Over the past couple of months, we’ve written a lot about Medicaid plans adopting managed care models for their long-term services and supports benefits. As we look at the emerging market, we took a deep dive into the programs in the 21 states that have adopted one of three types of models for managing these benefits. We’ve covered this state-by-state adoption as it has happened:
- Alabama Medicaid Delays MLTSS Procurement
- Virginia Awards Six Medicaid MLTSS Contracts For Commonwealth Coordinated Care Plus
- CMS Approves NJ Medicaid MLTSS Through 2022 With Pending Changes To Adult Behavioral Health
- Pennsylvania Medicaid Launches Southeast Region Enrollment In Community HealthChoices, Mandatory Managed Long-Term Services & Supports
- Michigan Considering Medicaid Managed Long-Term Services & Supports
- Louisiana To Delay Privatizing Medicaid Long-Term Services & Supports
- Nebraska Medicaid LTSS Redesign Calls For Phased Carve-In Starting January 2020
- Kansas, New York & Wisconsin Transition From FFS Medicaid LTSS To Managed Care Found To Be Successful
- Texas Medicaid To Pilot Managed Long-Term Services & Supports For Adults With I/DD
- Feds Approve New Mexico 1115 Waiver To Launch ‘Centennial Care’ Integrated Physical, Behavioral Health & Long-Term Services & Supports
As we completed our 18-month update of the MLTSS landscape in every state (see our new report, State Medicaid Programs With MLTSS: The 2019 OPEN MINDS Update), a few key takeaways emerged from our analysis.
Enrollment In MLTSS Programs Is Increasing
Overall these programs serve approximately 2.5 million individuals representing about 3.3% of the total Medicaid population. This is up by 11% from 2017 when enrollment totaled 2.2 million and represented 3.0% of the Medicaid population. The jump in enrollment can largely be attributed to Pennsylvania and Virginia—both large states in terms of population—rolling out their MLTSS programs.
There Is A Move Towards Combining MLTSS With Full Health Benefits in A Single Plan
In general, there are three models of MLTSS managed care:
- MLTSS systems integrated within full benefit Medicaid health plans;
- Specialty freestanding MLTSS with limited benefits and;
- Specialty freestanding MLTSS with full benefit health plans.
The data shows a decrease in the limited health benefit model and an uptake in full benefit health plans. This could be largely due to the implementation of Pennsylvania and Virginia programs in recent months, with their specialty freestanding MLTSS with full benefit health plans models.
At this point, the market movement is slow. Currently, there are 21 states with 26 MLTSS programs (our analysis did not include dual demonstrations). The number of states with MLTSS programs has remained the same over the past two years, although the states have not remained the same. In 2018, Pennsylvania implemented the first phase of their Community HealthChoices program and Rhode Island effectively ended their MLTSS program when the sole participating health plan terminated their agreement with the state (see Pennsylvania Medicaid Launches Southeast Region Enrollment In Community HealthChoices, Mandatory Managed Long-Term Services & Supports and Neighborhood UNITY/RHO Transition). States that are planning to implement MLTSS in the future are generally looking at a longer time frame-with implementations not planned until after 2021 (see Michigan Medicaid Looking To Implement Managed Long-Term Services & Supports Within Five Years).
There are at least seven states actively considering adding MLTSS to their Medicaid models. States such as Michigan and Nebraska are making sure they have the right infrastructure in place to make these new systems a success. States are also increasingly looking towards plans that serve the “whole person” and offer a full array of Medicaid benefits. We are seeing a decrease in the number of individuals served through freestanding limited benefit plans, such as the LME-MCOs in North Carolina that only provide intellectual and developmental disability waiver services at a capitated rate (they also receive a capitated rate to provide behavioral health services to all Medicaid enrollees) – for more see CMS Approves North Carolina’s 1115 Medicaid Managed Care Waiver, Ending The Behavioral Health Carve-Out.
There are a few strategic implications to keep in mind as this application of managed care models continues. Executives of provider organizations that have never worked in managed care systems—from I/DD support services to home care and assisted living—will find themselves facing new infrastructure and marketing challenges. As management of long-term care services are integrated with management of acute health care services and behavioral health services, issues of best practices and criteria for “appropriate” care are going to bubble to the service (for more on this issue, see the recent piece, To Improve Consumer Care In Medicaid & Beyond: Define Value & Make It Public, by OPEN MINDS chief executive officer Monica E. Oss). And, this connection between health, behavioral health, and long-term supports will increase the attention paid to the role of social services in consumer outcomes and cost containment.
For more, check out our recent coverage of the MLTSS landscape:
- In Managed Long-Term Care, Whole Person Takes One Step Further
- LTSS Drives Whole Person Care Strategies
- Optum Launches Initiative To Improve Self-Direction & Informed Decision Making For People With I/DD
- Aetna Medicaid Launches New Service Coordination Model
For more, join us at The 2019 I/DD Executive Summit in New Orleans on Monday June 3. The Summit is designed to give executive teams the strategic tools they need to build sustainable organizations in a value-based world. This year, the Summit is focused on helping organizations build a business model focused on improving performance outcomes, preserving consumer self-direction, and exploring new partnerships across the care continuum.