Successfully Enrolling People with Disabilities in Managed Care Plans

February 21, 2012


pdf File Analysis and Recommendations for the Implementation of Managed Care in Medicaid and Medicare Programs for People with Disabilities (230KB) [download]

pdf File Successfully Enrolling People with Disabilities in Managed Care Plans: Guiding Principles (311KB) [download]

The National Council on Disability (NCD) has sent a letter with specific recommendations regarding the implementation of Medicaid managed care for individuals with disabilities to the Centers for Medicare and Medicaid Services (CMS), accompanied by a set of twenty detailed guiding principles for "Successfully Enrolling People with Disabilities in Managed Care Plans." NCD sent the recommendations to articulate the implications of managed care arrangements in publically financed service systems for individuals with disabilities, and offer suggestions to address these issues. The paper identifies the key issues that must be addressed as state delivery systems move to managed care arrangements and makes a series of recommendations to improve the success of system change efforts in states nationwide. The attached principles articulate a set of guidelines that NCD says "must be meticulously observed in designing and carrying out managed care initiatives involving people with chronic disabilities" in order to ensure that they reap the benefits of a managed care environment and do not become "the victims of poorly conceived and executed public policies that fail to meet their needs."  NCD contracted with the National Association of State Directors of Developmental Disabilities Services (NASDDDS) to develop both the recommendations and the principles, as well as a forthcoming white paper on Medicaid managed care for people with disabilities, as part of pursuing their efforts to inform decision-makers on both the strengths and weaknesses of the managed care approach for this population as managed care-based Medicaid reforms sweep the country.

The recommendations document, "Analysis and Recommendations for the Implementation of Managed Care in Medicaid and Medicare Programs for People with Disabilities," offers an "assessment of the impact of managed care on people with disabilities to identify the opportunities and strengths to build on as well the weaknesses and risks that must be mitigated in pursuing managed care as a component of health care reform." Following this, NCD provides suggestions that focus on CMS's role in assessing state readiness, with a detailed list of factors the agency should consider, and on CMS's role in approving state contracts with managed care entities, including specific elements that NCD must require in the contracts.

In the principles document, NCD says it "recognizes that managed care techniques can create a pathway toward higher quality services and more predictable costs, but only if service delivery policies are well designed and effectively implemented, and achieve cost savings by improving health outcomes and eliminating inefficiencies, not by reducing the quality or availability of care." The principles document is meant to provide a clear set of guidelines that states and CMS can use to steer the development of these policies. The principles address personal experience and outcomes, designing and managing a managed care system, managed care operating components, and participants' rights.