Marketing

To prevent overreaching, states set various limitations on marketing.  Cold calling and door-to-door selling often are prohibited.  Some states limit or prohibit promotional gifts; more generally, MCOs often are prohibited from engaging in activities that could mislead consumers. Such standards can also apply to service providers, in order to limit a providers’s ability to steer consumers to a particular MCO.

Contents – To access the full text, please click each sub-topic.

  • MCO may not pay commission compensation to community outreach representatives for new members: Florida a
  • MCO may base compensation of marketing representatives on periodic performance evaluations which consider enrollment productivity as one of several performance factors: New York b
  • MCO may market directly to members or potential members only with marketing plan and marketing materials approved by state: Wisconsin c
  • MCO must prepare marketing plan and submit plan for approval to state: New York d
  • State is responsible for all marketing to members during enrollment process: Kansas e
  • Community outreach representative must refer all MCO inquiries to member services section or enrollment broker: Florida f
  • MCO must advise potential members that they should verify with preferred medical providers whether provider is included in MCO network: New York g
  • MCO marketing activities must occur in its entire service area in the county, and materials must be equitably available to all consumers eligible for enrollment: Wisconsin h
  • Marketing materials must be submitted to all members, unless otherwise approved by state: Kansas i
  • Representatives must inform consumers that representative is not state employee or enrollment specialist, if asked: Florida j
  • MCO must develop and implement written plan designed to control actions of its community outreach representatives: Florida k
  • MCO is responsible for actions of representatives: Florida l, New York m
  • MCO must provide initial and periodic training to representatives about outreach and marketing provisions of contract: Florida n
  • MCO must register each community outreach representative: Florida o
  • MCO must conduct background check of community outreach representatives: Florida p
  • MCO must report any community outreach representative who violates contract to state: Florida q
  • Representatives must wear identification showing MCO they represent: Florida r
  • MCO may do direct marketing of product to eligible members and those who will become eligible within next 6 months: Minnesota s
  • MCO is prohibited from direct marketing for product except through mailings and publications: Minnesota t
  • MCO must follow state’s Medicaid marketing rules and federal requirements under 42 CFR § 438.104: New York u
  • Marketing materials defined: New York v

