State Medicaid health maintenance organization policies and

The results of a survey of all state Medicaid agencies regarding their policies for enrolling and serving special-needs children in health maintenance organizations (HMO) are presented. The results reveal that many states have implemented one or more strategies to protect special-needs Medicaid recipients enrolled in HMOs. The survey results suggest, however, that such strategies are too limited in scope to ensure appropriate access to specialty services for all children with special health needs. In the majority of the 27 states using HMOs to service Medicaid recipients, special-needs children are not required to join. While there is a need for policies to protect special-needs children under all Medicaid managed-care arrangements, it is most critical in mandatory enrollment states.