There are 229,817 Medicaid consumers with intellectual/developmental disability (I/DD) who are enrolled in Medicaid managed long-term services and supports (MLTSS) programs, according to our newly released report: States With Medicaid MLTSS Programs For The Population With I/DD: An OPEN MINDS Reference Guide. These consumers represent less than 1% of the Medicaid population, approximately 8.8% of Medicaid consumers with I/DD, and 9% of the approximately 2.5 million individuals enrolled in Medicaid MLTSS programs. This is an 87% increase from 2016, when enrollment of the I/DD population in MLTSS was 113,732.
In 2016, six states had MLTSS programs for consumers with I/DD: Arizona, Iowa, Kansas, Michigan, North Carolina, and Wisconsin. Now, an additional four states have been added to that list: Arkansas, California, Florida, and Tennessee.
States vary in the types of health plans they use to finance and deliver services. Some use traditional, commercial health insurers, others are county-based, and still others use provider-led plans. Of the 10 MLTSS plans:
- One state uses provider-led entities
- Four states use commercial health plans
- Two states use public entities
- Two use a hybrid of public and commercial entities
That being said, what does the future look like and what types of models are states considering? At least three states—New York, North Carolina, and Texas—are actively exploring MLTSS for the I/DD population. Both New York and North Carolina are looking to adopt freestanding health plans that are specially designed to serve this population. New York is also looking at using provider-led entities while North Carolina intends to contract at least initially with quasi-governmental organizations (see North Carolina Creates New ‘Care Management Agency’ Certification For BH/IDD Tailored Plans and New York To Implement Managed Care For People Receiving I/DD Services). In Texas, the state cancelled a pilot for an I/DD MLTSS program, but is still actively working on the transition (see Texas Halts Plan For I/DD Managed Care Pilot, But Still Plans To Move LTSS For I/DD To Managed Care In 2020).
For executive teams operating in states with MLTSS programs for the I/DD population, the strategic management issues are state-dependent. In states that are moving to health plans to manage those benefits, provider organizations will need robust administrative capacities to participate in managed care (see Managed Care Competencies Assessment, The Five VBR Competencies I/DD & LTSS Organizations Need and The Evolution Of Successful Value-Based Contracting). In states where public entities are managing LTSS services for the I/DD population there is likely to be more focus on quality measures related to the value of care provided. There is also likely to be a focus on better integrating LTSS services with physical and behavioral health (most states which use public entities provide a limited set of benefits).
For more on this topic, check out our newest report: States With Medicaid MLTSS Programs For The Population With I/DD: An OPEN MINDS Reference Guide. The report provides information on the number of states with MLTSS programs for the I/DD population, estimated enrollment, the type of financing and delivery models, and the health plans serving the population.
And for even more, join us at The 2019 OPEN MINDS Performance Management Institute in Clearwater, Florida on February 13 for the keynote address, “A New Future For The Complex Consumer Market: Building A Comprehensive Community-Focused Strategy” featuring Tonya Copeland, Vice President, IDD Services & Employment & Community First CHOICES, UnitedHealthcare. And mark your calendars for The 2020 OPEN MINDS I/DD Executive Summit in New Orleans on June 1.