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Maryland has had an involuntary, incomplete assignment of Medicaid
patients to HMO's for the past two years. There are currently talks going
on at quite high levels about forcing all of Maryland's Medicaid
recipients into managed care schemes, a move which has most of us in
academic centers quite concerned.
 
In the Pediatric E.D., we have seen several problems. First, given the
difficulty of contacting at least part of the Medicaid population,
families and children have been assigned to HMO's but the mother has
never received notification. Often, the first the mother learns about her
HMO membership is when she presents to the PED with her sick child and
learns that she must seek approval from a system she never knew existed.
Gues who bears the brunt of mothers' anger?
 
Recruiters from HMO's have been very aggressive, to the point of signing
up patients without bothering to inform the patients and their mothers.
Quite illegal, but, until recently, tolerated. Several sales reps have
recently been indicted, but there have been no trials yet. Typical
responses from HMO CEO's have indicated amazement that such behavior
would occur and denial that they knew anything about it. This from people
who pay their recruiters by the head, and offer bonuses based on numbers.
 
Not infrequently, the one child in a family with extensive meeds is not
enrolled, while the rest of the family is. Cherry-picking, plain and simple.
 
As you may have gathered, I see the forced HMO conversion of Medicaid
patients in the worst light possible. If the managed care organizations
were accessible to patients, took their contracts seriously, and were run
by health care professionals with some business knowledge, rather than
business people with scant health care knowledge, the system might work
as some well-meaning legislators intended. I don't see that day coming
very soon.
 
Lots of luck on the conversion. Lay in a supply of Mylanta and Tylenol.
 
I have lots more comments, but this is enough for one session. Please let
me know if I can be of further assistance.
 
Allen R. Walker, MD
Pediatric Emergency Medicine
Johns Hopkins