The shift to Medicaid’s use of managed care for LTSS services is something we have reported on extensively – with 19 states and roughly 756,491 consumers now in play (see Where Are We With Managed Long-Term Services & Supports? and Medicaid Managed Care Enrollment and Program Characteristics, 2014). And, in this month’s upcoming issue of the OPEN MINDS Monthly Management Newsletter, we’ve narrowed our focus to look at the six states that have included I/DD services in that mix – for a preview of our coverage, see Managed Long-Term Services & Supports & The IDD Market: A Market Map.
Of these six states, two are using risk-based capitated models paid to health plans for financing – Michigan and Wisconsin. While risk-based capitated financing for medical services has been around for decades, that financing model for LTSS services is new. And, when we were reviewing the construction of these capitated rates, I found one issue intriguing – what is the appropriate use of family caregivers in MLTSS systems? And how does use of family caregiver support services factor into capitation rates?
Family caregivers provide informal, and often unpaid, care and support for a disabled family member in need of long-term care. There are an estimated 14.7 million caregivers assisting 7.7 million older adults (see Informal Caregivers For Older Adults Likely To Experience Emotional, Physical & Financial Difficulties). About one-third of adults between the ages of 25 and 45 provide this kind of care for an elderly or disabled family member – with 59% of those providing care on a daily basis (see One-Third Of Adults Ages 25 To 45 Provide Unpaid Care For A Disabled Family Member). This extensive unpaid, and often continuous, caregiving takes a toll on caregivers, both emotionally and financially. It is estimated that unpaid caregivers forego $200,000 and $300,000 per household in lost income, pensions, benefits, and retirement savings (see Risk And Reform Of Long-Term Care).
In the research report, Care Coordination In Managed Long-Term Services And Supports, the AARP Public Policy Institute identified care coordination trends – but states that “The importance of family caregivers is often acknowledged, but their role in care coordination remains unclear….” In the current group of states participating in the Medicaid MLTSS Rate-Setting Initiative, current policy is that rate-setting and risk-adjustment methodologies should not take into account unpaid caregiver support because there is no way to fairly account for differences (for more, see Developing Capitation Rates for Medicaid Managed Long-Term Services and Supports Programs: State Considerations).
I think there will be some interesting questions in the years ahead as MLTSS models mature. First, should families be expected to provide support services and, if so, should they be paid? Should families have the option to be paid caregivers? And does the use of family caregivers conflict with self-direction by consumers? How do health plans engage and support family caregivers? And what role can innovation in general, and technology specifically, play to address these questions and concerns?
For more on the importance and use of family caregivers in health and human services, check out these resources from the OPEN MINDS Industry Library:
- The Number Of Tech-Enabled Professionals & Caregivers On the Increase
- Next Friend Risk
- 24% Of Caregivers In The United States Are Between Ages 18 & 34
- More Than Half Of Informal Caregivers For People With Schizophrenia Provide Assistance On A Weekly Basis
- Study On Dementia Caregiver Support Testing CRM Platform As Tool For Family Caregivers
And for even more, join us in California on August 24 for The 2016 OPEN MINDS California Management Best Practices Institute, where we’ll look at how one state is managing the changing I/DD market in the session, “Navigating The Challenges Of Serving Individuals With Intellectual & Developmental Disabilities: A Discussion Of The Transitioning California Market” – featuring Stephen Mouton, Psy.D., MBA, Clinical Psychologist & Policy Liaison, Los Angeles County Regional Center; Marty Griffin, Ph.D., Senior Vice President, Southern California Operations, ANKA Behavioral Health, Inc.; and Richard Louis, III, Senior Associate, OPEN MINDS.