Leadership from a State Medicaid Director: How One Leader Implemented Program Changes
Lee Bezanson

MEDICAID MYTHOLOGY
FACTS AND FICTION



Black and White Cartoon of a hiker asking God, "While I can explain the meaning of life, I don't dare try to explain how the Medicaid system works."



MYTH #1
THERE IS A  MEDICAID PROGRAM

  IF YOU'VE SEEN ONE MEDICAID PROGRAM, 
    YOU'VE SEEN ONE MEDICAID PROGRAM

 MEDICIAD IS A TOOL THAT SUPPORTS MULTIPLE SERVICES TO MULTIPLE
GROUPS

Children  Pregnant Women Families
Elders          Persons with Disabilities




TWO BROAD CATEGORIES OF SERVICES


BASIC HEALTH INSURANCE

Medical model

  Standardized services
     Doctor, hospital, lab etc.

 For all who have a card


LONG TERM SUPPORTS

Non-Medical Model

 Individualized Services
     --Nursing Facility/ICF-MR
     --Home and Community-Based Waivers
     --Personal Care Services

 Only for Subset of Medicaid eligible persons




CURRENT TREND REVERSE RELIANCE ON INSTITUTIONS
MAXIMIZE COMMUNITY INTEGRATION





MYTH # 2

MEDICAID IS MEDICAL MODEL   I DON'T WANT IT!

BASIC HEALTH INSURANCE

 Is Medical - Should Be
 We all Need it   you, too, may break a wrist


THE OTHER MEDICAID 
LONG TERM SUPPORTS

 Medicaid is the only act in town
 Personal Care Services   State Plan Option
 Habilitation/Rehabilitation Services
 Home and Community-Based Waiver Services
 Increasingly Consumer-Directed
 Great Opportunity for creativity



MYTH #3 

THE MEDICAID DIRECTOR CAN FIX IT

 CIVICS 101   We live in a political world
 State Structures Vary Greatly
 Legislatures Appropriate the $$$$$
 Executive Can Play a Big Role
 Specific Agency Heads May Be More Important than Medicaid Director
 KNOW YOUR STATE'S DYNAMICS



MYTH #4

MEDICAID IS INFLEXIBLE

 BEFORE YOU BLAME THE FEDS, CHECK OUT WHAT OTHERS HAVE DONE

 ALWAYS START WITH A GOAL YOU WANT TO ACCOMPLISH AND FIGURE OUT
HOW TO DO IT   NEVER START WITH AN ASSUMED RESTRICTION



MYTH #5 

MEDICAID CAN DO OLMSTEAD ALONE

 IT TAKES MORE THAN MEDICAID TO MOVE INTO AND LIVE IN THE
COMMUNITY OF YOUR CHOICE

 OLMSTEAD IS IMPORTANT BUT WE NEED TO KEEP OUR EYES ON THE
BROADER GOAL OF FULL CIVIL RIGHTS   FULL INTEGRATION



Current Supports for Work
Severity of Disability


          Future Disablity



          Some Disability

Unmet Needs

          ADA


          SSDI (1 year disability)



          SSI (1 year disability)


          APTD (4 year disability)
     


Persons with
Developmental
Disabilities
Persons with

Mental Illness




Persons with
Physical
Disabilities




Children with
Special Needs
HCBC-ECI
Waiver















LEVELING THE PLAYING FIELD