Emerging Practices in Medicaid Primary Care Case Management Programs. Use of PCCM by Population


Since 1990, states have primarily used PCCM programs to enroll people in the following Medicaid categories of eligibility: AFDC/TANF, poverty level pregnant women, and poverty level children. Medicaid use of PCCM programs for these populations has been fairly stable and very high. Also relatively stable is the use of PCCM for institutionalized populations as a percentage of states with PCCM programs; this has remained fairly low. As Chart B illustrates, states' use of PCCM programs to enroll other populations has fluctuated between 1990 and 1998. Among the states that operate PCCM programs, the number choosing to enroll SSI children increased dramatically; those choosing to enroll SSI adults living in the community dropped and then gained ground.

Subpopulations excluded or exempted from PCCM programs have remained fairly constant. Most frequently excluded/exempted are: Medicare dual eligibles (excluded in 83 percent of the 29 states operating PCCM programs in 1998), people receiving long-term care in institutions (excluded in 79 percent in 1998) or in the community (excluded in 69 percent in 1998), and people with other insurance (excluded/exempted in 69 percent in 1998). Other subpopulations excluded/exempted from state PCCM programs included: children in foster care (in 62 percent of the states), children with special health care needs (in 31 percent), and American Indians/Alaska Natives (in 28 percent).

Chart B:

Chart B: Use of PCCM by Population. See text for explanation of chart.

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