Community-based programs traditionally have relied on Medicaid payments and federal grants to survive and serve as the safety net to the low income and uninsured. Two approaches are possible. They can form a managed care plan by themselves or in partnerships with others or seek contracts with HMOs. Considering the general lack of sophistication in CBO's infrastructure, such as computerized systems, administrative evaluative tools, and contracting experience, the second approach is more likely to occur. B. Recommendations Following are some general guidelines for Medicaid Departments based on the experiences of other states that have incorporated Medicaid recipients into managed care plans.
Considerable time is required to develop policies and procedures, education, and evaluation systems.
States that have transitioned rapidly due to political or financial consideration have experienced considerable controversy and confusion. Develop standards of care plans. For the HIV infected individuals, these plans should cover the complete array of services required in disease management. This system must be clearly defined and held accountable for provision of appropriate care and ensuring that individuals do not fall through the cracks. This data is essential to negotiate equitable but cost reducing rates for both per patient reimbursement and carved out costs.