The National Council on Disability (NCD) issued a report in mid-April which shows that people with disabilities that currently receive long term services and supports (LTSS) are at risk of losing services as they transition from fee-for-service models into Medicaid managed care. More and more states are expanding managed care into service areas that have traditionally been fee-for-service. People with disabilities, particularly those with intellectual and developmental disabilities, have traditionally been carved out from managed care arrangements, due to the unique and complex needs of this population. However, many states are starting to serve this group through managed care as a way of managing costs and seeking to enhance efficiency.

In preparing the report, the NCD hosted ten community forums nationwide, gathering input from hundreds of stakeholders to learn of their experience with Medicaid managed care. People with disabilities consistently said that they lost access to care when transitioned to managed care from a fee-for-service model, particularly long-term services and supports. One issue identified is that often services are stopped before a beneficiary has sufficient opportunity to appeal a denial. NCD said that "Center for Medicaid Services (CMS) must clearly emphasize to states the expectation that authorized long-term services and supports services continue pending appeal." Recipients often believe that managed care companies do not fully understand the services, supports, and needs of the people receiving services.

A new final rule addressing requirements for Medicaid managed care systems is expected to be released from CMS within the next couple of months. That rule may address some of the points raised in the NCD report.

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