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

Agency and Other
Comments
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extensive experience with voluntary programs may not fully prepare
health plans and state officials if as research suggests, those who select
prepaid care in voluntary situations tend to be healthier than those who do
not. A state may find it useful to develop and operate a targeted or
relatively small-scale program before moving to any large-scale effort to
mandate the enrollment of disabled beneficaries, Smal-scale programsr
would allow health plans, beneficiaries, and state staff to gain experience
with meeting the diverse and complex needs of disabled individuals in a
prepaid setting
For states that elect to move immediately into a large-scale program, the
areas shown in figure 5.1 are even more criticaL Adequate preparation,
consensus-building, and program safeguards assume greater significance
when substantial numbers of people are being added, particularly if their
ability to change plans readily is limited.
Understanding the various approaches currently being tried will provide
states with a good starting point for planning their own efforts. Making
prepaid managed care work for disabled individuals will be achieved only
through the combined and continuing efforts of states, health plans, and
beneficiaries and their advocates.
We provided a draft of this report to the Administrator, HCFA. The draft
report was reviewed by officials in HCFA'S Office of <strong>Managed</strong> <strong>Care</strong>, Office
of Research and Demonstrations, and the <strong>Medicaid</strong> Bureau. HCFA officials
had no technical or other comments on the report draft In addition, we
provided relevant sections of the draft report to <strong>Medicaid</strong> staff from the 17
states in our report. All but one state responded with comments, generally
agreeing with the accuracy of the information. Officials in Arizona
commented that the draft report seemed to suggest prepaid managed care
is not suitable for people with disabilities. We believe, instead, that given
the limited state and health plan experience with serving disabled
individuals in prepaid care and the medical complexity of their health care
needs, careful attention is required in designing, implementing, and
monitoring programs for this population.
In addition to requesting comments from HCFA and state agencies, we
provided the draft report to several independent researchers from the
National Academy for State Health Policy, the <strong>Medicaid</strong> Working Group,
MEDSTAT, and Fox Health Policy Consultants These researchers
generally agreed with the accuracy and comprehensiveness of our
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