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

174
STATEMENT OF BARBARA SHIPNUCK, DEPUTY SECRETARY
FOR HEALTH CARE POLICY, FINANCE AND REGULATION,
STATE OF MARYLAND DEPARTMENT OF HEALTH AND MEN-
TAL HYGIENE, BALTIMORE, MD
Ms. SHIPNUCK. Good morning. I am Barbara Shipnuck. I am the
Deputy Secretary for Health <strong>Care</strong> Policy, Finance and Regulation
for the State of Maryland, and we are the newest 1115 to come on
line.
Unlike some States, we chose to go statewide and to include both
our disabled and traditional moms' and children's welfare population
in our demonstration project. The demonstration's official
start date was on June 2; our first day of capitation and services
was July 1. As of yesterday, of the 330,000 people we plan to enroll
in the 5-month rollout phase between June and November, we had
89,000 individuals enrolled.
The guiding principles behind the development of Maryland's
1115 waiver application and the program we designed was to place
our <strong>Medicaid</strong> recipients into what we call a "medical home"; this
was the guiding principle of our secretary, Marty Wasserman,
whom some of you know from his background as a local health officer
and his presence in many of the national associations. So he
was determined that not only would we create a medical home for
these individuals and, as Mr. Scanlon pointed out, that's one of the
areas where you particularly have to pay attention if you are dealing
with special needs populations-ut he was also determined
that we combine the <strong>Medicaid</strong> impetus and the financing concerns
that we all share with the health paradigms that often are
overlooked when you try to roll into just a <strong>Medicaid</strong> managed care
program without the tie-ins to the milestones that your State is
facing and the targets for the year 2000 without reassessing what
your strengths and weaknesses are and without working very
closely with your public health comrades in your department or
your State structure.
In Maryland, we may be unique in terms of the way our department
is structured, because our public health and <strong>Medicaid</strong> are
under one department, and yet our eligibility and human resources
and environmental health are in a separate department. So we
tend to have basically two branches in the department that the
Secretary supervises, and those are the <strong>Medicaid</strong> and the public
health sides. So there was a tremendous amount of linkage and collaboration
as we went through the process at the department.
But what Maryland did, which we are very proud of, and it is
now being held up as a model for States that are beginning to
enter the arena, was to have a very, very extensive public process
in the development of our program from the very, very beginning.
So, unlike some States where the State itself designed the program
and then took it out for review or submitted it to HCFA and then
got the public comments, Maryland worked with the various constituencies
from the very beginning.
So during 1995, there was a committee that continued to grow
because different constituencies, advocacy groups, individuals, and
legislators wanted to participate, and at the final count, there were
132 individuals on this committee who reviewed the various proposals
and steps for what kind of waiver application the State of