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

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G A O Washiton, D.C. 20548
Health, Edueadion, and
Hma Services Division
B-266320
July 22, 1996
The Honorable William S. Cohen
Chairman
The Honorable David HE Pryor
Ronldr.g Minority Member
<strong>Special</strong> <strong>Committee</strong> on Aging
United States <strong>Senate</strong>
The Honorable Bill Frit
Chairman
Subcommittee on Disability Policy
<strong>Committee</strong> on Labor and Human Resources
United States <strong>Senate</strong>
Adults with developmental disabilities are highly dependent on public
programs for meeting their long-term care needs. Most persons with
developmental disabilities have mental retardation, but others have severe,
chronic disability resulting from cerebral palsy, epilepsy, or other life-long
conditions, except mental illness, that began before they were 22 years
old. The population with developmental disabilities receives more than
$13 billion annually in public finding for long-term care, second only to
the elderly. More than 300,000 adults with developmental disabilities
receive government long-term services financed primarily through
<strong>Medicaid</strong> and to a lesser extent through state and local programs.
Long-term care services can include supervision and assistance with
everyday activities such as help in dressing, going to the bathroom,
managing money, and keeping out of danger. Persons with developmental
disabilities have traditionally received their long-term care in institutional
settings.
Recently, states have begun to significantly expand the use of the <strong>Medicaid</strong>
1915(c) home and community-based waiver, enacted by the Congress in
1981, to provide alternatives to institutional care for persons with
developmental disabilities.' The waiver program has two advantages. First,
it gives states a tool to control costs by allowing them to limit the number
of recipients served. In contrast, states must serve all eligible individuals
in the regular <strong>Medicaid</strong> program Second, it permits states to meet the
needs of many persons with developmental disabilities by offering them a
broader range of services in less restrictive settings such as group or
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