Medicaid Managed Long Term Care

On Tuesday, February 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of November 2022, over 65.3 million people are enrolled in Medicare; more than 35.1 million are enrolled in fee-for-service Medicare and over 30.2 have a Medicare Advantage plan. Over 91.7 million enrollees have Medicaid and CHIP; more than 84.8 million individuals have Medicaid and over 6.9 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

On Tuesday, February 21, 2023 The Association of Community Affiliated Plans, Medicaid Health Plans of America, and Sellers Dorsey released their highlights from the 2022 State of Medicaid Managed Care Report. The report covered five core areas of managed care across the country, the current state of managed care, the history of federal regulations and key changes, effective approaches from six states, innovations and successes from MCOs, and outcomes stemming from managed care.

This past Tuesday, the Centers for Medicare & Medicaid Services (CMS) announce the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). As of October 24, 2022, over 65.2 million people are enrolled in Medicare, an increase of 132,757 since the last report. More than 35 million people are enrolled in Original or Fee-for-Service Medicare, and more than 30.2 million are enrolled in a Medicare Advantage or other health plan. Over 91.3 million enrollees have Medicaid (84.3+ million) and Children’s Health Insurance Program (CHIP) (7.0+ million), an increase of 462,322 since the last report. More than 12 million enrollees are eligible for both Medicare and Medicaid and are counted for both programs.

This blog post from Mathematica discusses the importance of partnerships between states and the federal government through highlighting topics covered at NAMD's 2022 conference. Sessions touched on innovations developed as part of recently approved 1115 demonstrations in Arizona, Massachusetts, Oregon, and Arkansas which focused on the ways states are providing whole-person care by addressing the health-related social needs of members. The post also explores Mathematica's work with CMS and states to build stronger measurement and evaluation infrastructure for a broad range of demonstrations, including those addressing substance use disorder, mental illness, and health-related social needs.

JAMA researchers found lower service use and lower Medicaid spending among the Black population for both during a review of health care spending statistics between White and Black Medicaid enrollees. Medicaid beneficiaries make up a diverse population, yet existing disparities persist. To explore differences in Medicaid spending between Black and White populations, researchers conducted a cross-sectional study using data from three states in 2016. Researchers used data from 1,966,689 enrollees in the study, including both adults and children. Of this population, 867,183 identified as non-Hispanic Black, and 1,099,506 identified as non-Hispanic White.

Prior to COVID-19, Indiana hosted stakeholder workgroups to identify needed improvements to its Medicaid-funded long-term services and supports (LTSS) system. The pandemic amplified existing disparities, including inequitable access to community-based care, unaligned and uncoordinated care for dually eligible individuals, and broad gaps in capacity and resources to effectively oversee and implement the LTSS reform effort. With support from Arnold Ventures, Indiana’s Family and Social Services Administration (IN FSSA) is working with project partners to design a Medicare-Medicaid integration strategy for dually eligible individuals enrolled in MLTSS and engage providers in its development process.

ADvancing States is pleased to announce the release of a new issue brief, Addressing Nursing Facility Financing Challenges during MLTSS Program Development developed in collaboration with Milliman. This brief is intended to shed light on the complex and often-misunderstood relationship between nursing facility financing and Medicaid delivery system design.

In this blog post, Nancy Archibald, MHA, MBA, Associate Director of Integrated Care at CHCS, describes the state of Indiana's plan to launch Medicaid managed long-term services and supports in 2024. The state is receiving grant funding through Advancing Medicare & Medicaid Integration, an Arnold Ventures initiative developed in partnership with CHCS that assists states in filling resource gaps in designing and launching integrated care programs.

This report explores the role played by managed care organizations delivering Medicaid long term services and support programs during the COVID-19 pandemic. The report looks at the roles and responsibilities of governments, nursing homes, and MLTSS plans and argues their role in the pandemic response as well as the role of federal funding and data use, should all be examined further to inform future policy.

CMS has released a Center Informational Bulletin providing tools to states and CMS to improve the oversight of managed care and increase beneficiaries’ access to care. In the bulletin, CMS shares resources to improve compliance with managed care standards and requirements and guidance setting the content and format of the Annual Managed Care Program Report. The bulletin also outlines multiple tools and resources for improving managed care oversight that are currently in development at CMS.