| Managed Care On-Line News: Articles |
AIS ATLANTIC INFORMATION SERVICES, INC.
1100 17th Street, NW, Suite 300, Washington, D.C. 20036; 202-775-9008; Fax 202-331-9542
NEWS RELEASE
FOR IMMEDIATE RELEASE
Contact: Christopher Gearon
(202) 775-9008
STATES IMPOSING TIGHT RESTRICTIONS ON HOW HMOs CAN MARKET TO AND ENROLL MEDICAID RECIPIENTS
Smaller and new HMOs claim restrictions favor large plans and those with already strong brand identity.
WASHINGTON, Jan. 29, 1997 - As states rush to shift Medicaid recipients into managed care plans as a cost-saving measure, they are also placing restrictions on how those plans can market their services to and enroll Medicaid members.
A survey of state Medicaid programs released today by Atlantic Information Services (AIS), Washington, D.C., and Integrated Healthcare Services (IHS) , Princeton, N.J., finds that 94% of the 33 states contracting with Medicaid HMOs regulate the marketing practices those HMOs use to attract and enroll Medicaid recipients. Forty-three states (89%) responded to the survey.
While the regulations vary, many states ban direct solicitation of potential enrollees and require HMOs to submit their marketing plans to the state or to an outside enrollment broker for approval.
"States say the curbs are necessary to protect Medicaid recipients, many of whom are members of vulnerable populations," notes Christopher Gearon, editor of News and Strategies for Managed Medicare & Medicaid. "But some smaller HMOs say that the restrictions put new HMOs and Medicaid-only plans at a disadvantage." Their fear, according to Gearon: the curbs act to limit market share by giving larger HMOs and those with already high brand recognition an advantage.
State Medicaid officials, however, are split on the impact of the restrictions. Just more than half (52%) believe the restrictions don't impact enrollment, while 50% say they do have an impact or don't know the impact.
Among the survey's findings:
· one-third of states restricting HMO marketing to Medicaid recipients invoked the curbs last year
· While imposing restrictions, 55% of the responding states say they have never experienced abusive practices by Medicaid HMOs.
· Less than half (45%) of states with marketing restrictions have assigned the marketing and enrollment functions to private sector enrollment brokers. Twenty-three percent (23%) have made public employees responsible for this function, while the rest use a combination of private and public resources.
Atlantic Information Services publishes News and Strategies for Managed Medicare & Medicaid as well as other newsletters, books and materials for health care managers and decision makers. IHS, a health care consulting firm, works with managed care plans, hospitals, and insurers to identify business opportunities, build provider alliances and create innovative marketing solutions. IHS clients provide services for more than 3.5 million lives in 34 states. Contact AIS at (202) 775-9008, IHS at (609) 514-0211, ext. 18.
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