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

101
Our experience with the AFDC populations and the elderly have taught
us several lessons:
1. Humility -
We did not have all the answers and we are continuing to learn
how to better serve low income individuals.
*2. One Size Does Not Fit All -
Small programs targeted to unique members needs (i.e. high risk
pregnant mothers or children with asthma) are more effective than
a population or blanket approach.
3. Listening to the Member -
Our <strong>Medicaid</strong> members have taught us how to design services for
them. We are not the experts.
4. Cannot Separate Health and Social Needs -
A member who is given a prescription which must be refrigerated,
but has no refrigerator, will not be compliant. Knowing the
individuals social supports, housing situation, etc. is critical to
maximizing the effectiveness of health care services received.
As we now begin to explore 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.
The disabled population truly represents, I believe, the greatest
challenge of all for managed care organizations. This is true for a number of
challenges sited below:
1. The disabled individual covered by government programs are on
these programs not because they are low income, but because
they are medically needy. Many require extensive medical care
to address chronic conditions as well as acute episodes of care.
2. Their health status can be much less predictable and more
volatile than other <strong>Medicaid</strong> or commercial populations.