Using MSIS Data to Analyze Medicaid Eligibility and Managed Care Enrollment Patterns in 1999. Tables 8A-8B: Medicaid Managed Care Enrollment by Plan Type and Eligibility Group for December 1999

02/01/2003

Table 8A shows the number of Medicaid enrollees, by eligibility group, in each of the eight types of managed care plans in December 1999 The count is duplicated because an individual could have been enrolled in more than one type of plan, in which case he or she would have been counted more than once. Table 8B converts the data in Table 8A to a percent distribution; the percentages reflect the duplicated counts in Table 8A.

Data have not been available in the past showing the differences in managed care enrollment across Medicaid eligibility groups. A priori, it seemed likely that all the medically needy groups, the poverty-related aged and disabled groups, and the other aged and other disabled groups would have relatively lower rates of managed care enrollment. The medically needy often have intermittent Medicaid eligibility due to the spend-down requirements, making it more difficult for them to have the continuity in enrollment important to managed care. The poverty-related aged and disabled would not be likely to enroll in managed care plans in many states, since their Medicaid benefits are limited to Medicare cost-sharing expenses. The other aged and other disabled groups include many of the institutionalized, making them less likely to enroll in managed care.

Although managed care enrollment numbers are reported for the 1115 eligibility groups in Table 8A, they are analyzed separately, since the 1115 demonstration programs across states vary considerably in their size and focus.

Findings

  • Overall, 25 percent of aged individuals and 43 percent of disabled individuals on Medicaid were enrolled in some type of managed care in December 1999. Those in the SSI-related eligibility groups were most likely to be managed care participants, with 38 percent of SSI aged and 50 percent of SSI disabled persons enrolled in some type of managed care plan. For SSI aged persons, about 22 percent were enrolled in dental plans, 13 percent were in HMOs, 7 percent were in BHPs and less than 3 percent were in PCCMs. Among SSI disabled persons, 21 percent were enrolled in HMOs, 15 percent were in dental plans, 12 percent were in BHPs and 11 percent were in PCCMs. Only 31 percent of the aged and 22 percent of the disabled medically needy groups reported any managed care plan enrollment. As expected, the rates were lower for the poverty-related and other aged and disabled groups.

  • Similarly, children and adults in the AFDC cash assistance-related (Section 1931) groups were more likely to be enrolled in some type of managed care plan than children and adults in any of the other eligibility groups. The overall managed care participation rate for children on Medicaid was 67 percent, but it was 76 percent for AFDC children. The overall rate for parents or adults was 52 percent, but 72 percent for AFDC adults. For the remaining child eligibility groups, 69 percent of children in the other eligibility group were enrolled in some type of managed care plan, compared to 66 percent of children in the medically needy group and 60 percent of children in the poverty-related group. Only 42 percent of foster care children were enrolled in some type of managed care plan, the lowest managed care participation rate for children.

  • Compared to AFDC adults, the managed care enrollment rates for medically needy adults and other adults were lower with 52 percent and 60 percent, respectively, enrolled in some type of managed care plan. Only 33 percent of poverty-related adults were enrolled in some type of managed care. This lower rate probably results in part because this group consists entirely of pregnant or post-partum women.

  • About 89 percent of children and 82 percent of disabled individuals who were eligible for Medicaid through state 1115 demonstration programs were enrolled in some type of managed care plan. In contrast, only 31 percent of 1115 adults were enrolled in some type of managed care. However, a majority of the 1115 adults only qualified for limited family planning benefits. None of the 1115 aged were in managed care. (Only Vermont reported any 1115 aged enrollees, and their benefits were limited to pharmaceutical coverage and Medicare cost-sharing.)

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