Prepared by Mary Anderlik, Researh Profesor,
Health Law and Policy Institute,
and Wendy Wilkinson, Attorney and Project Director, Southwest DBTAC, ILRU
Getting Started:
Families USA Foundation has a number of guides that provide a basic overview of a topic, and then offer extensive information, case studies, and best practices for advocates. Two may be of particular interest to people with disabilities and disability advocates:
A Guide to Meeting the Needs of People with Chronic and Disabling Conditions in Medicaid Managed Care (January 1998).
A Guide to Access to Providers in Medicaid Managed Care (April 1998).
These guides are free. For more information, you can contact FamiliesUSA by email at
info@familiesusa.org, by telephone at (202) 628-3030, or visit their website, www.familiesusa.org.Reviewing Managed Care Contracts:
The National Health Law Program has created "An Advocacy Checklist for People with Disabilities" to assist in review of state Medicaid managed care contracts. This document, and other valuable tools, are available on the NHeLP website at
www.nhelp.org.Evaluating MCO and State Plans:
In October 1998, the Health Care Financing Administration published a document entitled "Key Approaches to the Use of Managed Care Systems for Persons with Special Health Care Needs." This guidance document is intended to aid states in planning, but it can also be used to hold states, and health plans, accountable. (After all, if something is "key," it should be addressed at the state and plan levels.) This document is available at
www.hcfa.gov/medicaid/smd-snpf.htm. The revised 1915(b) waiver renewal application form requires states to report on their efforts to comply with ADA requirements, among other things. See "Section F: Special Populations" and "Addendum to Section F: Draft Interim Review Criteria for Children with Special Needs." In states that are implementing mandatory managed care for Medicaid beneficiaries with special needs, advocates should review this information and monitor program and plan performance. (Note: HCFA has yet to issue a much-anticipated report to Congress on safeguards for special needs populations.)Managed Mental Health Care:
The National Alliance for the Mentally Ill has created a report card that can be used to evaluate mental health services. To see how it works, request a copy of Stand and Deliver: Action Call to a Failing Industry by calling 1-800-950-NAMI, or read a summary at
www.nami.org/update/reportcard.htm.The Substance Abuse and Mental Health Services Administration has a Managed Care Technical Assistance Series that includes titles such as Partners in Planning: Consumers’ Role in Contracting for Public-Sector Managed Mental Health and Addiction Services. Like the other materials referenced in this resource list, this helpful guidebook should be available free-of-charge. You can get more information from the SAMHSA managed care initiative website,
www.samhsa.gov/mc.