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

697
Some managed care organizations have historcally induded benefciaries on governing bodies or on
their boards of directors. Through participating in the governance of organizations, people living with
HIV have worked in partnership with managed care organizations. Consumer boards are another way for
health care plans to gain input from consumers or to receive technical assistance in analyzing issues. For
these boards to work effectively, however, they must be structured to expand their role beyond simply
advising and they must be given decision-making authority. In the <strong>Medicaid</strong> context, given that all ben-
eficiaries have low incomes, it is necessary for the managed care organizations to pay for the costs of
beneficiaries to participate on governing or consumer boards.
Consumer boards alone, however, are insufficient. <strong>Managed</strong> care programs must have well-articu-
lated grievance processes that allow beneficiaries to challenge denials of service or to complain about
inappropriate care. Additionally, states must monitor grievance patterns in order to identify and
correct on-going problems reported by consumers. States must also support ombuds programs or
consumer advocacy initiatives in order to monitor trends or identify and address newly arising ac-
cess or treatment-related concerns.
Furthermore, it is important to recognize that issues related to parity, indusion and representation of
people living with HIV disease are often difficult to adequately address. A lack of understanding of the
diverity of the HlV-affected communities can make it challenging for the mainstream health care system
to successfully address the needs of people living with HIV. This is complicated by the difficulties assod-
ated with seeking the participation of individuals whose health status frequently changes. People living
with HIV must insist upon being partners with stare <strong>Medicaid</strong> agencies and managed care plans. Wide-
spread participation of the HIV-affected communities and other beneficiaries must be a part of all ded-
sion-making processes regarding <strong>Medicaid</strong> managed care programs.
WHAT IS MANAGED i C
^rsagd M care nss#vr~dse Lcsgratinn .<strong>Managed</strong> ar. is~ Iwalsh ear. driHerIV
egds Iwir a.^ dtel ieskr. system qytentcitsr fr.,qsartiy rtikliln per'
,(wider sdd.zw os, aares, hos-> cngiafktdpaysss~essrarrsng2e.
M AICINO MEDIC AID UANAOCrD C ARE WORK AjAde P1 r hep hrq H11IV