I recently had the opportunity to interview Dave Richard, the Executive Director at The Arc of North Carolina.  It was a very insighful conversation as Dave was able to elaborate on his agency's experience with North Carolina's transition away to Managed Care Organizations (MCOs).  The MCO model is gaining steam in states across the country because, for the states, the management of medicaid waiver services gets outsourced to private insurance (MCO).  The state not only saves money by not having to administer the funds they also typically set up a supports budget per participant based on needs assessments that come out to be, on average, cheaper per person than the old way.  This capitated model is appealing to state legislatures because it reduces state medicaid expenses helping the state government get to a balanced budget.  While this model seems great from a state government perspective, it is less than appealing to providers of i/dd services for a variety of reasons.  Dave talked about these reasons, as well as the importance of having electronic records during an MCO transition.  Below is an exerpt from the interview.  

MediSked, LLC Announces a New Partnership with AHRC New York City as Provider of Human Service Software Solutions

As we travel across the country meeting with provider agencies, a commonality shared by most is the anxiety of what the future of state Medicaid waivers will bring them.  It's no secret that the country and states are looking for measures to be more efficient with Medicaid and Medicare dollars.  This threatens the vitality of provider agencies, sometimes to the point that we see agencies paralyzed to make any changes (especially with software) as they are unsure of future cash flow and regulations. 

The trend of States moving health care from Medicaid to Medicaid Managed Care is one that is growing.

This directly affects provider agencies in terms of how their clients are managed, how funding is structured for each client and ultimately how to bill for reimbursement. So far 11 states have some or all of their long term services through private insurers, with another 24 states having applied for demonstration grants.

Within our customer base, we have customers in states that are in all stages the Managed Care trend. Also, we possess the experience to assist to manage the changes while minimizing the administrative impact to the agency.

For more on this growing trend, check out this Forbes article published on Wednesday:

?http://www.forbes.com/sites/howardgleckman/2012/07/11/private-insurers-are-betting-big-on-managed-care-for-dual-eligible-seniors/