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

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Broad and explicit state health department involvement at all stages of the 1115 process.
A. Assuring the Integration of all State Departmental Resources for
Transition to <strong>Medicaid</strong> <strong>Managed</strong> <strong>Care</strong> in order to ensure greater
commitment on the part of state <strong>Medicaid</strong> staff to the conversion to
managed care, staff needs to be fully integrated into a collaborative
process by which planning of the pre-applieation and design phase
takes place. Staff also should be involved during the approval,
implementation and monitoring and evaluation phases, again to
ensure an understanding of the goals to be achieved and a
commitment to facilitating the transition.
The appropriate state agencies, including public health, should be
invited to provide the necessary resources for adequate technical
assistance to the state <strong>Medicaid</strong> agency to assist in anticipating
potential problem areas.
B. Reconciling Conflicting Policies between State Departmental
Discretionary Programs and the New <strong>Medicaid</strong> System
Programmatic authority for health care services to vulnerable
populations (persons with HIV/AIDS, minority populations, and
persons with mental health and substance abusc probles)
historically have been a central mission of PHS agencies, such as
Ryan White CARE Act Title I and 11 funds, Maternal Child Health
Block grants, Mental Health/Substance Abuse Block grants and so
on. The restructuring of the <strong>Medicaid</strong> delivery system inherent in
the 1115 waiver program may place manv of these federally
funded programs in jeopardy due to the loss of <strong>Medicaid</strong>
reimbursement dollars. Other asras where this may be problematic
are Federally Qualified Health Centers, and mental health and
substance abuse disorders. Due to these potential conflicts and
ramifications for much needed programs, the State Department of
Health should assess the impact of its waiver proposal on their
federally funded programs that may be working at cross purposes
with their existing <strong>Medicaid</strong> program. The state should identify
policy options targeted toward specific programs that may need
assistance during crucial transition periods in to <strong>Medicaid</strong> managed
care, for example providing transitional financial support to a
program during the phase-in of <strong>Medicaid</strong> managed care.
2. Stakeholder Involvement in the Development and implementation of Waivers.
State <strong>Medicaid</strong> agencies need to involve public health agencies, social service agencies
and other key stakeholders, such as non-governmental organizations, consumer groups
and family members, patient advocacy groups, providers, and any other relevant