Managed Care

On Monday, June 13, 2022 CMS released the 2020 Medicaid Managed Care Enrollment and Program Characteristics and Data Tables. This national data is broken down by program, population, and individual state. The enrollment data provides a snapshot of Medicaid managed care enrollment as of July 1, 2020.

Prior to COVID-19, Indiana hosted stakeholder workgroups to identify needed improvements to its Medicaid-funded long-term services and supports (LTSS) system. The pandemic amplified existing disparities, including inequitable access to community-based care, unaligned and uncoordinated care for dually eligible individuals, and broad gaps in capacity and resources to effectively oversee and implement the LTSS reform effort. With support from Arnold Ventures, Indiana’s Family and Social Services Administration (IN FSSA) is working with project partners to design a Medicare-Medicaid integration strategy for dually eligible individuals enrolled in MLTSS and engage providers in its development process.

ADvancing States is pleased to announce the release of a new issue brief, Addressing Nursing Facility Financing Challenges during MLTSS Program Development developed in collaboration with Milliman. This brief is intended to shed light on the complex and often-misunderstood relationship between nursing facility financing and Medicaid delivery system design.

This brief shares data on state policy choices about Medicaid HCBS, including target populations, functional eligibility criteria, financial eligibility criteria, waiver waiting lists, benefit packages, out-of-pocket costs, use of capitated managed care, self-direction opportunities, covered provider types, electronic visit verification systems, and provider reimbursement rates.

In this blog post, Nancy Archibald, MHA, MBA, Associate Director of Integrated Care at CHCS, describes the state of Indiana's plan to launch Medicaid managed long-term services and supports in 2024. The state is receiving grant funding through Advancing Medicare & Medicaid Integration, an Arnold Ventures initiative developed in partnership with CHCS that assists states in filling resource gaps in designing and launching integrated care programs.

This report explores the role played by managed care organizations delivering Medicaid long term services and support programs during the COVID-19 pandemic. The report looks at the roles and responsibilities of governments, nursing homes, and MLTSS plans and argues their role in the pandemic response as well as the role of federal funding and data use, should all be examined further to inform future policy.

States received approval for temporary changes to their HCBS programs from CMS, within the Department of Health and Human Services to enable states to limit in-person contact to reduce the spread of COVID-19. This GAO report describes the temporary changes to Medicaid HCBS programs and examines CMS’s monitoring and evaluation of the effects of those changes.

CMS has released a Center Informational Bulletin providing tools to states and CMS to improve the oversight of managed care and increase beneficiaries’ access to care. In the bulletin, CMS shares resources to improve compliance with managed care standards and requirements and guidance setting the content and format of the Annual Managed Care Program Report. The bulletin also outlines multiple tools and resources for improving managed care oversight that are currently in development at CMS.

This Mathematica article summarizes some of their key findings from a recent study utilizing NCI-AD data. The study contributes important information to the field of managed care long-term services and supports (MLTSS) and quality outcomes. One finding shares “MLTSS enrollees rated their experience of care and quality of life more favorably than fee-for-service beneficiaries.”

The AARP Public Policy Institute recently launched a three-year initiative which aims to transform long term care in the United States. LTSS Choices will be a series of reports, blogs, videos, podcasts, and virtual convenings that seek to catalyze reform and spark ideas to modernize LTSS, long term services and supports. The goal is a long-term care system that provides a wide range of choices to meet the dynamic needs and preferences of consumers and their families.