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8 <br />future than has been true over the past decade. This altered (low <br />growthj fiscal landscape has enormous implications for the health <br />and vitality of these systems and even more profound implications <br />for the people and families who depend on these systems for <br />supports. In this vein, dismissing managed care makes no sense. <br />DD service systems will need to take advantage of every tool <br />available in order to survive and be responsive to the people they <br />support." These words were written at a time when Congress <br />appeared to be on the brink of imposing an across-the-board cap <br />on federal Medicaid spending. Today, our nation is rapidly <br />approaching another crisis in financing not only of Medicaid <br />services but of other major social entitlement programs as well <br />(e. g., Medicare; Social Security, SSI, Food Stamps, etc.J. Given the <br />circumstances, Smith and Ashbaugh's admonition to consider all of <br />the "arrows in our quiver" seems as relevant today as it was thirteen <br />years ago. And, as unsettling as it may seem, managed care is one <br />of those arrows. <br />For access to the full article referenced above as well as <br />information about waivers from several advocacy groups, please <br />see the waiver section on the OPC website, <br />www.oacarea proclram.com <br />8. What will happen to my (or my child's) services? <br />In general, most services should remain the same, although who approves <br />them will change. <br />Expansion of the waiver should be a fairly seamless process for consumers. <br />It should result in greater consistency across the state in the services that <br />are provided, in how services are accessed, and in expectations and <br />requirements for providers. If savings are realized, they can be put toward <br />creative, innovative services that may not be typical Medicaid <br />reimbursable services. The biggest change will be that Medicaid services <br />will no longer be authorized by the state's current vendor, Value Options, <br />but instead will be authorized by the LME. How case management is <br />provided may also change for some consumers (see question # 12) <br />9. Will I be able to keep my same provider? <br />As much as possible, OPC will work to help consumers keep their current <br />provider if they so desire. <br />As indicated in the 1915 (b) waiver amendment <br />(http://www.ncdhhs.gov/mhddsas/waiver/2011 /section 1915-bwaiver- <br />renewal l 1-13.pdf) "Enrollees will have free choice of providers within the <br />prepaid inpatient health plan (PIHP) and may change providers as often <br />