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indemnity model of payment by the government agency to a disability model of empowering the consumer to purchase, pay for, and arrange the specific logistical details of desired services directly.152 The consumer-directed model is supportive of consumer autonomy, although this model is not without some feminist critics.153 Most State Medicaid programs are in a transition period involving a move from the traditional fee-for-service provider payment model to various incarnations of managed care,154 under which Medicaid beneficiaries participate in private health plans run by insurers.155 This transition may be understood as follows:
Managed care differs from the fee-for-service system because the MCO [managed care organization] assumes either full or partial financial risk. Under the traditional fee-for-service system, medical providers issue a fee for each service they provide and are reimbursed by the state’s Medicaid program. Fee-for-service providers are only responsible for the specific service they provide . . . . However, under the risk-based approach to managed long-term care, the state’s Medicaid program arranges to have a single MCO, also known as a contractor, [or several competing MCOs] provide a package of long-term care benefits. The MCO then contracts with medical providers to render medical services to the beneficiaries within their program. When choosing which medical providers to contract with, the MCO may seek providers known to be cost-effective or it may choose to pay providers a capitated per patient fee.156
152. See Pamela Doty et al., New State Strategies to Meet Long-Term Care Needs, 29 HEALTH AFF. 49, 49 (2010); H. Stephen Kaye, Toward a Model Long-Term Services and Supports System: State Policy Elements, 54 GERONTOLOGIST 754, 755 (2014). Compare Lori De Milto, Program Results Report – Cash & Counseling, ROBERT WOOD JOHNSON FOUND., http://www.rwjf.org/content/dam/farm/reports/program_results_reports/2015/rwjf406468 (describing the Cash & Counseling concept of consumer choice as implemented in the U.S.) (last updated Feb. 28, 2015), with Barbara Da Roit & Blanche Le Bihan, Similar and Yet So Different: Cash-for-Care in Six European Countries’ Long-Term Care Policies, 88 MILBANK Q. 286 (2010) (describing the concept as implemented in the European context). 153. See Daniela Kraiem, Consumer Direction in Medicaid Long Term Care: Autonomy, Commodification of Family Labor, and Community Resilience, 19 J. GENDER, SOC. POL’Y & L. 671, 695-99 (2011). 154. See Sarah Somers & Jane Perkins, Sunshine and Accountability: The Pursuit of Information on Quality in Medicaid Managed Care, 5 ST. LOUIS U. J. HEALTH L. & POL’Y 153, 157-58 (2011) (noting that managed care entities may take several different forms). For a critical perspective on this development, see John V. Jacobi, Medicaid Evolution for the 21st Century, 102 KY. L.J. 357, 363-64 (2014). 155. See Pear, supra note 137; Ctrs. for Medicare & Medicaid Servs., CMS Proposes Rule to Strengthen Managed Care for Medicaid and CHIP Enrollees, https://www.cms.gov/ Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-05- 26.html (visited April 28, 2016). 156. Jenna Steffy, Medicaid Managed Long-Term Care: Will It Solve Medicaid’s Financial Crisis?, 21 ANNALS HEALTH L. ADVANCE DIRECTIVE 72, 76 (2011).