Medicaid Managed Care - U.S. Senate Special Committee on Aging

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tract infections. He cannot perform activities of daily living or instrumental
activities of daily living with out assistance. One kidney
ceased functioning due to a series of UTIs several years ago and
was surgically removed.
This person needs prescription medications to manage spasticity
and the urinary tract infections. This must be supported by ongoing
lab tests to identify the urinary tract infection and to monitor
kidney and liver function to detect drug-related side effects such as
liver damage. He needs to be regularly evaluated by a physical
medicine specialist and a urology specialist.
His general health care should be monitored by a psychiatrist or
other physician knowledgeable about the unique impacts of spinal
cord injury upon major body systems specially the urological system.
He requires ongoing physical therapy to maintain functional
abilities and persona assistance with both ADLs and IADLs. His
assistive technology needs include a powered wheelchair, various
seat cushioning and positioning systems, and arm splints. Routine
health screening and service coordination is required.
Our fourth profile is a 29-year-old woman with cerebral palsy
who walks with a limp but without any mobilit assistance. She
has no speech difficulties. She wants to have children when the
time is right. She was recently rejected by a managed care provider
due to her cerebral palsy. As she ages, the effort that it takes for
her to walk will age her joints and tendons more rapidly than normally.
Eventually, she will require some assistive technology with
mobility, such as a scooter, causing a reduction in the amount of
exercise she gets. This will require a modification in her diet, her
physical therapy, and her exercise regime.
This person requires routine health screening and ongoing physical
therapy to maintain her current good health. When she is
ready to have children, she will need obstetric and gynecological
services from a specialist knowledgeable about disability. As she
ages, she will require an orthopedist or physical medicine specialist
to assist her in determining which mobility aids he should use to
balance the competing needs for mobility and exercise.
In summary although it is difficult to draw conclusions from
only four pro fes of ividuals with disabilities, there are several
overarching themes that can be identified.
The first and most important theme is the need for access to a
variety of specialists, especially those knowledgeable about disability.
These specialists may or may not be most effective playing the
role of primary care physician, depending on the unique needs of
each individual.
The second theme is the need for home and community-based
long-term services and assistive technology. These essential supports
enable individuals with disabilities to access health care, to
work, to attend school, and to recreate. They are critical for the
prevention of secondary disabilities, because they enable people
with disabilities to avoid behaviors that trigger secondary conditions.
The classic example is spinal cord-injured persons who restrict
drinking fluids because they have no assistance in using the
bathroom, which leads to urinary tract infections.
Prescription medications assist people in managing the myriad
conditions that often accompany disability. They too can prevent or