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

639
and family members, patient advocacy groups, providers, and any other relevant
stakeholders, throughout the waiver process but especially at the early stages of the
development of 1115 Demonstration waivers.
This requires active participation of these agencies and groups during the planning
process to assist in anticipating potential issues that will emerge when designing a
successful transition of <strong>Medicaid</strong> beneficiaries into managed care. States should
strengthen their requirements for consultation that would help bring relevant expertise
and perspectives to the planning and development process of <strong>Medicaid</strong> 1115 waivers land
provide evidence in their applications that such a process was conducted.
Integration of Public Health Functions and <strong>Managed</strong> <strong>Care</strong>
To ensure that the transition to <strong>Medicaid</strong> managed care addresses the needs of the
beneficiary population essential public health functions must bc maintained and
supported via the transition. Public health agencies have been challenged to provide
individual and community-based health services and interventions for disadvantaged
populations. For example, community interventions that alter the environment by either
changing health-related behaviors or reducing the risk of causing a health problem. Many
have relied on <strong>Medicaid</strong> revenue from personal health services to support vital population
overhead public health functions like disease surveillance, food safety and so on. With
the rapid movement of <strong>Medicaid</strong> beneficiaries into managed care, this population's
personal health services needs will be met within the new delivery system, while the
community/core public health functions will remain with public health departments.
Because <strong>Medicaid</strong> funds have been important revenue sources to public health agencies.
their ability to track and intervene on behalf of community-based health issues may be
compromised due to this loss of federal support. This jeopardizes the public health
infrastructure supported by HRSA's MCH block grants and a variety of CDC grants to
States. Thus, deliberate steps in the transition to <strong>Medicaid</strong> managed care should promote
important collaborative public-private partnerships between state and local health
agencies and managed care plans.
Compliance, Monitoring and Evaluation
To assess the quality of health care service delivery and to obtain baseline information
compliance with the special terms and conditions negotiated between the state and
HCFA. monitoring of compliance and evaluation activities are essential. A state working
group, which draws on the expcrt knowledge or individuals and organizations involved in
the assessment of health services among varied patient groups would help identif the
areas that warrant closer scrutiny. In addition, a working group could examine
opportunities for use of some standard data sets across all waivers and develop
mechanism to permit active involvement of appropriate state agencies to participate in
reviewing the proposed evaluation designs..