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Medicaid managed care task force

Families oppose the Managed Care Organization (MCO) model of care management.  NH has a long, proud tradition of locally based supports and services through our area agency system as protected by RSA 171 A.  In part, this statute established the framework that persons who experience disabilities are citizens who deserve to be supported in their local communities as a matter of civil rights.  The MCO model of care is a medical model, as such it is not an appropriate model to achieve the goals of inclusion, equity and opportunity for citizens who experience disabilities. 

In 2014 ABLE NH members voted to make Medicaid Managed Care one of the state wide issues to take on.   The implementation of “Step 1”- moving Medicaid recipients into Managed Care Organizations (MCO’s)for acute care medical services resulted in many families being denied critical care and medicine for their loved ones with a disability.  Members of the task force have been successful in building stronger relationships with many stakeholders and creating greater awareness around the issue of managed care. 

Between 2014-2015, the task force was successful in ensuring that the Governor’s Commission on Medicaid Care Management (MCM) meetings were available via webex and successfully pressured Wellsence to drop 500 policy codes to simplify the process for providers to ensure greater approvals of therapy – specifically for children with Autism in need of speech therapy.  

In 2016, in pursuit of transparency and accountability, the task force continued to participate in MCM meetings to ensure that MCO’s were addressing the ongoing challenges that families with disabilities faced under the MCO model of managing care.  Additionally, the task force supported the passage of SB 553, legislation that created a work group to study and evaluate the move to managed care for “Step 2” services which are long-term supports and services (LTSS) for the 5 Medicaid waivers that fund long term care for persons who experience disabilities and seniors.  Families oppose the move to a managed care for their loved ones with disabilities who require long term supports and services.

In 2017, the task force worked hard to educate legislators on the lack of cost savings to the state after moving to the MCO model of care management for Step 1, acute care services.  In fact, FY 2016 saw cost overruns and NH was forced to pay additional monies to the MCO’s.  The task force supported SB 155, a bill further delaying the implementation of managed care for Step 2, long term supports and services, until July 2019.  One long time employee of the Dept of Health and Human Services remarked “I have never seen such a wide cross section of disability across the lifespan present at a hearing.” 

The task force is engaging with families and individuals to create a list of innovations to improve the services in our area agencies.

To join the task force. please contact Lisa Beaudoin Lisa.ablenh@gmail.com 

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