Managed 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.

This report presents information on managed care’s enrollment and spending. It explores the growth of enrollment in Medicaid Managed Care in the United States and the contributing factors. It also analyzes the fact that funding does not directly parallel enrollment, as the share of total Medicaid spending that went to managed care only grew from 15 percent to 37 percent between 1999 and 2012, despite enrollment growing from 63 percent to 89 percent during that same time period.

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.

This report is the second in a series of publications from the MLTSS Institute. There are unique challenges in implementing a managed long-term services and supports (MLTSS) program for people with intellectual and developmental disabilities (I/DD). The report provides context on the intersection of program design and participant advocacy and outlines successful strategies for both states and health plans. It also highlights promising practices from MLTSS programs delivering I/DD services.

As part of Mathematica’s ongoing evaluation project of section 1115 demonstrations, they have released their interim findings on MLTSS programs. This preliminary report looked closely MLTSS programs in New York and Tennessee and found mixed results regarding the goals of reducing hospitalizations and rebalancing care. Mathematica aims to release a final report on the effectiveness of MLTSS in 2019.