What You Can Do TODAY About Managed Care


Some other bloggers have been talking about managed care, and I wanted to share some action points for all of us. There are many things we can do right NOW to make our situations better. Currently about 21 states have pending proposals to combine all of their public healthcare spending into managed care. Click here to comment on them.

These proposals would combine physical and mental health care, preventative care, peer support, and institutional care in hospitals and nursing homes all into one huge package. These gigantic contracts and organizations might do some good – by letting preventative care and acute care come out of the same pot. This would remove one major excuse for not funding recovery, that prevention comes from a different budget than acute care. This would allow people to really understand how much money complete recovery saves.

The problem, and the reason we all need to start speaking up LOUDLY, is that many of these huge organizations have never heard of complete recovery. We need to educate people about the distress model of extreme states – that our problems may come from life situations and not genetics. I don’t say medical model vs. recovery model because recovery is actually more evidence based than a physical defect model. Instead, I say distress model vs. disease model, because there is no real evidence for a disease view of emotional suffering. Complete recovery means “all this goes away.” It means finding out the real truth and how to handle problems from people who have already handled those kind of problems.

Denise Baynham and Les Washington from SIDE in Kansas City, KS. SIDE is one of the best peer support centers in the nation.
Denise Baynham and Les Washington from SIDE in Kansas City, KS. SIDE is one of the best peer support centers in the nation.

Yet many large health care organizations have never heard of the partial recovery that is being advertised now by mainstream advocacy organizations, let alone the complete recovery that readers of this site know is possible. Whenever I talk about recovery now I have to clarify whether we’re talking about complete recovery, ie, you don’t need labels and meds for life.

We need to speak up now to ask that our agenda be included in these contracts that states are writing to lump all of their healthcare into one system. I don’t usually get involved in advocacy because I want to provide alternatives to our broken model rather than try to fix what’s beyond repair. But this is a big big time for being heard right now and we need to get on top of it. A lot of people have not yet figured out how big the impact of these changes are going to be.

The main way to get involved with this is at the state level. We can be working with our statewide networks or forming statewide networks to share this kind of information. Each state who wants to use managed care will or has already sent in an application for a waiver from the Center for Medicaid Services (CMS) then get public comment. Then CMS will put it back out for public comment a second time and we need to get our comments repeated on this second offering. We need to be involved with all stages of these processes. Here are the links to the public input forums that will allow your voice to be heard right now:

A webinar with a cross disability group working on this, the Disability Rights, Education & Defense Fund (DREDF) on June 11.

A list of states who received grants to integrate medical and community based services into managed care plans for people who are dually eligible for Medicare and Medicaid.

The list of States who showed interest in pursuing an integrated managed care approach for people dually eligible for Medicare and Medicaid.

The link to the CMS 1115 demonstration website where all states could ask for variances in Medicaid billing so they could integrate medical and community based services for people who were eligible for Medicaid only.

Here is the CMS Idea Factory to post comments on some of the waiver requests submitted by states. This the the link I’ve posted in other parts of this article.

Here are the kind of things we can ask for:

  • We need to make sure that we have seats at the table for all decision boards and committees, not just one token seat in a room of 30 people. We need a good solid 25% or 30% representation on all committees making decisions about our people. Also, if every committee person but us is on the clock for someone, it’s not fair for them to ask us our self-employed advocates to work for free. They need to respect our time and budget stipends or consulting contracts into these committees.
  • We can ask that managed care companies be required to spend a certain percent of each mental health dollar on peer support or non-medication based care.
  • We can ask that people receiving mental health services have 100% control of their funding decisions as people with developmental disabilities do in many states.
  • We can required HMO’s to offer non-medication options before prescribing medications.
  • Now is the time to make certain psychiatric abuses illegal. We can ask that uninformed ECT, forced medication, seclusion and restraints, uninformed medication prescriptions, or doctors who repeatedly violate good prescribing practices are completely excluded from the managed care contracts.
  • We can ask for medication tapering teams, for respite care, for more peer support centers, for shared decision making, for support groups, for peer phone lines, etc, all the things we’ve asked for before. We can require that managed care companies provide these services.

Everything this community is saying that we can and should do, we need to get loud and involved and vocal. This is a BFD – big big big deal. We need to be really loud right now to get our agenda heard. Here are ways to spread the word about this input opportunity. Keep in mind that you’ll mostly work through your existing channels to increase our ability to give input. It’s easier to work through people with whom you already have some kind of connection.

Tips for conducting a social messaging campaign:

Priscilla Ridgway from Wichita State University, one of the nation's leading experts on peer support and complete recovery.
Priscilla Ridgway from Wichita State University, one of the nation's leading experts on peer support and complete recovery.

Try to bring in as much storytelling and emotion as possible. The best book on social marketing, The Dragonfly Effect, says that we act on things that are surprising, interesting, evoke our emotions, and have the chance to help people. Include these in your story.

