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

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Washington conducts 20-minute interviews with consumers on such issues as
access, voice and ownership of the treatment process. Finally, New York is
developing a peer education program in their Prepaid Mental Health Program.
Beneficiary-run organizations will receive funding to assist beneficiaries learn about
the program and to monitor enrollment practices.
Some states have found it especially difficult to get children and adolescents as well
as their families to the planning table. States have used strategies such as paying for
gas and child care, but noted it was also important to have staff support for the
consumers and family members to educate and support them in understanding the
issues.
Many states use consumer and/or family member satisfaction surveys, but stressed
that by themselves they may be of limited use. More useful information may be
obtained by asking consumers about improvements in their quality of life or ability
to live independently.
Consumer input can also be gained through grievances and complaints. States gain
this type of input through:
* offering consumer hotlines and 800 phone numbers;
* employing consumer advocates;
* studying plan disenrollment and switching;
* aggressively reviewing informal complaints; and
* establishing ombudsman programs outside the system
Delaware found that many <strong>Medicaid</strong> beneficiaries speak freely with enrollment
brokers. The beneficiaries recognize these brokers as independent of either the plans
or the state. The brokers are often available at community areas, and considered
responsive by <strong>Medicaid</strong> beneficiaries. To take advantage of this, the state combined
ombudsman and enrollment functions. However, others worry that the
independence of the enrollment brokers will be compromised if they take on
responsibilities for complaints and grievances.
Using peer leaders to educate consumers on their rights and responsibilities as
managed care enrollees was stressed. Some states also use special care coordinators
who teach persons with mental illness how to enroll and use the system with no
disruption of care.
The National Academy for State Health Policy 0 8/97 IV-96