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Implementing Medicaid Managed Care Without Harming Americans with Disabilities

Author: National Council on Disability

Published: 2013-03-19 : (Rev. 2016-11-05)


Main Digest

With no end to the budget conflict in sight, the National Council on Disability (NCD) - an independent federal agency that advises the President, Congress, and other federal agencies on disability policy - today released a report titled "Medicaid Managed Care for People with Disabilities: Policy and Implementation Considerations for State and Federal Policymakers" to assist with the implementation of managed care reforms without harming Americans with disabilities.

In the report, the agency outlines twenty-two principles to guide the design and implementation of managed care services for Americans with disabilities. NCD also recommends that the Centers for Medicare and Medicaid Services (CMS) create and circulate a comprehensive, easy-to-understand procedure spelling out the process for determining state demonstration waiver requests that seek to link Medicaid managed long-term services and supports.

Today, more than two-thirds of the 70 million Medicaid beneficiaries receive at least a portion of their services through a managed care plan.

Until recently, the vast majority of these enrollees have been people without disabilities, however, now more than half the states are enrolling adults with disabilities as well as children with specialized medical needs. In addition, the number of States utilizing Medicaid managed care for long-term services and supports jumped from 8 in 2004 to 16 in 2012. This trend will undoubtedly increase as the Affordable Care Act expands Medicaid eligibility next year.

"A growing number of states are providing long-term services and supports through Managed Long Term Services and Supports," said Jeff Rosen, NCD Chairperson. "If implemented wisely, as intended, these changes can expand home and community services, increase inclusion, ensure quality and improve efficiency. If done poorly, decades of progress could be lost. NCD offers these guiding principles and recommendations to provide the kind of technical assistance on the design and implementation of support services that States, providers and consumers have been asking for."

Key Findings

Sample Recommendations

The full report, including the guiding principles and specific recommendations developed by NCD, are available online at:

NCD is an independent federal agency that advises the President, Congress, and other federal agencies on policies, programs, practices and procedures affecting people with disabilities. NCD works to further the goals of the Americans with Disabilities Act (ADA) of 1990: equality of opportunity, full participation, independent living and economic self-sufficiency for all people with disabilities.

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