Over the past couple of months, we’ve written extensively about the move by states and insurers to implement Medicaid managed care for the population with intellectual and developmental disabilities (I/DD). Insurers such as Optum, Aetna, and Centene are building out models to better serve this population and some states such as Arizona are adding vertical carve-outs for the I/DD population (see The Medicaid Vertical Carve-Out Model Comes To I/DD and I/DD & Managed Care – What Are The Early Lessons For Providers?).
When most people talk about the move to managed care for the I/DD population, they are referring to the move to managed care mainly for long-term services and supports (MLTSS) by Medicaid plans. However, even in states without MLTSS, Medicaid health plans are providing acute care services for these consumers. We’ve just completed an analysis of state Medicaid programs to see what these coverage patterns look like in Enrollment Of The Medicaid I/DD Population In Managed Care For Acute Care Services.
The quick answer – 66% of Medicaid beneficiaries with I/DD get their acute care benefits through Medicaid health plans. The long answer – the actual market landscape, overall and on a state-by-state basis, is more complex and based on a number of factors including eligibility pathway for Medicaid, age, among others. The first major determinant is whether a person receives long-term services and supports (LTSS). If a person does not receive LTSS, they are likely enrolled in the same financing and delivery system as the aged, blind, and disabled (ABD) population. For those receiving LTSS, enrollment for acute care services is determined by whether an individual receives LTSS in the community (through a home- and community-based waiver) or in an intermediate care facility for I/DD (ICF/IDD).
Think of the process as starting with the 78.6 million individuals enrolled in Medicaid in 2016, of which approximately 2.6 million had an I/DD. Of those 2.6 million, 882,076 (33%) are receiving LTSS and 1,766,911 (67%) are not receiving LTSS.
Looking at these two populations we found that 85% of the I/DD population not receiving LTSS were enrolled in managed care. Conversely, for the population receiving LTSS, 27% were enrolled in managed care. Breaking down that LTSS number further, 27% of the population with I/DD receiving home- and community-based services (HCBS) were enrolled in managed care, as were 26% of the population residing in an intermediate care facility.
For a state-by-state look, check out: Enrollment Of The Medicaid I/DD Population In Managed Care For Acute Care Services. This report provides a model for estimating the percentage of the I/DD population enrolled in managed care. Our analysis includes, on a state-by-state basis, the estimated number of individuals with I/DD enrolled in Medicaid, the financing and delivery systems for different subsets of the I/DD population, and the percent of the I/DD population enrolled in FFS and managed care.
In summary, the impact of managed care is a key factor in serving the I/DD population – whether consumers are enrolled commercial health plans or in Medicaid. On the Medicaid side, a number of states are looking to create “vertical” I/DD-centric plans in New York and North Carolina (see New York To Implement Managed Care For People Receiving I/DD Services and North Carolina Issues Final Guidance On Nine Consumer Categories Automatically Included In The BH/IDD Medicaid Managed Care Tailored Plans). And, a number of states are moving value-based reimbursement for these services (see Eight States Using Alternate Payment Models For I/DD Services). Executives of provider organizations serving the I/DD population need to take a look at this market intelligence and plan accordingly (see The Four-Part Checklist For VBR Success and Managed Care Competencies Assessment).
For more, join us at The 2019 Technology & Informatics Institute for the session in Philadelphia on October 29, Data Makes The Difference: Using Data To Manage Care Coordination & Value-Based Arrangements featuring Dr. Jason Raines, MPA, SSBB, Founder and Principal, Raines Consulting Group, LLC. And mark your calendars for The 2020 OPEN MINDS I/DD Executive Summit in New Orleans on June 1.