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

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Appendix I
Scope and Methodology
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We focused our work on <strong>Medicaid</strong> 1916(c) waivers for adults with
- developmental disabilities. We also examined related aspects of
institutional care provided through Icnas, state plan optional services, and
the csLA program, all under <strong>Medicaid</strong>.
To address our study objectives we (1) conducted a literature review,
(2) interviewed national experts on mental retardation and other
developmental disabilities, (3) collected national data on expenditures and
the number of individuals served, and (4) collected and analyzed data from
three states. National experts interviewed included officials at HCFA; the
Office of the Assistant Secretary for Planning and Evaluation (AsrE) in the
Department of Health and Human Services; the Administration on
Developmental Disabillties; the President's <strong>Committee</strong> on Mental
Retardation; the National Association of Developmental Disabilities
Councils; the Administration on Aging; the National Association of State
Directors of Developmental Disabilities Services, Inc. (NADDDS); and the
ARC, formerly known as the Association for Retarded Citizens. We also
interviewed researchers at University Affiliated Programs (uAp)u on
developmental disabilties at the Universities of Illinois and Minnesota and
Wayne State University.
We conducted our case studies in Flocida, Michigan, and Rhode Island. We
chose these states for several reasons. The three states provide a range of
state size and geographic representation. Each state has a substantial
developmental disability waiver program that serves more people than its
ICFrMR program. Experts told us that these states would provide examples
of different state strategies for utilizing the <strong>Medicaid</strong> waiver. This included
their policies regarding large and small institutions as well as the design
and implementation of their waiver programs. The three states also have
important differences in the administrative structure of their
developmental disability programs. Rhode Island administers its waiver
program statewide through the Division of Developmental Disabilities in
the Department of Mental Health, Retardation and Hospitals. Florida
places statewide administration and oversight responsibility for its waiver
program in Developmental Services, the Department of Health and
Rehabilitative Services, but operational responsibility rests with its 15
district offices of Developmental Services. Michigan places statewide
administration and oversight responsibility for its waiver programs in the
state Department of Mental Health, but operating responsibilities rest with
52 Community Mental Health Boards (cMHs), which are local government
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