Medicaid Capitated Managed Care Program for SSI Disabled

摘要

In 1992, 16 states enrolled members of the SSI-disabled population in capitatedand/or fee-for-service managed care plans. Mandatory policies were more common among states, but programs were more prevalent in voluntary states. Capitated programs in mandatory states were smaller, non-profit, privately owned, and had larger numbers of SSI-disabled recipients enrolled than programs in voluntary states. Health maintenance organizations (HMOs) tended to include more services in their capitation rates than IPAs, but IPAs were more likely to cover supportive services needed by the SSI-disabled population. The majority of administrators know little about this population and had no plans to significantly increase their enrollment. The study shows that states would increase enrollment if they (1) learned more about the demographic characteristics, utilization, and cost experiences of this population, limiting the uncertainty involved with providing services under a risk-based model, and (2) used providers who had experience in serving the SSI-disabled population.