Section 1932(a) was enacted as part of the Balanced Budget Act of 1997. As previously discussed, the BBA recognized that Medicaid managed care had become the service delivery mode for more than half of all Medicaid beneficiaries by the late 1990s, and made mandatory managed care a State Plan option under certain conditions. Section 1932(a) is basically the same as the §1915(a) authority with the exception that it allows mandatory enrollment--except for dually eligible persons and children with special needs. However, these populations can be included on a voluntary basis. It can be used to create a managed care plan for either health care or long-term care or both.
See Table 8-5 for an example of a program that uses §1932(a) in combination with a §1915(c) waiver and Medicare Special Needs Plan authority to create a voluntary MLTC program for dually eligible adults of all ages with disabilities.
|TABLE 8-5. Wisconsin Family Care Partnership (FC-P)|
|Target Group||Older persons and persons under age 65 with physical disabilities who are clinically certified to need institutional level of care. Enrollment is voluntary.19|
|Service Area||16 counties, with expansion underway.|
|Scope of Medicaid Capitation||All Medicaid services, including primary and acute health care, long-term care services (HCBS and institutional), and behavioral services. (Medicare services are also fully capitated in a separate payment that FC-P receives from the Medicare program.)|
|Authorities||Section 1915(c) waiver and §1932(a) State Plan amendment. Wisconsin borrowed from the PACE model to create a program that includes all Medicaid and all Medicare services in one package for dually eligible persons. (But FC-P does not require enrollees to be dually eligible.) Because the program deviates substantially from PACE (e.g., it includes persons under 55 years of age), it could not use the §1934 PACE authority. Instead, it combined a §1915(c) HCBS waiver with the State Plan managed care option of §1932(a). Section 1932(a) is usually used for mandatory managed care programs, but it can also be used with exempt populations (e.g., dually eligible persons) on a voluntary basis. Medicare services are provided using the Medicare Special Needs Plan authority.|
|More information is available at: http://dhs.wisconsin.gov/wipartnership/.|