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

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Ms. CHRISTENSEN. Thank you.
Go ahead, Peggy.
STATEMENT OF PEGGY L. BARTELS, DIRECTOR, DIVISION OF
HEALTH, BUREAU OF HEALTH CARE FINANCING, WISCONSIN
MEDICAID PROGRAM
Ms. BARTELs. Good morning. My name is Peggy Bartels, and I
am the Director of the Bureau of Health <strong>Care</strong> Financing and am
responsible for the administration of the Wisconsin <strong>Medicaid</strong> Program.
Thank you for the opportunity to speak with you today.
My testimony has been provided to you as an attachment, a
handout, if you d like to follow along.
Wisconsin <strong>Medicaid</strong> is the State's largest health insurer. In fact,
it is ten times larger than the single largest health insurer in the
State. Our annualbenefits budget is $2.4 billion, covering one of
the broadest benefit packages in the Nation. Approximately
450,000 persons are eligible for Wisconsin <strong>Medicaid</strong>-almost 10
percent of the population.
We administer our <strong>Medicaid</strong> program in a highly efficient manner.
Approximately three-quarters of our administrative resources
are contracted to the private sector. Our administrative costs are
just over 2 percent of our benefits costs, while the average health
plan in Wisconsin has administrative costs ranging from 8 to 15
percent.
We have made a long-term commitment to managed care for
<strong>Medicaid</strong> recipients. In general, we define "managed care" to mean
capitated, risk-based contracts for comprehensive health care with
licensed insurance companies that are HMOs. Wisconsin <strong>Medicaid</strong>
started contracting with HMOs for low-income women and children
in 1984, so we have a decade-and-a-half of experience.
Since then, we have started managed care programs for the elderly
and disabled, which we are now evaluating and intend to expand.
We have a strong HMO market in Wisconsin, and the benefits
of Wisconsin <strong>Medicaid</strong> managed care are well-recognized. We
have demonstrated significant savings while at the same time improving
access and health care quality.
We currently administer the following specific managed care programs.
Our largest HMO program is the one for low-income women
and children, operating in 68 out of 72 countries-in fact, every
county where there is an HMO. Nineteen HMOs provide comprehensive
health care to 202,000 recipients. In addition, we administer
numerous managed care demonstration projects for the elderly
and disabled. These programs include our program for all-inclusive
care for the elderly, the PACE projects, and our unique
partnership program, an HMO program for disabled adults, and
managed care programs for severely emotionally disturbed children.
These programs are summarized in some detail in one of the
attachments you have.
All of Wisconsin's managed care programs operate from the same
basic principles: quality improvement activities must be multipronged-no
one thing tells you what's going on. <strong>Medicaid</strong> managed
care must be accountable to all interested parties. <strong>Managed</strong>
care programs must be targeted to the enrolled population, and a
broad public-private partnership is necessary to succeed.