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

239
necessarily relevant to the AFDC population. So it is a new set of
issues for States that they are attending to.
In this packet, which I hope you all have, by way of background
information, I have put together a chart on the state enrollment
carve-out policies. The chart shows that most of the States are not
enrolling these populations. There are a number of States that actually
prohibit enrollment, whether their program voluntary or
mandatory, of a variety of special needs populations: the dually eligible
receiving home and community-based long-term care services,
people receiving institutional long-term medical, children in foster
care, and subsidized adoption.
There is another chart that you might want to look at concerning
the eligible population, and which is demonstrative of some of the
points that I want to bring home today, about the connection to the
long-term care and the service support system. There is a chart in
here that shows the number of States that are enrolling dually eligible
persons; whether that enrollment is voluntary or mandatory;
and the linkage of the health care system in which they are enrolled
to the long-term care system. So you can see that some
States are ahead of others in creating that linkage, but all States
have got to address that linkage in one way or another. This highlights
how they do it.
I have another chart in here about the number of States that are
enrolling elderly and adults with disabilities. The States that are
enrolling children with disabilities are not included in this chart
but they are few in number. This chart gives you a view of some
data we collected on a survey that we did which captured the extent
of mental health coverage under a risk contract, the extent of
nursing facility coverage, and the extent of home health coverage
under risk contract. So you can see, again, what the connection is
between these other services and medical care for special needs
populations.
I also want to turn your attention briefly to a list of the kinds
of issues that States need to consider as they look to expanding
risk-based contracts and to include these populations. I purposely
left rate-setting off of this list. I felt fairly certain that that had
been covered somewhere before in these forums; it always is.
Ms. CHRISTENSEN. We will probably do a hearing on rate-setting
and a couple other big issues.
Ms. HORVATH. The first issue, I think, outside of rate-setting that
States need to consider is coordination of services across systems.
The special needs populations are dealing with a variety of service
systems: long-term care, school-based systems for children with
special educational needs, case management. So many of the special
needs population adults and children are working in multiple
programs with multiple case managers. State program policy needs
to consider this fact and decide how it should be handled as the responsibility
of the HMO or not.
Also, I would like to mention the State of Utah and their foster
children enrollment in Salt Lake City. How they have addressed
this issue of case management is they have a case manager outside
the HMO. They do not require the HMO to coordinate services, but
they have an outside case management nurse for these children
who coordinates their health services within the HMO, does the fol-