Home > Uncategorized > Do we really want managed care for the disabled?

Do we really want managed care for the disabled?

Hang Lee struggled to get his words out in testifying on Wednesday morning before a packed public hearing in Boston on a proposal by the Patrick administration to introduce managed care into the delivery of services for the disabled.

Hang said he is concerned that under the proposal, he and thousands of other disabled people who are eligible for both Medicaid and Medicare, will see reduced funding for medical equipment and services they currently need and might need in the future. 

Hang suffers from cerebral palsy and scoliosis, debilitating and progressively worsening diseases of the spine and nervous system that he anticipates will leave him completely immobilized in a few years.  “I am in constant pain and emotional agony,” said Hang, his face contorted with the effort to speak each sentence.

He said he anticipates he will evenually need a body brace, which costs thousands of dollars.  “A cut in services means a reduction in funding for the brace,” he said.  

Hang was one of dozens of people, who are dually eligible for Medicaid and Medicare-funded services, who testified at the hearing held by the Executive Office of Health and Human Services.   Under the EOHHS proposal, private vendors, known as Integrated Care Organizations (or ICOs) would be hired to manage medical, prescription drug, and disability services to thousands of those people.

Medicaid helps fund a range of residential, employment, and other services for persons with disabilities, while Medicare funds medical care and prescription drugs for many of those same people.   The EOHHS maintains that their proposed system would cut costs of care by eliminating overlap, redundancies, and a lack of coordination between Medicaid and Medicare.  Medicare and Medicaid will spend a projected $3.85 billion in 2011 on health care for dual eligible adults ages 21-64 in Massachusetts, according to EOHHS.

COFAR and the SEIU Local 509 state employee union called for exempting the management of residential care, day and transportation, service coordination and other services from the proposal.    SEIU representative Stu Dickson maintained that while the union “agrees with the need to address needless costs of medical procedures, tests abuse, billing and administrative redundancies, etc., this is profoundly different than the care of human beings.”   Dickson contended that  in implementing the proposal, Massachusetts would compete with other states in a “race to the bottom” in care for the disabled.

“This proposal appears to be another step in this administration’s quest to privatize key services to the state’s most vulnerable people and to remove government from its responsibilities in that area,” I testified on behalf of COFAR.  

Even the human service providers are not sold on further privatization in this area.  In a December 16 email to members, the  Association of Developmental Disabilities Providers stated that “the Arc (of Massachusetts) and ADDP do not believe there is current research available that validates significant cost savings attained by turning over large parts of State Medicaid programs to  managed care companies.”

As did Hang, many in packed hearing on Wednesday said their main concerns were the retention of consumer choice and access once a corporate entity was making decisions on who gets what services. 

Other speakers maintained that they had spent years, in some cases, in finding doctors and therapists for their conditions and might lose those specialists under a managed care system.  “My doctors all work together,” one woman testified.  “My concern is I’m enrolled in a managed care plan and my doctors are not enrolled in it, what do I do?”

“We have to make sure the big corporations don’t just look at the bottom line,” said one man who relies on Medicaid-funded personal care attendants for his disability.

Others called for more planning for oversight of the ICOs, and more accountability.   Dale Mitchell of Ethos, a nonprofit provider of services to the elderly and disabled, called for an “independent care management entity” that would oversee the managed care system and prevent it from “chipping away at consumer control and input.”

Victoria Pulos of the Mass. Law Reform Institute said the involvement of consumer-based organizations is needed to establish “accountability systems” to oversee the ICOs.  And Laurie Martinelli of the National Alliance on Mental Illness maintained that the “role of families needs to be spelled out” in the EOHHS proposal, in addition to more planning for issues such as transportation of clients.

Let’s hope the folks at EOHHS are listening to all this.

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  1. SES
    January 6, 2012 at 12:31 pm

    Seems to me we really should take a shot at fixing what already exists rather than creating and adding another layer of bureaucracy to do it. We have all heard various in depth reporting (like on 60 minutes) about rampant medicare/medicaid scams that cost the taxpayers hundreds of million (even billions) every year. How about fixing that first?

    The creation and maintenance of another bureacracy just further diverts scarce $$$$ from the folks that need it and appears to further remove decisions from the people in the best position to make it.

    This appears to be similar to current HMOs in the health insurance industry. Speaking for myself, since HMOs were created, my health insurance premiums have more than tripled while the quality of the care has declined. Waiting a month for a test to determine why your doubled over with stomach pain hardly seems like an improvement in the system just like doctors offices that don’t answer their phones during lunch hour hardly meets the “consumer driven” advertisements. My health insurance premium is more than my mortgage!!!

    I think I need someone to explain to me in plain language how going along with the HMO concept is the way to go. I just don’t see it.

    • January 6, 2012 at 3:35 pm

      Great points. I think our collective experience has taught us that managed care will enrich certain private players in the system without controlling either health care costs or health care fraud. As you suggest, why not tackle the scams first before adopting measures to further reduce benefits and services? It seems the habitual response of our governmental leaders to the health care crisis is to create more private bureaucracies that don’t work while further removing government from its responsibilties in this critical area.

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