Long Term Services and Supports

While healthcare payment systems are moving toward paying for value, the unique needs of individuals with I/DD and their families means that the transition toward alternative payment models (APMs) for Medicaid-funded services must be undertaken carefully. This white paper includes 14 payment reform principles to guide the development and assessment of new and emerging APMs for Medicaid I/DD services. The paper also includes 13 recommendations for current and future APMs for I/DD services.

Medicaid value-based payment (VBP) models tie payment to outcomes including quality of care, health status, and costs. This guide presents a checklist of four issues for consideration as states identify issues to consider when developing and adopting value-based payment (VBP) models for HCBS within managed long-term services and supports (MLTSS) programs. The guide also reviews strategies for stakeholder engagement.

On Thursday, November 15, 2018, the Kaiser Family Foundation (KFF) published an issue brief exploring the upcoming changes to spousal impoverishment policies in Federal Medicaid HCBS policy. This report provides an explanation of why spousal impoverishment policies exist, the changes made by the Affordable Care Act (ACA), and the potential implications of the expiration of these ACA changes.

This recently released report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019. The report focuses on changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

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 report examines the role of formal long-term services and supports (LTSS) in Medicaid. The report focuses on how sociodemographic changes will impact the demand for LTSS in the future, and as a result, Medicaid use and expenditures.

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.