Thursday, March 7, 2013

Action alert: Medicaid managed care language in proposed legislation


Family Voices Indiana shares the following information and encourages its members to share their voice regarding programs and services that benefit children with special health care needs:

Indiana currently enrolls some of its Medicaid recipients (Hoosier Healthwise and Care Select) in managed care organizations, or health plans. A health plan is a group of health care providers (primary care doctors, specialists, home health care providers, pharmacies, therapists, and more).  When you choose your doctor, or primary medical provider (PMP), you also choose your health plan.  For most health care services, you must use the health care providers who are in your health plan.

A few years ago, the state enrolled most recipients of Medicaid Disability, including those on Medicaid waivers, into Care Select. However, this population had difficulty finding primary medical providers (PMPs) in certain areas of the state. Some of this population is also dually enrolled in private insurance, and that is yet another set of doctors or networks they must comply with. Sometimes those directives were at cross purposes. Also, it required some families to have their child with special health care needs see a different doctor than the rest of their children. As a result of some of those issues, those on waivers were no longer enrolled in Care Select.

The Kaiser Family Foundation has an issue brief on this topic here. They point out this issue: "Managed care offers potential to increase access and improve the coordination of care, particularly for those with the most complex needs. At the same time, it has the potential to disrupt access and care and to compromise the well-being of beneficiaries if they are unable to navigate the system or health plans are not equipped to meet their needs."

There is currently language in SB 551 that states:
"Before August 1, 2013, the office of Medicaid policy and planning shall present a plan to the Indiana general assembly and the commission concerning the following:
        (1) Whether to require a Medicaid recipient who is eligible for Medicaid based on the individual's aged, blind, or disabled status to enroll in the risk-based managed care program."

Read the entire bill here.

Also, in HB 1001:
"Sec. 14.5. (a) The office shall develop a plan to require a Medicaid recipient who:
        (1) is eligible for Medicaid based on the individual's aged, blind, or disabled status; or
        (2) receives long term care services;
to enroll in the risk-based managed care program."

Read the entire bill here.

It's important to make sure families are at the center of decisions that impact the health and well being of their children. Share your voice with your legislator.
Find their contact information here


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