CA

"3.23.4   Enrollment Restriction
Enrollment may proceed to the plan's maximum total number of Members unless restricted by DHS.  Such restrictions will be defined in writing and the Contractor notified at least 10 days prior to the start of the period of restriction.  Release of restrictions will be in writing and transmitted to the Contractor at least 10 days prior to the date of the release."  California Contract, page 32.

CO

"II. ELIGIBILITY AND ENROLLMENT…
4.  Contractor Enrollment
The Contractor shall agree to serve a population broadly representative of the various age, social, and income groups within the categories of aid as defined in Exhibit B. Notwithstanding any other provision of this Contract, the right of the Contractor to limit Client Enrollment in an aid category to a percentage of total Enrollment which reflects the distribution of Clients by eligibility category in the Service Area is acknowledged and affirmed."  Colorado Contract, page 15.

FL

"5  Patient Acceptance.  It is agreed that the MediPass provider will:
a.  Accept patients pursuant to the terms of this Agreement, including both assignments and voluntary enrollments up to the limits set by the Agency and the MediPass provider..."  Florida Contract, page 8.

MD

"I. THE MCO AGREES: ...
B.  In accordance with COMAR 10.09.63.02, to accept enrollments by the Department of HealthChoice-eligible Medicaid recipients (the 'Enrollees') up to the maximum numbers specified in Appendix A of this Agreement, and each update to Appendix A of this Agreement, and each update to Appendix A."  Maryland Contract, page 1.

"APPENDIX A
MAXIMUM NUMBER OF RECIPIENTS PERMITTED TO BE ENROLLED IN EACH LOCAL ACCESS AREA IN THE MANAGED CARE ORGANIZATION'S APPROVED SERVICE AREA(S) ...

Local Access Area...Maximum Number of Children Under 21...Maximum Number

Allegany
Anne Arundel North
Anne Arundel South
Baltimore City - SE/Dundalk
Baltimore City East …"  Maryland Contract, Appendix A.

MN

"Section 3.1.2. Enrollment...
B.  Order of Enrollment … The STATE may limit the number of Enrollees in the HEALTH PLAN if in the STATE's judgment, the HEALTH PLAN is unable to demonstrate a capacity to serve additional Enrollees."  Minnesota Contract, page 20.

MT

"2.2  ENROLLMENT LIMITS AND GUARANTEES
A.  Prior to the start of the contract the DEPARTMENT and the CONTRACTOR will mutually agree in writing to establish a maximum Medicaid enrollment level for Medicaid RECIPIENTS by enrollment area...

2.2.1  Enrollment limits
The DEPARTMENT and HCFA must be satisfied with the HMO's ability to serve ENROLLEES in the enrollment area, prior to the initiation of enrollment. Otherwise the CONTRACTOR must submit to the DEPARTMENT proposed enrollment levels by enrollment area and a description of the rationale for each enrollment level thirty (30) days prior to the desired effective date of the request and in the format required by the DEPARTMENT…"  Montana Contract, page 32.

NH

"Article II
Functions and Duties of Contractor
In consideration of the Agreement of the State contained in Article III, Contractor Agrees: ...

2.5  ENROLLMENT LIMITS---To protect itself against over subscription in order to maintain high standards of quality, Contractor may set a limit on the number of incoming Enrollees from all groups, including the State, that may receive services at any one of its health centers or independent practice doctor's office. This limit must be equitably applied for all groups. Contractor shall give sixty (60) days written notice to the State when setting such limits. In addition, the State and Contractor may negotiate specific enrollment limits during the course of the Agreement. Such limits will be established in accordance with Article X. Contractor and the State shall cooperate in informing Enrollees and potential Enrollees about such enrollment limits. This paragraph is not intended to authorize such limitation of Enrollees for whom coverage is already in effect. Any change to the enrollment limits must be executed through a formal Agreement Amendment and subject to Health Care Financing Administration prior approval.

2.6  COMPOSITION OF ENROLLMENT---Medicare and Medicaid Enrollees must constitute less than seventy-five percent (75%) of the total enrollment of the Contractor."  New Hampshire General Service Agreement, page 7.

NM

"2.B.5 Composition of Enrollment
CONTRACTOR shall ensure that Medicare beneficiaries and Medicaid recipients constitute less than 75 percent of its total enrollment If CONTRACTOR also has an agreement to provide Medicare managed care services, CONTRACTOR shall ensure that Medicare and Medicaid beneficiaries constitute less than 50 percent of the MCO's enrollment."  New Mexico Contract, page 27.
 

ND

"2.10  Enrollment Limits and Guarantees
(1)  The Contractor agrees that persons receiving benefits under Medicare (Title XVIII) or Medicaid (Title XIX) shall comprise no more than 75 percent of the Contractor's total enrollment population, unless the Department obtains a federal waiver of this requirement...
This provision does not apply if the Contractor is a grantee under Section 329 or 330 of the Public Health Services Act or an HMO primarily owned and controlled by such grantees...
(2)  Prior to the start of the contract the Department and the Contractor will mutually agree in writing to establish a maximum Medicaid enrollment level for Medicaid recipients by enrollment area.  The Contractor must submit to the Department proposed enrollment levels by enrollment area and a description of the rationale for each enrollment level…"  North Dakota Contract, Attachment C, page 14.

OH

"5101:3-26-02  Managed care plan:  Eligibility, enrollment and automatic enrollment...
(B)  Enrollment.
(1)  The following applies to enrollment in MCPs…
(g)  Except as provided in paragraph (B)(1)(f) of this rule, no more than seventy-five per cent of the enrollees within an MCP's contiguous service area may be medicare beneficiaries and/or medicaid eligible individuals except that:
  (i)  The seventy-five/twenty-five per cent enrollment mix requirement in this rule may be waived annually for a maximum of three years if the HCFA regional administrator waived the similar federal requirement found in 42 CFR 434.26, as amended.
  (ii)  If any federal regulatory agency or legislative body alters the required percentage composition of MCP enrollment, ODHS will make any necessary amendments to conform.
  (iii)  MCPs must notify ODHS within thirty days of HCA's approval to become a medicare-contracting MCP."  Ohio RFP, Appendix E, OAC 5101:3-26-02, pages 1-2.

VA

"3.  Pre-assignment to HMOs
Clients will be pre-assigned to HMOs in accordance with 12 VAC 30-120-370 (E) as follows: ...
D.  All other clients will be randomly pre-assigned to an HMO on a basis of approximately equal numbers by HMO in each locality."  Virginia Contract, page 24.

WV

"3.20 Maximum Enrollment Levels
The Department may establish a maximum Medicaid enrollment level for Medicaid recipients for the Managed Care Plan on a county-specific basis dependent on the Department's evaluation of the capacity of the Managed Care Plan's network. Subsequent to the establishment of this limit, if the Managed Care Plan wishes to change its maximum enrollment level, it must gain the Department's approval…"  West Virginia Contract, page 21.

"4.2.2 Enrollment Limits
Medicaid and Medicare enrollees must constitute less than 75 percent of the MCP's total enrollment."  West Virginia RFA, page 28.