AHIP/ADAPT Guiding Principles for Serving Individuals with Disabilities through Medicaid Health Plans
America’s Health Insurance Plans (AHIP) and ADAPT, a national disability rights organization, support the following guiding principles for serving individuals with disabilities through Medicaid health plans to promote availability of services that are responsive to these individuals’ interests and concerns. We have worked in close consultation to create these guiding principles as a foundation for ongoing collaborative action.
Regional training:
National, regional, state-based, and local training should be designed and conducted through collaboration of individuals with disabilities, health plans, States, and other stakeholders. These initiatives should focus on how the integration and delivery of acute and community long term services advance community integration principles such as:- consumer directed services;
- person centered planning;
- accessible, affordable, integrated housing;
- voluntary service coordination;
- delivery of services in the most integrated setting;
- access to independent community-based service coordinators;
- service plan responsive to the unique needs of individual enrollees, including access to network and out of network specialists, if needed, who have experience in serving individuals with disabilities;
- delivery of services based on individual need as determined by functional assessment;
- livable wage/benefits for attendants; and
- comprehensive, continuous quality improvement programs.
Ongoing dialogue with stakeholders, including individuals with disabilities:
In establishing and operating programs to provide services to individuals with disabilities through Medicaid health plans, States should ensure significant statewide and local ongoing public input in the development of Medicaid health plan contract requirements and program design including eligibility, rates, community integration principles, and program requirements. As part of this process health plans should facilitate ongoing, active participation by individuals with disabilities.
Community integration:
State programs should include and adequately fund a requirement that Medicaid health plans provide covered individuals, regardless of age or extent of disability or place of residence, with the option for services to be delivered in the most integrated setting, and that services be based on a functional assessment outlined in a person centered plan. To allow covered individuals to take advantage of this option, States should facilitate access to housing that meets the individual’s needs. Access to community integration services should not be linked to specific types of housing.
Outreach and education:
An aggressive strategy of outreach and education for populations with all disabilities regardless of age should be implemented to ensure that these individuals have the information they need to be knowledgeable about the programs and services available to them. These efforts should include use of community based organizations, whenever available, in the development and implementation of these outreach and education initiatives.
Community integration and consumer directed services:
Medicaid managed care programs that serve individuals with disabilities should offer home and community-based services as an option for covered individuals regardless of age or extent of disability. There should be no institutional bias in the financial or functional eligibility criteria for the coverage of long term services and supports provided under State Medicaid managed care programs. Consumer directed services should be offered as a first delivery option for all covered individuals. To allow covered individuals to take advantage of this option, States should facilitate access to assistance with locating accessible, affordable, and integrated housing not linked to their other community support services.
Control of individual health maintenance activities:
Covered individuals should have the option of developing, negotiating, and implementing plans to accept risk for and take control of their activities of daily living, instrumental activities of daily living, and health maintenance activities. Health maintenance activities should include but not be limited to:- medicine administration;
- catheterization;
- ventilator care including suctioning;
- IV injections;
- wound care;
- tube feeding;
- bowel care.
Access to medical equipment and assistive technology:
Funding should be provided under State Medicaid managed care programs for coverage that allows individuals access to appropriate medically or functionally necessary durable medical equipment (DME) and assistive technology that would enhance independent functioning and promote independent living for covered individuals, including professional assessment of need and type of equipment, and set-up and training for users.
Approved March 2007