Managed Care

Presentations from the 2016 National Home and Community Based Services (HCBS) Conference.

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 2017 highlights these achievements, allowing states to share best practices, present unique partnerships, and recognize the work of their peers.

This report discusses what is known about effective programs to support family caregivers and emphasizes evidence-based programs for family caregivers of persons living with dementia. Evidence-based programs to help caregiving families are not widely available in communities. This report looks at barriers to scaling up effective programs and draws attention to programs that have been shown to improve one or more aspects of the quality of life of family caregivers.

In 2017, ADvancing States administered a survey of state agencies that deliver LTSS, including aging and disability agencies as well as Medicaid programs, regarding the significant policy, fiscal, and operational issues occurring within each state. During the survey, we collected detailed information about the structure of agencies, the supports provided, and the populations served by state programs.

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.