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

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populations we serve in our <strong>Medicaid</strong> program. We also create multilingual
materials; all of our enrollment and communication materials
are in the above-mentioned languages. We hire social workers
who are basically problem-solvers. Their role is to figure out, based
on the mini health assessments that we do, where services are
needed, and they go out and connect this population with
nonmedical services.
These are just a few of the programs that we have added since
beginning to work with low-income and elderly populations 10
years ago. These innovations are illustrative of the important
value-added features that managed care organizations must be
willing to develop and invest in in order to adequately meet the
needs of nontraditional managed care populations.
Each of the above programs was designed based on barriers to
getting needed services that have been identified by either members
or our providers. We quickly learned that coverage does not
equal access, and that by merely enrolling the AFDC and the elder-
Il populations into a managed care plan and expecting them to
then look and act like a commercial population is a big mistake indeed.
Our experience with the AFDC population and the elderly have
taught us several lessons. No. 1 is humility. We did not have all
the answers, and we do not have all the answers now. We are continuing
to learn how to better service low-income individuals on a
daily basis.
No. 2, one size does not fit all. Small programs targeted to
unique member needs like high-risk pregnant mothers or children
with asthma or dual-eligibles are much more effective than a population
or blanket approach.
No. 3, listening to the members. Our <strong>Medicaid</strong> members have
taught us how to design services for them. We are not the experts.
No. 4, you cannot separate health and social needs. A member
who is given a prescription which must be refrigerated and who
has no refrigerator will not and cannot be compliant. Knowing the
individual's social supports or lack thereof their housing situation,
and so on, is critical to maximizing the edfectiveness of health care
services received.
As we now begin to explore again enrolling the disabled population,
we are trying to learn from these lessons of the past. The
rest of my testimony will provide insight and recommendations for
how managed care organizations can effectively develop programs
to meet the needs of this unique population.
I believe the disabled population-and I have been in this business
for 10 years-represents the great challenge of all for managed
care organizations, and I have been cheered by some of the
comments about how this population should be able to naturally fit
into this, because I perceive that there still may be some barriers
or reticence on behalf of managed care in regard to this population,
and it is for the challenges that I am going to cite below.
We have talked briefly about this, but the disabled individuals
who are covered by Government programs are on these programs
not necessarily because they are low-income but because they are
medically needy. Unlike any other population that we enroll, where
you will have some healthy and some who need services, the dis-