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Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid.

Published byDora Butler Modified over 9 years ago

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Presentation on theme: "Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid."— Presentation transcript:

1 Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses Results of a National Survey Presented by Carol Tobias, Director Medicaid Working Group Medicaid Working Group Boston University School of Public Health Funded by the Center for Health Care Strategies - 2000

2 Medicaid Working Group - Boston University School of Public Health2 Health Plan Responses 127 plans (+-) enroll the SSI population 127 plans (+-) enroll the SSI population 61 health plans responded - 48% response rate 61 health plans responded - 48% response rate 61% predominantly (>75%) Medicaid plans 61% predominantly (>75%) Medicaid plans 39% commercial + Medicaid plans 39% commercial + Medicaid plans 59% also enroll Medicare beneficiaries 59% also enroll Medicare beneficiaries

3 Medicaid Working Group - Boston University School of Public Health3 States

4 4 Total Medicaid Enrollment

5 Medicaid Working Group - Boston University School of Public Health5 Medicaid SSI Enrollment SSI Enrollment

6 Medicaid Working Group - Boston University School of Public Health6 Clinical Programs - Overview  98% of plans have special clinical programs for Medicaid enrollees  Most (87%) have programs for MCH population or asthma/ diabetes disease management.  More than half (61%) have programs for some portion of SSI population

7 Medicaid Working Group - Boston University School of Public Health7 General Categories of Programs  Disease Management  Intensive Case Management  General Case Management  Behavioral Health Programs

8 Medicaid Working Group - Boston University School of Public Health8 Disease Management Programs n n Asthma59% Diabetes49% n n CHF/Cardiovascular20% n n Pregnancy20% n n Hypertension11% n n Sickle cell10% n n HIV/AIDS 8% n n COPD 7%

9 Medicaid Working Group - Boston University School of Public Health9 Case Management Programs n n Pregnancy/high risk44% n n Children with special health care needs25% n n HIV/AIDS23% n n Serious mental illness17% n n Physical disability/rehab/DME users16% n n Transplants16% n n Developmental disability 8%

10 Medicaid Working Group - Boston University School of Public Health10 Special Behavioral Health Programs  Only half of the plans receive the Medicaid capitation for behavioral health  Of these, 59% carve-out behavioral health services to a BHO  Half of the plans report special mechanisms to coordinate behavioral and physical health services

11 Medicaid Working Group - Boston University School of Public Health11 Special Behavioral Health Programs 10 plans described a special behavioral health program for one or more of the following populations: n n People with serious and persistent mental illness n n Children with serious emotional disturbances n n People with developmental disabilities n n People with physical disabilities

12 Medicaid Working Group - Boston University School of Public Health12 Detailed Program Descriptions  51 plans  18 states  71 programs –46 programs for MCH population, asthma or diabetes case management, hypertension –20 programs for SSI population or some portion, special needs –5 programs for COPD or cardiac disease mgmt.

13 Medicaid Working Group - Boston University School of Public Health13 20 Plans With Programs for SSI  SSI population 5 plans  Chronically ill, special needs populations 5 plans  Children with special health care needs 4 plans  Frail elders 3 plans  HIV 3 plans  Sickle cell, physical disability, CHF 2 plans  Morbidly obese, rehabilitation, transplants, wound care, foster children, COPD ( 1 plan each)

14 Medicaid Working Group - Boston University School of Public Health14 Referral Sources

15 Medicaid Working Group - Boston University School of Public Health15 Case Management Functions

16 Medicaid Working Group - Boston University School of Public Health16 Other Program Functions

17 Medicaid Working Group - Boston University School of Public Health17 Special Provider Relationships

18 Medicaid Working Group - Boston University School of Public Health18 Program Obstacles

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