What’s Happening in Managed Care?

2007 Legislature considers changes for people with disabilities Managed-care changes are in the works at the state capital. As Minnesota […]

2007 Legislature considers changes for people with disabilities

Managed-care changes are in the works at the state capital. As Minnesota legislators consider expanding enrollment in prepaid health plans for persons with disabilities, several issues have come to the forefront this session. Among several key changes, proposed legislation would strengthen the ombudsman services.

Enhancing the Role of the Ombudsman

The Ombudsman Office (for state managed health care) needs to grow to meet a growing population. The office helps people enrolled in health plans to solve problems with access, service and billing. It also provides information about the grievance and appeal processes available through both the health plan and the state. As more persons with disabilities enroll in prepaid health plans, the role of the Ombudsman will become increasingly important. “We simply need trained ombudsmen staff to assist persons with disabilities who voluntarily choose to join a managed care plan. This is an expanded population so we need an expansion of the ombudsmen’s office for managed care,” said Anne Henry, attorney with the Disability Law Center.

Proposed legislation would raise enrollee’s awareness of the ombudsman’s role and their own rights. It would require local agencies to provide annual information to health plan enrollees about the role of the Ombudsman and their right to have complaints resolved. Under current law, this information is provided only once-at the time of enrollment. The bill also requests funding for increases to Ombudsman staff; the office would hire more people who are specifically trained and experienced in providing assistance to persons with disabilities.

Further, the proposal would give annual reports to legislators so they can assess how well the prepaid health plans are working. The Ombudsman Office would have to document their activities by program, age and eligibility type. This information would have to include the number of persons assisted, the types of problems encountered, and any actions taken, including appeals and outcomes for enrollees. Based on these findings, the report would make recommendations for changes to managed-care contacts, grievance and appeal processes, or other changes for general improvement of managed-care services. These enhanced reporting requirements will enable policy makers and advocates to better understand whether prepaid health plans can adequately meet the diverse and complex needs of persons with disabilities.

Delaying the Expansion of Minnesota Disability Health Options

Under the new legislation, the Minnesota Disability Health Options (MnDHO) would not expand beyond the seven-county metro till 2009. The purpose of the delay is to allow the Minnesota Department of Human Services, with input from consumers, advocates, and health plans, time to further develop an expansion plan and more clearly define the requirements for quality disability care coordination.

MnDHO is a voluntary managed-care option for Medicaid-eligible adults (age 18-64) who have a certified primary physical disability. MnDHO operates through a partnership between UCare Minnesota, a health plan, and AXIS Healthcare, a disability care coordination organization. MnDHO covers the full range of Medicaid, Medicare and home and community-based services benefits. AXIS Healthcare provides each MnDHO enrollee with a team of disability specialists to help coordinate their health-care, housing, transportation and other social service needs. “AXIS has made my life so much better. My nurse knows all of my health concerns. Since joining AXIS, I’ve been healthier, happier and more independent,” David Adank, MnDHO member.

The MnDHO program as it exists now will continue to operate in Hennepin, Ramsey, Anoka, Dakota, Scott, Carver, Washington counties despite the delay.

New Options for Basic Services

Beginning in January 2008, persons with disabilities would also have new options for receiving basic health-care services through a prepaid health plan. Basic services do not include any long-term or home and community-based services. As additional choices become available, it is important to be aware of the differences among plans and types of services offered. These new programs remain voluntary; Medicaid fee-for-service will continue to be an option for healthcare service delivery for persons with disabilities.

Take Action!

If you feel strongly about health care for people with disabilities in Minnesota, now is the time to get involved.

• Find out who represents you: Go to www.leg.state.mn.us and click on “Who Represents Me.” You can also call 651-296-2146, TTY-651-296-9896, for help in identifying your representative and senator.

  • Talk to your legislators: It is important that they hear from you. Your stories, input, and experiences are the most valuable pieces of information legislators can have before making decisions that impact your health-care options.
  • Participate in Advocacy Day: Tuesday April 3, 2007. Visit www.courage.org for more information.
  • Join the disability community for a rally at the capitol: The Minnesota Consortium for Citizens with Disabilities Rally at the Rotunda, Thursday April 12, 2007. For more information visit www.mnccd.org