Managed Care

A report by The Menges Group on behalf of the Association for Community Affiliated Plans estimates the current savings of the managed care model in Medicaid and the additional savings that can occur if remaining fee-for-service (FFS) expenditures were moved into a capitated MCO setting. The report estimates that in 2016, the MCO model delivered nationwide Medicaid savings of $7.1 billion. This represents an overall savings of 2.6% on all the funds paid via capitation.

In recognition of a lack of reliable and robust information on the value of state managed long-term services and supports (MLTSS) nationally, this report aims to partially fill the gap with data and evidence from a survey of state agencies and a review of relevant outside research, and to also serve as a jumping off point for future study.

This report from Truven Health Analytics describes Medicaid long-term services and supports (LTSS) expenditures. The report shows federal fiscal year 2015 data, along with updates for FY 2012 through 2014 spending. Along with discussing trends in Medicaid LTSS expenditures, the report includes numerous data tables that summarize national and state-level expenditures by service category and state.

This brief, a product of the Complex Care Innovation Lab made possible by Kaiser Permanente Community Benefit, outlines the current state of Medicaid NEMT services, its challenges, and opportunities for improvement. It explores alternative transportation models piloted by states and health plans across the country, including the use of transportation network companies, such as Uber and Lyft, to augment NEMT services.

On February 8th, the Government Accountability Office publicly released a report on Medicaid managed care and Long-term Services and Supports. The report examined MLTSS program goals, payment structures, financial incentives for plans, and federal monitoring programs. The report makes several recommendations for CMS.

This report represents two years of work by the HCBS Committee and and contains the Committee's final set of recommendations. It describes key components of a conceptual foundation for home and community based services (HCBS) quality measurement, specifically an operational definition of HCBS, a list of characteristics describing high-quality HCBS, and a measurement framework of 11 domains and 40 subdomains.

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.

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 •

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). This final rule updates the options available and provides increased flexibility to states and Medicaid and CHIP managed care plans to communicate with beneficiaries.

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). As states increasingly turn to managed care to deliver long term services and supports (MLTSS) to seniors and people with disabilities enrolled in Medicaid, CMS has strengthened approaches to MLTSS programs and beneficiary protections, while allowing states flexibility in program design and administration.