Making managed care work for people with disabilities

Over two years ago, with states increasingly moving to contract with managed care organizations for the care of people with disabilities and chronic illnesses, States of Health explored the concerns of some of these health care consumers and their families. Worries centered on the health plans' lack of experience serving disabled and chronically ill patients; the prevalence of a medical model of care, which undervalues services that enable a person to maintain a high quality of daily life; and incentives to cut costs that would result in inappropriate or negligent care. Little has been resolved since then. A few health plans--mostly small specialty plans--serve as oases of best practices, but their attitudes and ways of operating are far from adoption across the board. Advocates argue that the best targeted, most reliable consumer protections involve consumers themselves in the planning, design, and implementation of managed care programs.