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

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Ms. CHRISTENSEN. Well, so much to absorb; I think I am going
to just go sit at my desk and absorb it.
I know we are scheduled to leave at 11. For our panelists who
are willing to stay and take questions, I believe the room is available,
but if you have to leave, I don't have a problem with your
leaving.
We can just go to questions unless anybody else wants to comment
on anybody else's comments.
Any questions.
Yes.
QUESTION. [Inaudible.]
Ms. CHRISTENSEN. I'm sorry, I can't hear. If you want, we can
put the mike out.
QUESTION. No. I can stand. [Inaudible.]
Ms. CHRISTENSEN. The question is: are many States including
substance abuse in their <strong>Medicaid</strong> managed care.
Ms. SHIPNUCK. We are, and as I indicated, we have indicated
that individuals who need substance abuse services are one of the
special target special needs populations in Maryland.
The Maryland <strong>Medicaid</strong> package traditionally was not a generous
one in terms of the fact that <strong>Medicaid</strong> did not cover residential
treatment for adults, and when we started the program for the
demonstration, we were bound by what had been in the package.
What was very interesting was that as the legislature began to
look at the tie-in with welfare reform, they determined that one of
the barriers to employability was folks who had substance abuse
problems.
So this year, before we even rolled out the demonstration, they
-expanded the substance abuse benefit package so that we have an
enhanced benefit package. We have required managed care organizations
to case-manage that, and we will be tracking that because
the additional piece of it was not in our original capitation configuration.
So we have some nuances to work with, but substance
abuse is very much a specific service available to <strong>Medicaid</strong> recipients
within Maryland.
Ms. HORVATH. I just looked at our June 1996 survey, which was
a point-in-time survey, and we had asked how many States included
substance abuse, and 28 said that they did for some or all
of their enrolling populations. We asked how many are contracting
with a separate risk contract-in other words it is pulled out of the
general MCO contracting-where is a limited benefit in the general
MCO contract or whether the full scope is covered. So States handle
it different ways, but 28 said that in some way, shape or form,
it is a capitated service.
Ms. BARTELS. I would add one other point. We also cover it in
our managed care programs. Substance abuse treatment comes in
many nontraditional models, and nontraditional models are not always
covered by regular <strong>Medicaid</strong> fee-for-service; but in <strong>Medicaid</strong>
managed care, with the appropriate contract requirements and incentives,
managed care organizations will create those flexible and
creative treatment alternatives, for example, that will create opportunities
for moms and their kids to get the treatment they need
without splitting up the family.