LESLIE L´ OPEZ University of California, Santa Cruz De Facto Disentitlement in an Information Economy: Enrollment Issues in Medicaid Managed Care This article discusses enrollment issues in New Mexico’s Medicaid managed care (MMC) system and seeks to illuminate reasons for per- sistent problems reported by workers and clients. It argues that between 1997 and 2000, the MMC and welfare reforms raised enrollment barriers by complicating and dehumanizing the system, thus “technically disen- franchising” workers and clients. Specifically, the new system increased the need for professional, in-person enrollment assistance precisely when the state decreased its provision of it. Some aspects of the State Child Health Insurance Program (SCHIP) reforms indirectly aggravated those same problems, and though they also significantly lowered barriers in some areas, overall the new system was plagued with preexisting barri- ers as well as new, unmet needs that produced “de facto disentitlement” to health services. [bureaucracy, enrollment, labor, Medicaid managed care, New Mexico] I t is a warm July afternoon in 1999 at Hand-in-Hand 1 Preschool, in Albuquerque’s South Valley. Today, 2 years after the implementation of Salud!, New Mexico’s Medicaid managed care (MMC) program, the school’s back- yard has been set up for a community “speak-out.” Clients and providers have come here to air concerns and frustrations—and to get some information from someone who knows how it is all supposed to work. One young mother of two stands at the microphone and describes a long chain of bureaucratic snafus. When she and her infant son became eligible for Medicaid and thus Salud!, she called in her selection of an available primary care provider (PCP). But her Medicaid was delayed by 2 months, and, when her card finally arrived, it showed the wrong PCP. She called in to change it, but the change would not be effective for another 30 days. Meanwhile, she and her child were not on the list of the assigned PCP either, so they had no access to care. Her son got behind on his immunizations and her account was sent to collections while she tried to untangle the problems by phone with her Medicaid caseworker, with Salud!, and MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 19, Issue 1, pp. 26–46, ISSN 0745-5194, electronic ISSN 1548-1387. C  2005 by the American Anthropological Association. All rights reserved. Please direct all requests for permission to photocopy or reproduce article content through the University of California Press’s Rights and Permissions website, www.ucpress.edu/journals/rights.htm. 26