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

814
combination of HealthPartners dollars, public program
dollars, and the public educational system. The areas where
the exact sources of funding are unclear include: case
management, physical therapy (PT), occupational therapy
(1), speech and language services, home health/personal
care attendant (PCA) services, and to a smaller degree,
durable medical equipment and medications.
Most families qualify for, or purchase, supplemental
coverage for these services. However, the vast majority of
those children receive PT, OT, and speech/language services
from-school. Usually the school pays the cost for these
services and they are neither coordinated with, nor
reimbursed, by HealthPartners or medical assistance (MA)/
TEFRA programs.
This underscores the larger public policy issue: Who is
responsible for paying for the care of children with special
health care needs? If HealthPartners provides a more
generous or comprehensive.benefit-package than its
competitors, it will cost moreand attract more families with
chronically ill children than would normally occur, resulting
in a competitive disadvantage.
The data indicate that the school system provides most of
the occupational therapy, physical therapy, and speech and
language services that this population receives. If the parent
survey is representative and schools cover between 60-80% of
these services, their annual cost for these 410 children within
HealthPartners would be between $400,000 and $800,000, two
to four timesgreater than the amount HealthPartners paid for
these services over the same period.
, -HealthPartners, like other health insurance providers,
typicallynbases theirbenefits on adult, acute,.rehabilitative
therapies rather than the habilitative needs of children. For
adults, PT; OT, and speech/language services are designed to
help adults regain function as a result of illness ok injury.
Since a child often never had the ability, for example, to walk
or talk in the first place; they often don't qualify for
"rehabilitation." Children with chronic illness or disability
VEhRA is a M-iesota pgopa that allows families who Lhve children with chrnic
conditions to receive Medical Assistance so they can contirue to receive care at home
Parents nake a tmonthly contribution based on income.
Children with Disabiities, Famiies and Managod <strong>Care</strong>
Only two families
reported using
mental health
services, and only two
more indicated any
problem in accessing
needed mental health
services.
Page 5