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

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Title V of the Social Security Act authorizes state programs to improve the
health of mothers and children, including children with special health
needs. These programs, which are limited in scope and vary among states,
provide and promote state and community-based systems of services for
children with special health needs and typically serve children from lowand
moderate-income families. Such programs arrange for initial
assessments, service plans, outpatient specialty physician services, and
therapies and care coordination for children with various chronic
conditions. Disabled children may receive various therapies and assistive
equipment-speech therapy and wheelchairs, for example-funded from
title V as well as from schools that must assure children access to certain
medical services that allow them to participate in schooL In many cases,
these services and equipment are also covered by <strong>Medicaid</strong>.
The often conflicting or overlapping requirements of <strong>Medicaid</strong> and other
programs, particularly Medicare, have been cited as a barrier to including
dually eligible beneficiaries in mandatory prepaid managed care programs.
In general, state officials cited the inflexibility of Medicare rules as a
deterrent to developing a <strong>Medicaid</strong> prepaid program that includes those
dually eligible for Medicare. Including those eligible for other programs
gives rise to the need for negotiations and extensive coordination between
the <strong>Medicaid</strong> staff, HcFA, and representatives from plans and other
agencies serving those beneficiaries. Table 2.4 provides examples of
barriers states encounter when attempting to include dually eligible
beneficiaries.
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