ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Wednesday, March 20, 1996 TAG: 9603200034
SECTION: BUSINESS PAGE: B-8 EDITION: METRO
DATELINE: HARTFORD, CONN.
SOURCE: Associated Press
MEDICAID RECIPIENTS are the target of advertising, though some find themselves later in programs that don't deliver.
On a vacant inner-city lot surrounded by barred storefronts, three cigarette billboards have new competition for the attention and dollars of the poor.
Just above an ad for Newports, a health maintenance organization called HealthRight is looking to gain a foothold with families in this low-income Puerto Rican neighborhood along Hartford's Park Street.
``It's about growing up strong,'' says HealthRight's message in Spanish. There's also a picture of smiling kids, and a toll-free number.
About 40 states, including Virginia, are using HMOs and other managed care programs to cut the cost of serving recipients of Medicaid, the federal-state health benefits program for the poor.
So far about 11.6 million people, more than 30 percent of Medicaid recipients, have been transferred from traditional health insurance to managed care, says the federal Health Care Financing Administration.
For HMOs, looking after the health of the poor has become a multibillion-dollar opportunity.
For Medicaid recipients, however, the transition has so far been rocky. Accusations of marketing abuses and poor care abound.
New York halted enrollments for nearly six months last year after state investigators found most of the plans weren't providing essential services like annual checkups, prenatal care and childhood immunizations.
The state also received complaints about aggressive door-to-door marketing in which people were recruited without knowing they'd have to give up their regular doctor. Some didn't even know they'd signed up for an HMO.
In Florida, a grand jury in January began a fraud investigation that included charges that sales agents offered welfare recipients free diapers to enroll in their plans.
In Baltimore last year, a former HMO marketing executive was convicted of conspiring to illegally gain access to records containing the names of Medicaid recipients to solicit their business.
Claudette Beaulieu, spokeswoman for Connecticut's Department of Social Services, said the state hopes to ensure quality health care while at the same time saving about $20.5 million a year, or 5 percent of its Medicaid premiums.
Even with that reduction there is still $389 million in premiums at stake, and 11 managed-care companies chosen by the state have been vying since July for Medicaid members. By the start of March, nearly 160,000 of the 228,000 recipients, or 70 percent, had enrolled.
Connecticut is hoping to avoid the abuses of its predecessors. Direct mail, face-to-face sales and other high-pressure tactics have been barred.
To help recipients choose among plans, the state turned to Benova Inc., a Portland, Ore., company that has worked on similar programs in California, Oklahoma and Oregon.
Benova functions like an independent insurance agency, with representatives helping recipients choose the plans best for them.
Rachel Block, a supervisor of managed care for the Health Care Financing Administration, sees ``a dramatic shift'' toward such independent brokers because some states were quickly overwhelmed by frenzied marketing.
``They've just basically learned the lesson that direct marketing by plans was something they did not have a very good handle on,'' Block said.
Nevertheless, companies still are able to make their presences felt, perhaps because they had been noticeably absent before.
Billboards and bus ads abound. Small ethnic newspapers and radio and television are also being used, with some ads featuring images of minority actors portraying single mothers.
The plans have also sent representatives to community fairs and festivals.
``Any plan that's reaching this population, that's putting thought into it and doing a good job at it, has to look at the demographics of the population,'' said Cathy Coyle, community relations and marketing director for HealthRight.
``There is a lot of it on TV. My God!'' exclaimed Ana Natal, jobs coordinator for a community outreach program.
Many poor people are pleased by the attention and the health-care choices they are getting, said Jacqueline Maldonado, a Medicaid recipient and single mother who works in a movie theater and teaches English as a second language.
Early indications show the Connecticut system has been well-received even though recipients must learn new habits, such as making and keeping doctor's appointments rather than dropping into emergency rooms.
``Before, with the Medicaid, you don't feel good - you go to the hospital. With the HMOs you have to call first, that's a new thing for me,'' Maldonado said.
LENGTH: Medium: 94 lines ILLUSTRATION: PHOTO: AP. A billboard in Spanish advertises a managed healthby CNBcare organization directly above an ad for cigarettes on Park Street
in Hartford. Eleven managed-care firms are competing in Connecticut
for the right to take care of the state's Medicaid recipients.
color.