Governor’s Budget Proposal:
People on Supplemental Security Income (SSI) and Medical Assistance (MA).

The Governor’s biennial budget proposal saves about $16 million in state funds and $23 million in federal funds by requiring certain people who receive SSI and MA to enroll in a managed care plan for their medical care.

Why is the Governor making this proposal?

The Department of Health and Family Services believes that SSI recipients use inpatient hospital services, emergency room and outpatient hospital services when less costly care would meet their needs. The Department argues that case and care coordination would address this problem.

Who would be required to enroll in a managed care plan?

People receiving only SSI and MA (not Social Security Disability Insurance {SSDI} and Medicare) even if a choice of managed care providers does not exist in a county. The people impacted include:

• People with developmental disabilities on waiting lists for services.
• People with mental illness not enrolled in a Community Support Program (vast majority).
• People with physical disabilities living at home.

Who is not required to enroll in a managed care plan?

• Family Care or Partnership program participants.
• People who receive Community Integration Program services or other Medicaid home and community-based waiver services.

Children under age 18 are not required to enroll unless the federal government gives a waiver to the state to include them.

What is a managed care plan?

Most people on SSI living in the community are generally able to get health care services from any provider. Under managed care, the state pays a fee to a managed care plan and the organization restricts access to its providers.

What are the positive aspects of managed care plans?

• Coordination of services by a care coordinator and primary care physician.
• Access to dental services.
• Full medical assessment within 60 days of enrollment.
• Studies have found that primary and acute care improves for most people.
• Under fee for service care plans providers are not obligated to serve MA recipients. Under managed care plans there is contractual accountability to provide care.

What are the potential drawbacks of managed care plans and this proposal?

• The Department is proposing paying only $600 - $750 per month to the managed care plan. Many people have medical care and prescription costs higher than $750 per month. Will they still receive care or their medications?
• Will people have access to specialists and specialty care when they need it? Or will people experience delays and lengthy prior authorization processes?
• Will people have access to costly specialized medications that may not be part of the managed care plan’s formulary?
• Will people have to switch doctors if their own doctor is not part of the managed care plan? Finding physicians who understand, respect, and are knowledgeable about people with disabilities can be very difficult.
• Continuity of care could be disrupted for people who frequently switch between fee for service care plans and managed care plans.