People with Disabilities and Medicaid Managed Care: Key Issues to Consider

February 13, 2012

  http://www.kff.org/medicaid/upload/8278.pdf

As many states expand their use of managed care in Medicaid, a growing number of beneficiaries with disabilities are being enrolled in risk-based managed care arrangements for at least some of their care. Further growth in managed care is expected in 2014, when the Affordable Care Act expands Medicaid eligibility to many uninsured low-income adults, including those with disabilities.

This issue brief looks at issues related to the development and implementation of managed care programs with the capacity to serve Medicaid beneficiaries with disabilities.  Drawing on existing research on Medicaid managed care and people with disabilities, the brief highlights policy considerations related to setting plan payment rates, developing adequate provider networks and delivery systems, and ensuring sufficient beneficiary protections and plan oversight.

The brief considers the wide range of intensive and specialized medical and long-term care needs facing Medicaid beneficiaries with disabilities that may include spinal-cord and traumatic-brain injuries, cerebral palsy, autism, Alzheimer's disease and severe mental illness, and the challenges states face in designing effective managed care programs that successfully meet those needs.