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

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CURRENT POLICYMAKING ENVIRONMENT
Nationwide, hundreds of thousands of
indiviuduals with developmental disabilities
and theirfamilies rely on long-term services
and supports provided through publiclyfunded
developmental disabilities service
systems. The central mission of these
systems is to enable individuals with developmental
disabilities to live and work in
their communities, achieve self sufficiency,
and excercise their full citizenship rights.
Over the past two decades, states have
made major strides in improving the quality
and cost-effectiveness of publicly-funded
developmental disabilities services. The
number of individuals residing in costly,
segregated public institutions has been cut
in half and scores of such facilities have
been closed. States have aggressively
expanded their home- and communitybased
waiver programs while de-emphasizing
the development of expensive intermediate
care facilities for persons with mental
retardation and related conditions (ICFs/
MR). States also have initiated and rapidly
expanded family support and supported
living and employment programs that more
effectively meet the needs of their customers
and make better. use of scarce public
dollars. More attention has been focused
on improving the quality and acuemsibility of
publicly-funded services as well.
A great deal has been accomplished, but
much miore remains to be done. Trapped
between rising consumer expectations and
tighter budget constraints, public MR/DD
service systems today face enormous
challenges, including:
* Umitations on federal <strong>Medicaid</strong> payments
to the states. Currently, federalstate
<strong>Medicaid</strong> dollars underwrite 70
percent of the operating costs of public
developmental disabilities systems. But
with both President Clinton and Republican
and Democratic Congressional leaders
supporting a balanced federal budget,
legislative steps to contain the growth in
federal <strong>Medicaid</strong> outlays are inevitable.
Reduced access to federal <strong>Medicaid</strong> dollars
will have serious consequences for developmental
disabilities services as well as
the public system's capacity to respond to
the legitimate needs of people with developmental
disabilities and their families.
* State <strong>Medicaid</strong> cost containment Initiatives.
States are intensifying their efforts
to contain <strong>Medicaid</strong> spending, particularly
through the application of managed care
. approaches across a wider spectrum of
<strong>Medicaid</strong> recipients and services. Accounting
for 35 percent of all <strong>Medicaid</strong> spending,
long-term care services -- including
<strong>Medicaid</strong>-funded ICF/MR and home and
community-based services for people with
developmental disabilities - are not likely
to be exempt from these cost containment
initiatives.
* Shifting.federal and state budget priorities.
Federal domestic assistance is being
cut in order to reduce the federal deficit.
Furthermore, human services programs are
being assigned lower priority in some states
due to other pressing budgetary priorities.
* Waiting lists.. Despite the steady growth
in funding for developmental disabilities
services over the past decade, most states
today have long waiting lists for services.
In some states, these waiting lists have
climbed so highithat individuals have little
prospect of receiving services except in dire
emergencies.
* Growing demand. Service demand will
continue to grow for the foreseeable future
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