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

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I have tried to list both the opportunities and the challenges of enrolling
the disabled population into managed care. In numerous conversations I had
with disabled individuals and advocates in preparation for this testimony, I
have put together a list of recommendations for next steps:
1. Move slowly and deliberately with caution. We are not ready to
go statewide, much less nationwide with moving the disabled into
managed care. We should look at developing pilots and
demonstrations and then evaluate their outcomes.
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
being delivered now, where can improvement be made, and how
do we ensure that we measure the outcomes. Disabled people
will tell you they know where dollars can be saved, but managed
care must include them in this discussion.
3. We must develop a credible risk adjustment payment methology
for this population. There is much talk about this for other
government populations (i.e. Medicare and <strong>Medicaid</strong>) but nothing
has been developed so far.
4. <strong>Managed</strong> care will have to address some of its utilization controls
and benefit limits. They may not be appropriate for a disabled
population.
5. <strong>Managed</strong> care will also need to be aware of the concern by many
in the disabled community about the over medicalizing of the
personal care attendant model. <strong>Managed</strong> care will need to
balance its risk management and quality assurance needs with
the appropriate independence agenda of many disabled people.
6. <strong>Managed</strong> care organizations must build trust with disabled
members. If a disabled person is mandated into joining an HMO,
and they are unhappy or mistrustful, they run the risk of noncompliance
or open defiance of care regimens.