On July 30, 1965, President Lyndon B. Johnson signed legislation establishing Medicare and Medicaid with the goal of creating a “Great Society” and forging a healthier nation. For 50 years, these programs have improved our overall security and provided an essential safety net for millions of low income and at-risk Americans—including people with people with disabilities and seniors.
The impact Medicare and Medicaid have had on the national health and well-being has been nothing short of profound. Before Medicare, nearly half of all Americans 65 and older had no health coverage. Today, that total is 2 percent. Combined, Medicare and Medicaid cover nearly 111 million people, or one out of every three Americans. The programs have transformed the way people with disabilities, seniors and those with low-incomes receive essential medical care.
In recent years, many states have chosen to enroll people with disabilities with high cost health care needs in Medicaid managed care (MMC) plans in an attempt to place program expenditures on a more sustainable course while simultaneously improving both the quality and accessibility of services.
The National Council on Disability (NCD) recognizes that MMC can create a pathway toward higher quality services and more predictable even lower costs, but only if service delivery policies are well-designed and effectively implemented, and achieve cost savings by improving health outcomes and eliminating inefficiencies without reducing the quality or availability of care.
Since December 2013, NCD has traveled across the country to host ten forums to facilitate collaboration between federal agencies, disability leaders, and other stakeholders in planning and implementing changes and improvements in Medicaid managed care services. NCD’s forums have provided valuable insights through facilitated discussion of the experiences preferences and desired outcomes for MMC as identified by the disability community, self-advocates, family members, federal and state agency representatives, health plans, and providers. NCD has received positive feedback that our outreach to and collaboration with agencies like the Department of Health and Human Services has been beneficial to MMC recipients. We will be issuing a report this fall with recommendations based on what we have learned thus far at the forums.
As states continue to expand Medicaid managed care to include more individuals with disabilities than have been covered in the past, it remains essential that these new delivery systems be structured to preserve the underlying principles of Home and Community Based Services (HCBS), which include a commitment to choice and consumer-focused care and services, measurable indicators of real progress and active promotion of community-based approaches. States must be careful to not to rush toward policies that favor short-term savings at the risk of jeopardizing essential services that seniors and other people with disabilities rely on to independently and remain active in their communities.
On this, the 50th anniversary of the passage of the law that established Medicare and Medicaid, NCD reaffirms our commitment to the Guiding Principles first offered in 2012 and reminds policymakers that transitioning Medicaid beneficiaries with disabilities into managed care involves many challenges. How we implement MMC changes is as important as what we change. To be successful, MMC modifications must meet the unique and specific needs of people with disabilities. Best practices and demonstrated successes can be expanded to meet the policy recommendations from experts, including people with disabilities, to minimize risks and maximize the benefits of MMC coverage.
Those who rely on the essential supports and services provided by Medicaid managed care deserve nothing less.