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

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abled population will all need services-some a little, some a lot,
but they will all need some kind of medical services. So I would
agree with some of the comments here earlier about the viability
of a primary care model and so on.
Second, their health status can be much less predictable and
more volatile than any other <strong>Medicaid</strong> or commercial population
that we enroll.
Third, managed care organizations-and we heard about this
earlier-often To not have contractual relationships with the types
of care settings and care providers who provide services to this population.
Fourth, rate-setting is particularly challenging for the disabled
population because of the volatility of health status and the unique
special needs that are often present.
Fifth, managed care organizations, because of liability and risk
management issues, may feel that they need to credential and certify
providers, thereby potentially over-medicalizing services that
are provided by friends and families of the disabled.
Sixth-Barbara mentioned this-disabled individuals often have
longstanding relationships with certain providers, many of whom
have been providing services to those populations often for years.
If the disabled individual is required to change providers, the impact
could be disruptive to the care plan and demoralizing for the
member.
Having listed those challenges, I also think there are positive opportunities
for managed care and the disabled population. No. 1, if
the disabled population represents the last basion of fee-for-service
medicine, and reimbursement continues to decline, this population
runs the risk of decreased access to health care services and programs
and the possibility of the creation of a two-tiered system,
one for the disabled and one for the rest of us.
No. 2, managed care through its purchasing power can reduce
the cost of certain services and drugs needed by the disabled person.
No. 3, managed care can act as an advocate for the disabled
member-and we have certainly seen that in my health plan with
the AFDC and elderly populations-ensuring access to quality services.
No. 4, managed care, through its credentialed network, can
measure quality outcomes on behalf of the members.
I have tried to list both the opportunities and challenges of enrolling
the disabled population into managed care. In numerous
conversations I have had with disabled individuals and advocates
in preparation for this testimony as well as the work we have done
over the last 12 years, I have put together a list of recommendations
for next steps.
No. 1, move slowly, deliberately, and with caution. We are not
ready to go statewide in Minnesota, much less nationwide, with
moving the disabled into managed care. We should look at developing
pilots and demonstrations and then evaluate the outcomes of
those pilots.
No. 2, we must include the disabled in the design, implementation
and evaluation process. My experience with many disabled individuals
underscores the need to first look at what services are