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Case Study 2: Background

This state currently operates Health for All, a mandatory Medicaid managed care program for all population groups, under a Section 1915(b) waiver. Older persons and persons with disabilities are included in Health for All, but it does not include long term services and supports (LTSS). People who use LTSS are enrolled in Health for All to receive primary, acute and behavioral health services, and receive LTSS through separate, fee-for-service, HCBS waiver programs under Section 1915(c). 

Marcia Mellen

Governor Garner is concerned about the sustainability of LTSS programs. The state’s population is aging rapidly, and disability rates are rising among younger adults.  In her recent campaign, she heard from beneficiaries and families about the challenge of navigating two different systems for health services and LTSS.  Those who also have Medicare coverage have a third system to figure out.  No one seems to talk to anyone else, and the beneficiary gets the run-around. 

Based on a presentation she heard at the National Governor’s Association, Governor Garner believes more people could receive services at home instead of institutions, LTSS expenditure growth could be reduced, and the experience of beneficiaries and their families could be greatly improved if LTSS and Medicare services were integrated with Health for All.
James Towne

The governor has asked her health reform advisor, Connie Johnson, to convene the Health and Social Services Subcabinet (HSSS) to draw up plans for such a program ASAP.  The HSSS includes the Commissioner of Health and Human Services, the Commissioner of Aging and Disabilities, and their key deputies, including the Medicaid Director. 

Connie has experience in both the health and social services systems, and she knows that Governor Garner’s directive will cause anxiety among beneficiaries, advocates and providers.  She knows there will be a lot of concern and misunderstanding, and she wants to be proactive in articulating the Governor’s goals.


As a first step, she convenes the HSSS to draft a program goal statement and high-level-approach. Once approved, this became the document that was disseminated internally and externally to introduce the initiative. 


Question Mark

If you were the HSSS, how might you describe this state's goals? You can use Worksheet 2.3 to help.

Next we'll see the Goals proposed by Connie and the HSSS.


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