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

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3. <strong>Managed</strong> care organizations often do not have contractual
relationships with the types of care settings and care providers
- who provide services to this population.
4. 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.
5. <strong>Managed</strong> care organizations, because of liability and risk
management issues, may feel that they need to credential and
certify providers, thereby over-medicalizing services that are
provided by friends or families.
6. Disabled individuals often have long standing relationships with
certain providers, many of whom may have been providing care
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.
There are also positive opportunities for managed care and the disabled
population:
1. If the disabled population represents the last bastion of fee-forservice
medicine and reimbursement declines, this population
runs the risk of decreased access to health care services and
programs and the possibly of the creation a two-tiered system,
one for the disabled, and one for everyone else.
2. <strong>Managed</strong> care, through its purchasing power, can reduce the cost
of certain services or drugs needed by the disabled person.
3. <strong>Managed</strong> care can act as an advocate for the disabled member,
ensuring access to quality services.
4. <strong>Managed</strong> care, through its credentialed network, can measure
quality outcomes on behalf of the member.