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

212
the <strong>Medicaid</strong> program are redeployed" to help us on certain activities, like mandis We also
use a lot of private, contraced resources to help us oversee managed care. We have an
enrollment contract of $1.7 million per year, a contract with an external peer review
organization of $1.4 million per year, special staff from our fiscal agent to assist us with dayto-day
operations of managed care - two Ombudsmen, six Contract Monitors, and four
systems/business analysts to help HMOs with their ulization reporting. We also spend about
$0.5 million per year on contracted actuarial services.
States need significant resources to assist managed care organizations used to working with a
commercial population to work with <strong>Medicaid</strong> recipients. <strong>Medicaid</strong> managed-cae is very
different from commercial managed care. To be successful, managed caretorganizations need
to recogiiz-e these differences and states need to hlp them learn how to aapt their product
lines to serve <strong>Medicaid</strong> recipients. <strong>Medicaid</strong> offers more benefits, is subject to greater public
oversight, and has more federal requirements tD meet than commrdial insurance. <strong>Medicaid</strong>
recipients are poor, generally less educated, and have more chronic health problems than the
commercial population. <strong>Medicaid</strong> recipients have more barriers to accessing hh care.
including the lack of transportation, inability to speak English and cultural doftences. We
believe that our <strong>Medicaid</strong> contract requirements, with their emphasis on the special health care
needs of low-income people, have resulted in significant changes in the commercial managed
care environment.
Developing the kind of broad infrastructure I have described - strong connact requirements;
credible vehicles for public accountability; programs tailored to c rs needs and
preferences; adequate access, choice and opportunity for consumer input; and strong audit and
enforcement capacities - takes time and money. Many state, <strong>Medicaid</strong> programs, including
Wisconsin's, have invested both for some time now.
<strong>Medicaid</strong> has become the national laboratory to refine and improve managed care. I am
confident that states can use their resources and experience to improve health care for persons
with special health care needs, while continuing to slow the rate of <strong>Medicaid</strong> expendintre
growth
-6-