Panel Calls for Big Changes in Medicaid

The New York Times published this article on November 23rd about changes being discussed for Medicaid services for the elderly and people with disabilities. Only one person voted against it...

Gwendolyn G. Gillenwater, a commission member who is policy director of the American Association of People With Disabilities, an advocacy group, voted against the report. “People with disabilities have not had good experience with managed care,” Ms. Gillenwater said. “We need federal protections and safeguards. People with disabilities should at least have a choice of two managed care plans. And what are your choices if you opt out of managed care? The alternatives are getting more and more limited."

This debate is an important one as Georgia moves forward with additional funding for people with disabilities.

Moreover, it said states should be allowed to enroll some of the sickest Medicaid recipients, including nursing home residents and people with disabilities, in managed care plans. The panel said such plans “would provide a medical home and better coordinated care” for people entitled to both Medicaid and Medicare. Care is often fragmented now because Medicaid pays nursing homes while Medicare is the primary payer for doctors and hospitals, and in many cases “clinical data is not shared,” the panel said. People enrolled simultaneously in the two programs account for 13 percent of Medicaid recipients, but more than 40 percent of Medicaid costs. Medicaid, which is financed jointly by the federal government and the states, covers two-thirds of the nation’s 1.6 million nursing home residents.

The problem becomes when managed care means less care...

Senator Max Baucus of Montana, the Democrat in line to lead the Finance Committee, said many of the proposals would make it more difficult for “the most vulnerable Americans” to get comprehensive care. John C. Rother, policy director of AARP, the lobby for older Americans, said, “In some states, flexibility means cutting benefits.”

How do we offer more flexbility and control without risking the level of care that makes community living for people with disabilities possible?