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

due to a host of complex demographic
factors, including the increased longevity
of individuals with severe disabilities and
the higher expectations of families that
have had access to early intervention and
special education services during their
children's formative years.
Public developmental disabilities systems
face a turbulent, challenging and unsettled
future. At stake is their ability to respond to
the critical needs of individuals and families
in a timely, reliable, and effective manner.
The widening gap between available resources
and consumer demand is confronting
state and local officials with thorny
policy choices. Should the gap be closed
by narrowing eligibility for services? Should
the range of services and supports be cut
back? Should access to certain services be
narrowed? Should systems operate on a
triage basis?
. nese choices have enormous implications
for the future role and mission of public
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developmental disabilities systems.
There is a distinct possibility that public
developmental disabilities systems will be
swept up in broader statewide managed
care initiatives. If so, the result could be
narrower access to specialized developmental
disabilities services and the substitution
of generic assistance that is not well
suited to the purpose. There are legitimate
fears that under managed care, essential
values - individual and family choice,
community integration, and person-centered
service delivery -- would be subordi-nated
to economic interests.
The application of managed care concepts
and approaches must be based on solid
public policy principles, goals, and objectives.
<strong>Managed</strong> care can work in the best
interests of individuals and families only
when it is employed as an instrument to
secure improved efficiency, measured
against performance and outcome standards
that embrace essential policy goals
and values.
THE SYSTEMS CHANGE AGENDA
If public systems are to keep faith with their
fundamental mission of furnishing effective
supports to people with developmental
- disabilities-and their families, all system
stakeholders must confront today's
harsh realities and agree on systematic
changes that will place such systems in a
the problem by narrowing eligibility or constraining
access to essential services.
Faced with the prospect of capped funding
and rising demand, public systems must
adopt "what's needed, no more, no less"
as a practical operating philosophy.
better position to carry out their mission. Current public systems are burdened with
The consequences of failing to act are very both state- and federally-imposed rules,
high. regulations, and funding methods that create
enormous barriers to the cost-efficient deliv-
A central element In this system change ery of services and supports to individuals
agenda must be productivity Improve- With disabilities and their families. Funding
ments - i.e., optimizing services and out- streams are categorical and fragmented.
comes within the constraints of a global Slot management approaches often result in
Jget. The resolute pursuit of this objec- a 'one size fits air system which furnishes
tive is absolutely necessary if public systems people with what is available not what is
are to withstand pressures to define away most cost-effective or what they really want.
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