Medicaid Managed Long Term Care

On Wednesday, July 20, 2016, the Center for Health Care Strategies, Inc. (CHCS) published a new brief, “State Trends in the Delivery of Medicaid Long-Term Services and Supports.” With support from The SCAN Foundation, seven states (Arizona, California, Kansas, Minnesota, New Jersey, Tennessee, and Texas) were selected to provide insights into current trends in both managed long-term services and supports (MLTSS) program refinement and long term services and supports (LTSS) system reform.

On Friday, July1, 2016, Mathematica Policy Research published a report summarizing the basic approach to rate-setting in Medicaid managed care and reviews the main options for structuring managed LTSS (MLTSS) rates. It presents examples from states with financial alignment demonstrations as well as long-standing MLTSS programs. The report concludes by highlighting the policy and operational considerations that should influence a state’s choice of strategy.

Gary Sullivan, a member of UnitedHealthcare in Tennessee, shares his perspective on the benefits he’s received from being a UnitedHealthcare member. Gary, who was a practicing attorney until his retirement, has been wheelchair-bound due to his muscular dystrophy for many years, and has significant need for help with activities of daily living.

CMS posted two new reports with Medicaid LTSS expenditures data. The first report focuses on the most recent data available and recent trends such as 1) an increase in LTSS provided in managed care programs and 2) increased used of newer Medicaid LTSS options authorized in the Deficit Reduction Act and the Affordable Care Act. The second report, “Improving the Balance,” uses data from FY1981 through FY2014 and documents the transition of Medicaid LTSS from institutional services to HCBS.

ADvancing States has released the association’s 2016 policy priorities. The priorities document outlines issues and recommendations regarding a wide range of health and human services programs important to older adults and people with disabilities. These include issues such as: • Implementation of the Older Americans Act reauthorization; • Medicaid LTSS innovations; • Support for caregivers; and • Employment for people with disabilities •

UnitedHealthcare Community & State released a White Paper unveiling a proposed quality framework for MLTSS programs. The framework, developed by UnitedHealthcare's National Advisory Board, extends beyond traditional clinical measures to measure the quality of the "services and supports" delivered in MTLSS, which is often most important for those accessing MLTSS benefits.

The annual 2014 Medicaid Managed Care Enrollment Report created by the Division of Managed Care Plans and the Data and Systems Group in the Center for Medicaid and CHIP Services at CMS, with assistance from Mathematica Policy Research, was released this week. Data on Medicaid enrollment is collected from every state, territory, and the District of Columbia, and is broken down into categories by program, population, and state. The report provides tables with nationwide data and data by state.

The historical progression of bundled payments from acute care to post-acute care and the growing recognition of the value of HCBS create an interesting opportunity for sustainably integrating medical services with other (LTSS). Building on past lessons from efforts to incorporate community-based LTSS into traditional medical care models, such as care transitions, may help to inform successful future strategies to enable bundles to more efficiently achieve the Triple Aim.

Many individuals with long-term services and supports (LTSS) needs either reside in institutions or are at risk for institutionalization. Rebalancing care to provide LTSS in the community is one goal of the federal Financial Alignment Initiative for Medicare-Medicaid enrollees. This profile details the experiences of the Health Plan of San Mateo (HPSM) as it implements a pilot program to help dually eligible individuals in nursing facilities transition back to community living.

This report presents the most current descriptive national information on the supply, organizational characteristics, staffing, and services offered by paid, regulated providers of long-term care services in five sectors; and the demographic, health, and functional composition of users of these services. Services users include residents of nursing homes and residential care communities, patients of home health agencies and hospices, and participants of adult day services centers.