Clinical Programs for Medicaid Enrollees with Disabilities and Chronic Illnesses

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

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

3. States Medicaid Working Group - Boston University School of Public Health

4. Total Medicaid Enrollment Medicaid Working Group - Boston University School of Public Health

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

6. 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 Medicaid Working Group - Boston University School of Public Health

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

8. Disease Management Programs • Asthma 59% • Diabetes 49% • CHF/Cardiovascular 20% • Pregnancy 20% • Hypertension 11% • Sickle cell 10% • HIV/AIDS 8% • COPD 7% Medicaid Working Group - Boston University School of Public Health

9. Case Management Programs • Pregnancy/high risk 44% • Children with special health care needs 25% • HIV/AIDS 23% • Serious mental illness 17% • Physical disability/rehab/DME users 16% • Transplants 16% • Developmental disability 8% Medicaid Working Group - Boston University School of Public Health

10. 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 Medicaid Working Group - Boston University School of Public Health

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

12. 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. Medicaid Working Group - Boston University School of Public Health

13. 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) Medicaid Working Group - Boston University School of Public Health

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

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

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

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

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