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

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DISCUSSION
Ms. CHRISTENSEN. Don't they know their stuff?
If you have questions and have written them down, you can hold
them up, and we will collect them, or if you just want to raise your
hand, we can take those, too.
Yes.
QUESTION. Question about a legislative proposal.
Mr. SMITH. They excluded or exempted <strong>Medicaid</strong> from the ability
of patients and physicians to decide on length of stay; is that correct?
QUESTION. Yes. [Inaudible.]
Ms. SMITH. Well, it will have a significant effect on the disabled
population because so many of the disabled receive their health
care through the <strong>Medicaid</strong> program. So in that sense, there is a
disproportionate impact on them.
Obviously, it clearly sets up a different standard of care; you now
have two standards of care operating, one for the Medicare program
and one for the <strong>Medicaid</strong> program. Those are effects of those
provisions. I cannot speak to what the motivation was. I would
imagine that the fiscal concerns of the States played a part in that,
but I cannot speak to what motivated it.
Mr. SCANLON. I am sure it was also consistent with the idea that
part of the <strong>Medicaid</strong> changes are to grant States additional flexibility,
and currently under the amount, duration and scope rules,
States have had flexibility that might have been taken away by
that provision, so it would be a step in the other direction.
Ms. CHRISTENSEN. I am going to go to a written question. This
one is for Patsy Riley from someone from an advocacy group, about
the social workers you employ as problem-solvers. Can you have a
sufficient ratio to patient needs and still offer competitive rates?
Then there is a second question: Can you adequately access other
public or private financing for housing, pre-employment services,
and so on, to avoid failing to meet raised expectations?
Ms. RILEY. The first question I think relates to the staffing ratio
of social workers to the number of enrollees we have. Let me just
back up and say that our social work model is not typical of what
you would see, for instance, in a county social worker kind of
model. They are not there to provide continuous and ongoing social
work support services for this population around their other kinds
of housing needs and those kinds of things, but rather to troubleshoot
and try to solve problems that are in the way of their getting
medical services. So it is a different kind of model perhaps than
what you are thinking of in terms of what a county social worker
would do.
Up to this point, we have a staff of four who work in that areaand
keep in mind our <strong>Medicaid</strong> population turns over quite a bit,
so they are kept quite busy in terms of providing the kind of problem-solving
activities that they engage in.
Your other question related to can we interact with or connect
up with other kinds of agencies to maximize or perhaps leverage
dollars that exist in other parts of the system. I think that some
of the interesting demonstration projects that are now going to
come out of this next round of trying to engage the disabled popu-