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

November 29, 2012

Individuals with disabilities are, by definition, a Medicaid population with special needs. Precisely because of their high needs and costs, Medicaid beneficiaries with disabilities are increasingly a focus of state efforts to improve care and manage Medicaid spending more effectively. In most states now, some children and/or adults with disabilities are subject to mandatory enrollment in managed care arrangements for at least some of their care, and more states are moving in this direction. Further, beginning in 2014, the Affordable Care Act will expand Medicaid to reach millions of low-income uninsured Americans, including many with disabilities, and states are widely expected to rely on managed care organizations to serve the newly eligible, mostly adult, population.

While managed care offers tools to improve care coordination and quality, identification of the conditions and structures essential to promote these aims, and of the problems that may result if they are absent, can help guide the design of sound managed care programs for all Medicaid beneficiaries, and particularly for beneficiaries with disabilities, for whom both the potential risks and gains may be greatest. To that end, this brief examines central issues in Medicaid managed acute care through the lens of disability.