MEDICAID HMOs: Study Suggests Improvements for Enrollment

      As more states look to Medicaid HMOs to reduce health costs, a new study suggests ways to encourage voluntary enrollment and evaluate enrollment systems. Neva Kaye and Cynthia Pernice of the National Academy for State Health Policy interviewed enrollment brokers, health plans, consumers and Medicaid agency representatives from seven states with "a range of enrollment policies and experience," and outlined different states' enrollment strategies. They suggest that translators, extended hours, home visits and community-based enrollment centers may increase voluntary enrollment by enhancing convenience; they also stress the importance of "hiring staff whose work is dedicated to enrollment." The authors also found that most states "re-assign beneficiaries who re-enter the managed care program to the same managed care providers that previously served them." Most beneficiaries selected a plan themselves, rather than waiting to be assigned, although the authors note that this decision was influenced by the degree of "provider overlap between plan networks and by word-of-mouth information about the consequences of failing to select a plan." Once enrolled in a plan, however, less than 2% of enrollees switched plans.

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      The authors also examined how states evaluate enrollment systems and caution against relying too heavily on voluntary enrollment rates to compare different states' effectiveness, since some states require all new members to choose an HMO, and others automatically re-enroll beneficiaries in managed care plans once they've chosen one. They found that states "routinely track enrollee-initiated disenrollments due to access and location issues," but called on Medicaid administrators to find out why others disenroll -- arguing that this strategy "shows more promise as a tool for identifying potential weaknesses within the system" (Neva/Pernice, October 1998).