. The state adopted several strategies to facilitate the enrollment of these individuals.

  • Staff education: The Medicaid agency worked closely with regional eligibility determination staff to educate them about the particular needs and concerns of the ABD members and about their managed care options.
  • Enrollment fairs: The Medicaid agency staff (including Exceptional Needs Coordinators) conducted health fairs and informational events at sites accessible to the targeted populations to help them understand how their health care delivery was going to change.
  • Transportation: The state enlisted the transportation contractor to transport prospective members to the enrollment fairs. The state ensured that the contractor was aware of the particular needs of the ABD populations.
  • Exceptional needs coordinators (ENCs): The state has identified nurses and social workers with case management experience to serve as ENCs for the PCCM members. (The state has required its contracted MCOs to hire ENCs for their special needs members as well.) The ENCs work with community service agencies and other providers to coordinate resources and services for special needs members.
  • Targeted outreach: During initial enrollment of the ABD populations, the ENCs make phone calls to those Medicaid beneficiaries who have high utilization of services, based on their claims history. The purpose of the phone call is to inform members about upcoming changes in their coverage, explain managed care, and to complete a profile to identify their outstanding health needs. The ENC also helps the prospective member select a PCP who can best meet their needs. The health information about the member is then forwarded to the selected PCP so that the provider is aware of the new member's health needs.

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