Public officials are wrestling with the question of how to reduce public spending while insuring that people with disabilities receive the services they need to live and work in the community.  It's important that decisions are made thoughtfully so that funding changes do not create barriers for citizens with disabilities to be meaningfully included in their communities.

One of the ways in which states are attempting to design integrated systems is through managed care organizations. A legal definition of a managed care organization (MCO) is a health care provider or a group or organization of medical service providers who offers managed care health plans. It is a health organization that contracts with insurers or self-insured employers (i.e., federal, state government) and finances and delivers health care using a specific provider network and specific services and products. As states look to contain costs and deal with budget shortfalls, they are moving to MCO's to deliver services to persons with developmental disabilities.

This movement to MCO's presents some unexpected challenges because states are attempting to provide non-medical supports and services through a system that was specifically designed for medical and health care needs. According to the National Council on Disability, "Designing and operating a managed care system for children and adults with chronic disabilities poses unique challenges given the highly diverse, wide ranging health and long-term support needs of the disability population. Those challenges multiply when a state attempts to create a unified system of acute health and long-term services that merges Medicare and Medicaid funding streams."

If the movement of individuals with disabilities into MCO's is to be successful, the National Council on Disability has created the following principles that must be adhered to: Guiding Principles.