Hi Becky,

WI developed over a decade a regionalized managed care system that only does LTC for the DD/PD/frail elder populations. We also had a self-directed option (known as IRIS) outside managed care that CMS at the time said was necessary (couldn’t offer just one choice). That option in 6 years has mushroomed to include nearly 12,000 individuals out of 55,000, and about 40% are folks with DD.  Our state only collects NCI data on this population, and our outcomes are above the national averages. Consumer satisfaction (despite incredibly low capitated rates and no increases for 8 years in personal care) is through the roof. The current managed care/self-direction system was created with about a decade’s input from local and regional stakeholders, extensive county-based pilots, data collection, and a promise of full entitlement when each county/region moved in (Counties had to agree to enter). I would highly recommend consulting with these two extremely knowledgeable people who have worked in other states as they moved to managed care and who have the historical knowledge of how WI did it (and perhaps things we should have included): Lynn Breedlove (former P&A director), xxxxxx@gmail.com; and Jim Canales, former county DD director and one of the managed care org’s CEOs until this past January: Jim Canales <xxxxxx@communitycarecw.org>

Our proposed biennial budget from the Governor would completely dismantle our current program; dissolve the local LTC MCO’s; fold our self-direction “into managed care”, and bring in 2-3 large statewide for-profit insurance companies to take over LTC, acute, primary, and behavioral health in an “integrated package.”

We are heartbroken….and working non-stop to ensure we preserve our high-quality, person-centered, outcomes-based, locally-grown system (have I mastered all my talking points?)

Beth

Iowa is jumping in to “Medicaid Modernization” (managed care)   We would like to poll the list serve about the experiences of states that have enrolled or are enrolling individuals who use long term services and supports in managed care.  We’re  especially curious about states that might be seeing positive outcomes for those individuals as a result of the change.  We’re certainly hearing the bad and ugly but we’d like to hear if there are positive results as well.  Thank you.  Becky

Becky Maddy Harker

Executive Director

Iowa Developmental Disabilities Council

700 2^nd Ave., #101

Des Moines, IA 50309

515-288-0442