  • MCO is prohibited from marketing for enrollment to any potential member: Florida w
  • MCO must not market to members of other health plans: New York x
  • Direct solicitation of consumers is prohibited: Kansas y
  • MCO must not communicate to any potential member to influence any enrollment or disenrollment decisions: Kansas ``
  • MCO must not engage in activities that could mislead or confuse: Florida aa, Kansas bb, Minnesota cc, New Mexico dd, New York ee, Wisconsin ff
  • MCO may not give away promotional items over $5 retail value: Florida gg
  • MCO may not use gift or other incentives to entice people to join: New Mexico hh
  • MCO must not offer any other insurance product as enticement to enroll: Kansas ii
  • MCO may not assert or imply that consumers will lose Medicaid benefits if they do not enroll with MCO, or inaccurately depict the consequences of choosing different MCO: New Mexico jj
  • MCO must not assert that it is endorsed by CMS, or federal or state government: Kansas kk
  • MCO is prohibited from stating that the recipient must enroll in MCO in order to obtain benefits or in order not to lose benefits: Kansas ll
  • MCO may not design marketing or outreach plan which discourages or encourages selection based on health status or risk: New Mexico mm
  • MCO is prohibited from asserting or implying that MCO offers unique covered services when another MCO provides same or similar service: New Mexico nn
  • MCO may not engage in door-to-door or “cold call” marketing: Kansas oo, New Mexico pp, New York qq, Wisconsin rr
  • MCO must submit notice to state to participate in a health fair or public event: Florida ss
  • MCO must submit additional disclosures to state if MCO is primary organizer of public event, or if MCO was invited by community organization: Florida tt
  • MCO’s community outreach representatives may provide outreach materials at health fairs and public events so long as main purpose of event is for community outreach, not marketing: Florida uu
  • MCO may engage in brand awareness activities at events that are not health fairs or public events: Florida vv
  • MCO may leave community outreach materials at health fairs and public events: Florida ww
  • MCO may send no more than 2 mailings per calendar year to members or potential members: Minnesota xx
  • MCO may not distribute materials in emergency rooms, provider’s offices, or other service delivery sites: New York yy
  • MCO is prohibited from using third-party-vendor mailing lists that specifically identify Medicaid recipients: New York ```
  1. Fla. Contract, Atch. II, p. 60.  (back)
  2. N.Y. Medicaid Advantage Plus Contract, App. D, p. 7.  (back)
  3. Wis. Contract, pp. 25, 126.  (back)
  4. N.Y. Medicaid Advantage Plus Contract, App. D, p. 5.  (back)
  5. Kan. RFP, p. 97.  (back)
  6. Fla. Contract, Atch. II, p. 61.  (back)
  7. N.Y. Medicaid Advantage Plus Contract, App. D, p. 3.  (back)
  8. Wis. Contract, p. 127.  (back)
  9. Kan. RFP, p. 98.  (back)
  10. Fla. Contract, Atch. II, p. 63.  (back)
  11. Fla. Contract, Atch. II, p. 58.  (back)
  12. Fla. Contract, Atch. II, p. 58.  (back)
  13. N.Y. Medicaid Advantage Plus Contract, App. D, p. 4.  (back)
  14. Fla. Contract, Atch. II, p. 63.  (back)
  15. Fla. Contract, Atch. II, p. 63.  (back)
  16. Fla. Contract, Atch. II, p. 63.  (back)
  17. Fla. Contract, Atch. II, p. 63.  (back)
  18. Fla. Contract, Atch. II, p. 63.  (back)
  19. Minn. Contract, p. 48.  (back)
  20. Minn. Contract, p. 48.  (back)
  21. N.Y. Medicaid Advantage Plus Contract, App. D, p. 4.  (back)
  22. N.Y. Medicaid Advantage Plus Contract, App. D, p. 2.  (back)
  23. Fla. Contract, Atch. II, p. 59.  (back)
  24. N.Y. Medicaid Advantage Plus Contract, App. D, 7.  (back)
  25. Kan. RFP, p. 97.  (back)
  26. Kan. RFP, p. 98.  (back)
  27. Fla. Contract, Atch. II, pp. 59-60.  (back)
  28. Kan. RFP, p. 98.  (back)
  29. Minn. Contract, p. 49.  (back)
  30. N.M. Contract, p. 150.  (back)
  31. N.Y. Medicaid Advantage Plus Contract, App. D, p. 6.  (back)
  32. Wis. Contract, p. 128.  (back)
  33. Fla. Contract, Atch. II, p. 60.  (back)
  34. N.M. Contract, p. 150.  (back)
  35. Kan. RFP, p. 98.  (back)
  36. N.M. Contract, p. 149.  (back)
  37. Kan. RFP, p. 98.  (back)
  38. Kan. RFP, p. 98.  (back)
  39. N.M. Contract, p. 149.  (back)
  40. N.M. Contract, p. 150.  (back)
  41. Kan. RFP, p. 98.  (back)
  42. N.M. Contract, p. 150.  (back)
  43. N.Y. Medicaid Advantage Plus Contract, App. D, p. 6.  (back)
  44. Wis. Contract, p. 127.  (back)
  45. Fla. Contract, Atch. II, p. 58.  (back)
  46. Fla. Contract, Atch. II, pp. 61-62.  (back)
  47. Fla. Contract, Atch. II, p. 58.  (back)
  48. Fla. Contract, Atch. II, pp. 58-59.  (back)
  49. Fla. Contract, Atch. II, p. 61.  (back)
  50. Minn. Contract, p. 49.  (back)
  51. N.Y. Medicaid Advantage Plus Contract, App. D, p. 6.  (back)
  52. N.Y. Medicaid Advantage Plus Contract, App. D, p. 6.  (back)

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