New Analysis From OPEN MINDS Finds 21 State Medicaid MLTSS Programs, With More Shifts On The Horizon

Gettysburg, Pa. (April 21, 2019) – The new OPEN MINDS analysis of Medicaid long-term services and supports (LTSS) programs has found that there are 21 states with 26 managed LTSS (MLTSS) programs. The number of states with MLTSS programs has remained the same over the past two years, although the states have not remained the same. This analysis was released in the report, State Medicaid Programs With MLTSS: The 2019 OPEN MINDS Update. The analysis also found that approximately 2.5 million beneficiaries, representing about 3.3% of the total Medicaid population, are served through a managed care financing system. This is up by 11% from 2017 when enrollment in MLTSS totaled 2.2 million and represented 3.0% of the Medicaid population. The jump in enrollment can largely be attributed to two new states, Pennsylvania and Virginia, rolling out new MLTSS programs.

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.

“Our report shows that although the market movement towards MLTSS is slow, the trend for the future is clear. There are at least seven states actively considering adding MLTSS to their Medicaid models; however, these states are generally looking at a longer time frame—with implementations not planned until after 2021,” said OPEN MINDS Market Intelligence Director Athena Mandros. “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.”

This report contains MLTSS enrollment by state, MLTSS model by program, populations served, and benefits included in the health plan contract. This report also takes a look at the future MLTSS landscape. A free summary analysis of the report can be found at: The Medicaid MLTSS Market Shift. The report, State Medicaid Programs With MLTSS: The 2019 OPEN MINDS Update, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS shop for $495.