Long-Term Care

This chapter is part of MACPAC's June 2018 Report to Congress on Medicaid and CHIP. It reports on the trend of states using managed long-term services and supports (MLTSS). The chapter discusses program outcomes, the added complexity of long-term services and supports in Medicaid managed care, and different directions being explored in MLTSS. It also identifies issues for further examination.

This annual report outlines Medicaid expenditures for all LTSS, including institutional services and HCBS, by service category and state. This report covers trends in total LTSS expenditures, LTSS as a Percentage of Total Medicaid Spending, HCBS as a Percentage of Total Medicaid LTSS, and more.

This paper examines whether there is evidence that MLTSS programs increase access to home and community-based services (HCBS). One theory states that MLTSS programs may reduce costs associated with the use of institutional services, thereby allowing states to expand HCBS services and reduce waiting lists. This brief uses this theory and examines changes in a state's HCBS waiting list as one way to measure access to HCBS.

This paper looks at the impact of various MLTSS policies on access to LTSS. It looks specifically at four states and the policies which these states identify as important to ensuring access. All four states identified network adequacy standards, transition of care, provider reimbursement, and level of care criteria as important factors. In addition, the paper examined participant-directed services policies and care coordination models.

This paper from AARP’s Public Policy Institute discusses the potential implications of the expanded use of telehealth from the lens of older adults and family caregivers. It discusses the hope that telehealth may help address rising healthcare costs, enable older adults to stay in their homes longer, and relieve pressure for family caregivers. It also emphasizes the importance of keeping older adults and their families at the center of telehealth expansion efforts and continuing research.

This report is the second in a series of publications from the MLTSS Institute. There are unique challenges in implementing a managed long-term services and supports (MLTSS) program for people with intellectual and developmental disabilities (I/DD). The report provides context on the intersection of program design and participant advocacy and outlines successful strategies for both states and health plans. It also highlights promising practices from MLTSS programs delivering I/DD services.

As part of Mathematica’s ongoing evaluation project of section 1115 demonstrations, they have released their interim findings on MLTSS programs. This preliminary report looked closely MLTSS programs in New York and Tennessee and found mixed results regarding the goals of reducing hospitalizations and rebalancing care. Mathematica aims to release a final report on the effectiveness of MLTSS in 2019.

This report from AARP's Public Policy Institute is part of a series of papers focusing on innovative strategies. It explores the benefits of self-directed care and looks at best practices used in Texas, Iowa, Wisconsin, and Florida. The report also provides a toolkit for educational and training purposes to help states improve and expand upon their self-directed LTSS programs.

CMS recently released a 2017 update to its 2012 MLTSS inventory, compiled by Truven Health Analytics. This study reviewed available information about the status of Medicaid MLTSS programs, and provides updates on the prevalence of MLTSS programs, total enrollment, and specific program design elements as of August 2017. The report surveys the landscape of MLTSS programs across the country, provides detailed summaries of each MLTSS program, and identifies national trends.

MACPAC’s 2018 Report to Congress on Medicaid and CHIP addresses managed care, telehealth, and disproportionate share hospital (DSH) payment. The report presents recommendations and analyses backed up by analyses of administrative data and reviews of federal and state policies in each of these areas.