Advocates for low-income people and those with disabilities fear the two companies that will provide health services to about 90,000 Nebraskans will focus on the bottom line, not the health needs of clients.

The advocates testified at a public hearing last week on new rules that will apply to the Medicaid program for most people in 10 eastern Nebraska counties.

The state has contracted with Coventry and UnitedHealthcare (its Share Advantage Plan), under what are called at-risk or full-risk managed care plans.

The two companies will be paid a set amount per client, based on the age and needs of the client.

The private company takes the risk and covers the cost if services for its clients cost more than the state's payment.

Each company will likely be paid about $101.5 million for the 11-month contract, which begins Aug. 1, said Vivianne Chaumont, the state's Medicaid director.

Full-risk managed care programs are focused on the bottom line, said Kelsie Brandlee, representing Nebraska Appleseed Center for Law in the Public Interest.

That philosophy fails to serve the health needs of clients, and fails to reform the system into one that works toward long-term savings and stability, she said.

It is telling, she said, that the new rules remove much of the current intent language, which makes clear that the programs should work for the benefit of the clients.

The few people who testified at the rules hearing on Thursday also said that the rules were difficult to understand, with multiple inconsistencies.

"Maybe this is delusional," said Kathy Hoell, executive director of the Nebraska Statewide Independent Living Council, "but we felt that the regulations should provide some guidance in how the program will be implemented.

"These regulations don't do that. Therefore, we are suggesting that you start over and make them understandable, cohesive and have them make sense," she said.

The full-risk managed care system being proposed reduces consumer choice and eliminates consumer involvement in developing enrollment materials, according to Mary Angus, with the Arc of Nebraska, a statewide group representing Nebraskans with intellectual and developmental disabilities.

The proposed rules also eliminate the role of system advocates who offer an avenue of redress for clients and critical feedback to the state on how well their program is working, Brandlee said.

The state has used at-risk managed care since the mid-1990s as one of the Medicaid options, Chaumont said.

Beginning in August, most low-income Nebraskans eligible for Medicaid in the urban east will have a choice between the two companies, but both programs will be operating under full-risk contracts.

These full-risk managed care contracts do not apply to most seniors using Medicaid.

The managed care pilot includes Lancaster, Otoe, Sarpy, Saunders, Seward, Washington, Dodge, Cass, Douglas and Gage counties.

Reach Nancy Hicks at 402-473-7250 or nhicks@journalstar.com.