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

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Ms. CHRISTENSEN. Thank you.
I think Jane is going to tell us about some of the other States
and what they are doing.
STATEMENT OF JANE HORVATH, DIRECTOR OF MEDICAID
PROJECTS, NATIONAL ACADEMY FOR STATE HEALTH POLICY
Ms. HORVATH. I am going to take probably a more shotgun approach
to this issue this morning. I appreciate the opportunity to
be here, and thank you for inviting me.
The National Academy for State Health Policy is a nonprofit organization
based in Portland, ME. We receive most of our funding
through foundations and do work with specific States around issues.
We have done a lot of work around enrollment of elderly and
disabled populations into <strong>Medicaid</strong> managed care programs for a
number of years, and I myself am working on a project with another
very special population within <strong>Medicaid</strong>, which is foster care
children enrollment into <strong>Medicaid</strong> managed care. I am working on
a Cummings Foundation project specifically with five States, building
interagency teams, to look at how best to do this for I think
what is arguably the most vulnerable of generally vulnerable population
of <strong>Medicaid</strong> clientele.
I want to just give you some background, and I really wanted to
zero in on special needs adults and children within <strong>Medicaid</strong> and,
in our experience, the things that States have to consider, I want
to give some brief examples of how States have approached the
issue of <strong>Medicaid</strong> managed care and vulnerable populations.
I have some handouts with charts that I'm not going to go into
detail on, but just reference.
Our records show that as of January of this year, there were 26
States that were enrolling elderly and/or some portion of disabled
populations into risk-based <strong>Medicaid</strong> managed care. I think what
is most important to keep in mind when you think about this population
and you think about what States are doing is to understand
that currently, of the 38 risk-contracting States, that most <strong>Medicaid</strong>
managed care programs as of yet do not integrate long-term
care or long-term support under a capitated program, which becomes
a crucial aspect when you are talking about children and
adults with special health care needs.
Concurrent with that, the other important caveat to keep in
mind is that most <strong>Medicaid</strong> programs, whether or not they are enrolling
elderly and disabled, do not integrate Medicare into their
system of care. It is an extremely difficult thing to do. It is not for
lack of desire on the part of State <strong>Medicaid</strong> agencies, but that's another
whole issue of politics and policies. You need to keep in mind
because both of those caveats when long-term care services and
supports are not integrated, people have to walk through at least
two systems, and it can create cost-shifting incentives that did not
necessarily exist in the fee-for-service system. When Medicare is
not integrated, it can certainly create cost-shifting incentives that
did not exist under fee-for-service.
So we try to keep these things in mind when we are thinking
about enroling special needs populations, elderly/disabled adults
and children, into <strong>Medicaid</strong> managed care. These issues are not