Medicaid

At the beginning of 2013, 16 states had Medicaid managed long-term services and supports (MLTSS) plans, with mandatory or voluntary enrollment. Target populations varied by state. In 13 states, MLTSS plan members were afforded the choice to participant-direct (PD) at least some HCBS services. Based on 5 in-depth state case studies expectations regarding availability and take-up of PD services in MLTSS varied as did methods of communicating expectations. PD varied from 1.2% in AZ to 24% in NM.

This letter provides guidance to states on how the long-term services and supports-related rules, including the estate recovery rules, in section 1917 of the Social Security Act (the Act), and federal regulations at 42 C.F.R. 435.700, et seq., apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules (“MAGI individuals”) and receive coverage for long-term services and supports (LTSS).

This checklist is designed to help consumers and other stakeholders assess state Medicaid Managed LTSS. It is based on federal guidance released in May, Community Catalyst’s paper “Putting Consumers First: Promising Practices for Medicaid Managed Long-Term Services and Supports,” and stakeholder recommendations on meeting consumers’ needs.

The report presents findings from a 50-state survey examining how well the needs of family caregivers are assessed when states evaluate the needs of older people & adults with disabilities who qualify for HCBS programs under Medicaid. It is the first detailed analysis of family caregiver assessment tools and processes in use by the states in Medicaid waiver programs. The report also highlights “promising practices” in family caregiver assessment in 3 states, and offers policy recommendations.

This guidance document is intended to provide guidance to states on how to apply the revised protocols for External Quality Review (EQR) of Medicaid managed care organizations, released in 2012, to managed long term services and supports (MLTSS) programs. Although the protocols already apply to MLTSS generally, this document offers specific suggestions to make their application to long term services and supports (LTSS) clearer and provides suggestions, examples and illustrations.

The annual Medicaid Long Term Services and Supports expenditure report includes Medicaid expenditures for all LTSS, including institutional and non-institutional settings, by service category and state. The data come primarily from CMS-64 reports.

New research from AARP and ADvancing States finds that two-thirds of states either have or will launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services over the next two years. To contain the growth of costs and improve care, many are moving to risk-based managed long-term services and supports models. This research finds that a number of states are exploring approaches to dual services integration outside of the CMS models.

This presentation at the 2012 Aging in America Conference provides an overview of the basics of Medicaid and traces the major trends in reform, including the Olmstead decision and subsequent move toward home and community-based services; the promulgation of Medicaid Managed Long-Term Services and Supports (LTSS); and a focus on “dual eligibles”.

A February 2012 online survey consisting of 30 questions was sent to all states and focused on three topics: consumer-directed personal care services; assessments and care plan changes; and case management. The survey results provide information about respondent states’ practices regarding Medicaid funded LTSS. Consumer-directed care was found to be provided majorly through waivers; most assessments contracted out; and case management paid for as a service rather than administrative cost.

This survey was sent to all states and consisted of three questions regarding the enrollment of Medicaid providers of home and community-based services. Of the 23 states that responded, the results highlight different enrollment procedures and opportunities for HCBS providers and varying agency oversight. The results show that Medicaid HCBS provider enrollment oversight varies by state, the majority reporting that the Medicaid agency, as opposed to the state aging agency, manages the process.