How will the enrollment process work?
Enrollment in managed care may be voluntary or mandatory. In a voluntary system, beneficiaries choose either to join an HMO or to stay in the fee-for-service system. HMOs may be attractive to beneficiaries because they offer a medical “home” and improved access to some services. But persons with prior provider relationships may avoid HMOs because they do not want to risk changing providers. In any case, it is important to ensure that beneficiaries understand their choice of delivery system and their responsibilities. If beneficiaries are enrolled in private plans and do not understand how they operate, public providers could be responsible for service costs when sick patients “incorrectly” show up at emergency rooms or non-plan providers for care. Mandatory enrollment in managed care increases the obligation of the state to provide adequate access to services. Under most waivers, the federal government requires that the state offer a choice of managed care plans. Mandatory managed care
