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Medi-Cal Beneficiaries with Disabilities: Comparing Managed Care with Fee-for-Service Systems

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Publication Date: August 2005

Publisher(s): California HealthCare Foundation

Topic: Health (Health care planning)

Type: Brief

Coverage: California


As part of his efforts to close California's budget gap, Governor Schwarzenegger has proposed restructuring Medi-Cal, including for beneficiaries with disabilities. The plan would triple the number of disabled beneficiaries enrolled in managed care. This issue brief synthesizes recent research about the experiences of non-elderly beneficiaries with disabilities in managed care and fee-for-service systems in California and other states. It is intended to help California policymakers understand and evaluate options for changing the delivery of and payment for services to Medi-Cal beneficiaries with disabilities. Key findings include:

*Limited data are available. Most states, including California, have done a poor job assessing the quality of care provided to Medicaid beneficiaries with disabilities and holding providers accountable for performance. *One recent national study showed no significant difference between the experiences of Medicaid beneficiaries in managed care and those in fee-for-service on most measures. *In California, managed care enrollees experience fewer preventable hospitalizations than those in fee-for-service. But patients with disabilities in both systems report difficulty finding physicians, communicating with their providers, and with physical access.

Regardless of the path that California ultimately chooses, the authors recommend strengthening state oversight by developing performance standards for health plans and providers that are relevant to people with disabilities. They urge public reporting on the performance of managed care and fee-for-service providers, as well as reimbursement mechanisms that will foster investment in efforts to improve the efficiency, quality, and coordination of care provided to beneficiaries with disabilities.