  • Send a short email with the link to friends, two paragraphs or less, and ask them to forward it (Email is still the #1 social messaging technique.)
  • Invite your Facebook friends to our Facebook invite: Post it on your profile page. We can use this invite to coordinate our suggestions so we can support each others’ ideas even if we live in different states. Post this event invite in the Facebook groups you are a member of that might be interested in it. If you don’t have a Facebook account, sign up for one. It’s extremely useful and doesn’t take much time if you ignore the games. Ask your friends to like your posts in the groups and keep commenting on it so it stays at the top of the group.
  • Send this out on Twitter. It’s very easy to create a Twitter account. If you don’t have one yet, it’s very useful, like a personalized magazine with links to articles. It’s not a chatter service like many people say, it’s a link sharing service.
  • Send a text message with a link to people on your phone contact list. Call 10 of the most important people and ask them to forward that text message.
  • Be ready to provide coaching suggestions for people who don’t have all of the the technical skills to move on your request.

Marketing people say that often action only happens when people have seen or heard something 5 different times or 5 different ways, so get people moving. Get on board with this now. This is important. If you want change in the mental health system, there is change happening in a large way right now, and it’s going to happen with or without us.

Click here now to get involved: http://cmsideas.uservoice.com/forums/141980-medicaid-gov




Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. Thanks for the tweets. I can’t get anyone to click the link, though, I think people are sick of hearing about health care reform and health insurance and stuff. There’s some resistance I’m not putting a finger on yet.

    The link I posted has a forum on top for the Medicaid.gov website and then the right hand margin is forums for every state with a current plan pending for comments. Right now, the only state with comments is Kansas.

    Examples and people who will benefit:

    Arkansas: The plan transitioned its ConnectCare 1915(b) waiver population of approximately 410,000 individuals into the demonstration. ConnectCare enrollees receive Medicaid State plan benefits.

    Arizona: This demonstration provides health care services through a prepaid, capitated managed care delivery model that operates statewide for both Medicaid State plan groups as well as demonstration expansion groups. (Capitated means doctors are paid by the patient instead of by the service so the doctors carry more risk so the insurance company can make more money.)

    California: The plan creates coordinated systems of care for Seniors and Persons with Disabilities (SPDs) in counties with new or existing Medi-Cal managed care organizations through the mandatory enrollment of the population into Medicaid managed care plans. (I.e. huge monopolies being set up, since when was a monopoly ever good for consumers?)

    Florida: most Medicaid beneficiaries in five counties are required to enroll in a managed care plan (either a capitated health plan or a fee-for-service Provider Service Network plan) as a condition of eligibility for Medicaid. Participation is mandatory for TANF-related populations and the aged and disabled with some exceptions.

    Indiana: Hoosier Healthwise (HHW), allows the State to mandatorily enroll certain State plan populations into managed care. The second component, the HIP component, allows the State to offer health coverage to working age adults with and without dependent children who are not covered under the Medicaid State plan. Individuals in HIP must enroll in a managed care organization to receive services. POWER Account contributions, similar to monthly premiums, are generally charged to all HIP participants as a condition of eligibility.


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  2. I don’t like peer support. Why would I want money spent on that?

    It’s just another way to marginalize people. Shut em away with their own kind? Pay a few “peer counselors ” to keep em docile? Of course not.

    I could go for some non medical alternatives though. I’d rather spend money on that than “peer counselors” . The whole world is my peer. I don’t want no stinkin clubhouse!!

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    • I think that in Peer Support, he who pays the piper plays the tune (I hope that is right).

      Howe ever the writer is talking about influencing commissioners to provide a wide range of relevant services, whether they be provided by Peers or not I am not too bothered but I do want a mainly drug free service based on proper social support with proper psych drug withdrawal services as the article suggests.

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      • I just think that people who are profiting from grants or employment as peer counselors should be in the same position as drug companies or doctors- if they want a seat at the table let it be one for the providers not one designated for “patients” or “consumers” or whatever the currently politically correct euphemism is. And there should be full disclosure if people post advocating funds for something which directly benefits themselves. It’s no different from NAMI taking money from the drug companies and then trying to speak for a group of people that has nothing to do with them. The loudest self-appointed advocates don’t represent the vast majority of people. This new peer industry stigmatizes and demeans people and it creates a class of career mental patients.

        But I agree with most of her other suggestions other than “peer” anything.

        I think everyone should be concerned about this not just labelled people.

        We’re all different. There is no group that represents the people that this will effect.

        I would rather sit in the seat of a taxpayer or a concerned citizen than the designated mentally ill
        chair. And No I don’t think you should be paid unless everyone else is. Just equal is enough. No special treatment.

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      • I agree. Peer support has come to mean segregating marginalized, labeled people with “their kind”. Maybe there are people who have recovered completely, in the sense that Corinna means, but there is not a strong incentive for such people to remain in the culture of “mental health consumerism”. They move on with their lives, out into the world, rather than remaining pigeon-holed in the world of “mental health”. I think you only get stuck in mental health once you see that as the context for your entire life story.

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