Medicaid Managed Long Term Care

This study from Milliman highlights the success that MLTSS programs have had in reducing institutional care for older adults and people with disabilities compared to states operating a fee for service system, both in absolute numbers as well as the acuity level of consumers receiving services in nursing facilities.

While faced with new challenges, reduced budgets, and growing populations requiring more services, states are stronger than ever, and the work they do is more effective than ever in reaching individuals and addressing their needs. The National Home and Community Based Services (HCBS) Conference 2018 highlights these achievements, allowing states to share best practices, present unique partnerships, and recognize the work of their peers.

State Medicaid programs are increasingly opting to cover home and community-based services. This report looks at the efforts of various state Medicaid programs, examines their structure, and highlights the challenges encountered. From this review, GAO highlights three main challenges: 1) difficulty recruiting and retaining home care workers, 2) difficulty serving those with complex needs and, 3) limited funding for HCBS services.

Medicaid value-based payment (VBP) models tie payment to outcomes including quality of care, health status, and costs. This guide outlines considerations for adopting value-based payment (VBP) to promote high-quality MLTSS programs. It combines insights from five states - Minnesota, New York, Tennessee, Texas, and Virginia - with input from national health policy experts.

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.

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.