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

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model to serve the elderly in Milwaukee and Madison and the Partnership model to assist
the elderly and persons with physical disabilities in Dane County and in rural Eau Claire,
Dunn, and Chippewa counties. The current enrollment in Wsconsin's PACE/Parmrship
program in all sites is 563 recipients.
We also are just completing a research and demonstration grant through a risk-based
capitated HMO for disabled adults in Milwaukee County. This model is unique in the
country in that it represents a partnership between a medical HMO (HumanaWHO) and a
community-based organization (the Milwaukee Center for Independence). The hybrid
organization is called I-CARE (2,714 enroUees).
* Finally, we operate a carve-out behavioral health managed care program for children with
severe emotional needs in two urban counties. Dane and Milwaukee (344 enrollees). Both
programs are fully risk-based.
All of Wisconsin's managed care programs operate from the same basic principles. These are:
* quality improvement activities must be multi-pronged;
- <strong>Medicaid</strong> managed care must be accountable to all interested parties;
v managed care programs must be targeted to the enlled populations; and finally,
* a broad public/private parmership is necessary to succeed.
These principles apply to managed care for all enrolled populations, including children and
adults with special health care needs. We define persons with special baalth care needs to
include the frail elderly and disabled children and adults. Disabled children and adults are
persons with developmental delays or disabilities, alcohol or other drug abuse problems.
physical disabilities, or mental illness. Persons in all these groups are enrolled in managed
care in Wisconsin Many of the children in our largest HMO program for low-income
families have special health care needs.
Wisconsin's managed care principles allow, and im fact reqiire, our targeted programs to be
flexible and responsive to different recipient groups. However, the fitdamental strategies
needed to support these principles are the same regardless of the population served.
It is important to note that states need flexibility to implement these principles. I will describe
what has worked in Wisconsin, but must emphasize that states are different and 'one size does
not necessarily-fit all."
A We believe the great secret of <strong>Medicaid</strong> managed care is that sat <strong>Medicaid</strong> programs, with
their attention to populations most at risk, ame improving managed care for everyone. In order
to met-our unique requirements and standards, we have found that our commercial HMOs
have changed the way they do business - and when they change, they do it for all ceolCes,
not just for <strong>Medicaid</strong>.
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