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

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This has pretty serious implications for the disabled population
where, if a plan is not providing services, they are particularly at
risk. The State's ability to come in and pull them out of a plan because
their enrollment is now the property of the plan becomes
very difficult. So these kinds of issues in pending legislation are
going to have a significant impact on your ability to move these
populations in. If plans have pre-termination rights, you may have
to reconsider how quickly and how much and what extent of services
you are going to put into managed care plans.
The other issue in terms of what is going on right now that will
affect the disabled populations is in the current plans for Medicare
and choices of plans. In other words, people now will start getting,
as Federal employees get, a packet of materials where they can
choose their plan or they can go into the traditional Medicare program.
Obviously, the expectation-if you do not choose a plan, you
automatically go into the traditionally Medicare program. The default
provisions right now, default enrollment into traditional Medicare,
are now regarded as somewhat ambiguous. That is, everybody
thinks that people who do not enroll are going to go into the
main Medicare program, but the language itself is somewhat ambiguous,
so that theoretically, it would be possible through regulation
or subsequent legislation or whatever to have something else
happening with those default enrollees.
I think that if this is an area where everyone has very clear expectations
about what they think is going to happen, you need to
be sure that the legislative language clearly reflects that expectation.
Given the fact that certainly in Medicare managed care, there
is also a similar lack of experience with disabled populations, you
want to be sure that you are not pushing people into these systems
sooner than these systems are ready to take them in.
I think at this point I'll stop.
[The prepared statement of Ms. Smith follows:]