The focus of this paper is on enrollment and disenrollment policy and practice in Medicaid managed care. Specifically, this paper examines policies and practices in risk-based programs with attention to Primary Care Case Management (PCCM) program policies only as they specifically interact with risk-based enrollment policies. In risk-based managed care, a Medicaid agency contracts with an entity (the contractor) to provide or arrange for the provision of an agreed upon set of services in exchange for a set fee per person enrolled per month where the prepaid fee does no vary month to month based on services used by the individual enrollee. In other words, in risk-based managed care the contractor assumes some level of financial risk for providing care to enrollees. A PCCM program in this discussion refers to a fee-for-service system where Medicaid pays a nominal amount per PCCM enrollee per month to the provider/care manager in addition to per service fees.