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

Al.
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STATEMENT OF ALFONSO V. GUIDA, JR., VICE PRESIDENT,
NATIONAL MENTAL HEALTH ASSOCIATION, ALEXANDRIA, VA
Mr. GuIDA. Ladies and gentlemen, good morning.
I do not have a written statement, and I intend to adhere strictly
to the 10 minutes I have been allotted.
I represent the National Mental Health Association. We are a
voluntary health organization that is concerned about raising
awareness, fighting the social stigma that is attached to mental illnesses,
and raising awareness about the need for health care, specifically
mental health care, for these individuals.
You folks are confronted with a lot of very serious policy issues
as they relate to <strong>Medicaid</strong> beneficiaries and the provision of services
for these individuals within a managed care setting, and I
want to step back a little bit and maybe try to weave some of the
policy issues you are confronted with with some of the day-to-day
realities of the individuals whom we are all concerned about here
at the table.
There are today about 13 million <strong>Medicaid</strong> beneficiaries in some
sort of managed care plan, in some sort of <strong>Medicaid</strong> managed care
arrangement. The vast majority of these individuals are low-income
women and kids, former AFDC recipients, primarily-now, I guess,
TANF recipients, or whatever we are calling the former AFDC program
today.
In most cases, States have not, or have moved more slowly in enrolling
disabled populations into managed care. That is not the
case with people with mental illness, unfortunately. There, the
States have moved with great vigor to enroll people with very severe
mental disorders-schizophrenia, manic depression, major
clinical depression, obsessive-compulsive disorder-into various
managed care arrangements. They have also moved with great
vigor to move children with serious emotional disturbances-youngsters
in the foster care system, youngsters in the special education
system into managed care arrangements to control their costs.
So that more or less, for millions of Americans with severe
mental illness, the vast majority of those individuals depend upon
<strong>Medicaid</strong> for the provision of both their acute care medical services-psychiatric
visits, access to prescriptions for psychotropic
drugs-as well as to an array of community-based services that are
necessary to sustain that individual in a community.
So, what are we talking about here? OK. Let's take schizophrenia
as an example. Ladies and gentlemen, when you have schizophrenia,
there is a series of symptoms that relate to the disorder. Now,
schizophrenia is a biologic imbalance in the brain. Individuals with
schizophrenia have a genetic predisposition to it. What occurs in
most cases, particularly in the most severe forms of schizophrenia,
is that the disease is marked by delusions, hallucinations, disorganized
speech, and grossly disorganized or catatonic behavior.
Now, the age of onset for schizophrenia is 18 to 21. In most
cases, as a result, you will probably never hold a job, or you will
never hold a job involving very serious, long-lasting, cognitive
interaction. Your ability to interact with your family, your ability
to hold a job, your ability to go to school, are all severely impaired