Medicaid Managed Care. Long-term Services and Supports Trends

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Martin Chapman
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1 Medicaid Managed Care Long-term Services and Supports Trends

2 Medicaid Managed Care Statistics As of 2011, 74.2% of Medicaid Enrollees were enrolled in a Medicaid Managed Care system As of 2011, California, New York, and Texas has the highest number of managed care enrollees California: 4,553,090 New York: 3,777,868 Texas: 2,786,985 2

3 Medicaid Managed Care Statistics As of 2011, all but three states (Alaska, New Hampshire, Wyoming) and the U.S. Virgin Islands had some percentage of their Medicaid population enrolled in a Medicaid Managed Care system As of 2011, 100% of the Medicaid populations in Idaho, South Carolina, and Tennessee were managed care enrollees 3

4 MLTSS Statistics Between 2004 and 2013, the number of individuals receiving LTSS through managed care programs increased from 105,000 to 550,000 As of 2012, 16 States operate MLTSS programs As of 2012, 8 included I/DD population in MLTSS (For example, WI, MI, DE) Over 10 states expected to or have already incorporated I/DD population into MLTSS since 2012 (for example, KS in 2014, NY working on it) 4

5 CMS MLTSS Trend Data States split on type of enrollment (mandatory or voluntary) Three major types of contractors: private, not-for profit, public or quasi public Private for profit have largest share of enrollment, nationally About half of states restrict to people needing institutional LOC Almost all contractors at risk for cost of institutional services About six states have Money follow the Person and MLTSS programs operating simultaneously Scan of network adequacy requirements lacking 5

6 State Experience: Illinois Integrated Care Program would include I/DD population Mandatory enrollment Draft plan received over 600 comments, most not considered Develop universal assessment tool to determine LOC 22,000 individuals waiting on DD services Illinois submits 1115 waiver to CMS, waiting on word whether it is complete 6

7 State Experience: Nebraska Nebraska is in the process of developing MLTSS program, to include: nursing facility services, Personal Assistance Services (PAS), home health services, home and community-based waiver services, physical and behavioral health care Temporarily suspended work on MLTSS due to focus on Balancing Incentive Program (BIP) grant program - Plan to use the results to inform MLTSS effort - Implementation target is pushed to January 2017, with RFP out no sooner than Sept 2015 Clients receiving DD services or enrolled in PACE excluded, at least initially Mandatory Enrollment for target populations - 7

8 State Experience: NJ Effective July 1, Automatic enrollment of participants in specified Medicaid waiver programs will be automatically enrolled, including: Community Resources for People with Disabilities (CRPD); and Traumatic Brain Injury (TBI) Waiver. Services will include: Personal care, respite, care management, home and vehicle modifications, home delivered meals, personal emergency response systems, mental health and addiction services, assisted living, community residential services, nursing home care An option is given to enroll in the Program of All-Inclusive Care for the Elderly 8

9 State Experience: Kansas Kansas advocacy to carve out I/DD eventually unsuccessful State enveloped I/DD services and population into Kancare as of Feb this year Three for profit insurance companies Concern around care coordination services Providers in ongoing conversations with state and contractors 9

10 State Experience: WI Family Care Inception: 1999 (five pilot counties, expanded to 57) Nine private non-profit contractors Voluntary, opt-in One contractor has gone bankrupt Sharp cuts in rates instigates lawsuits against Family Care 10

11 Program of All-Inclusive Care for the Elderly Integrated provider-based Medicare plan currently serving individuals 55+ Meet state requirements for a nursing home level of care - multiple, complex medical conditions, cognitive and/or functional impairments, and significant health and long term care needs 90 percent are dually eligible 104 Programs operating 31 states Provider-based medical care model: participants are served by an 11 member Inter-Disciplinary Team (IDT). - Each participant s needs are assessed, and an individualized care plan is developed 11

12 PACE: Covered Services Nursing Home Care Home Care Physical therapy Occupational therapy Adult Day Care Recreational therapy Meals Dentistry Social Services Transportation 12

13 PACE: Expansion At the State level Financial Alignment Demonstrations Nine States adopting Managed Care for the Dually Eligible CA, MA, IL, MI, OH, SC, NY, VA, WA PACE exists outside the demos: PACE participants must opt-out of PACE and into demos, individuals cannot be passively enrolled into PACE Hoping to serve as a point of comparison after demos are completed Medicaid Managed LTSS PACE exists alongside MLTSS Offers provider based alternative to insurance model continuum of options At the Federal level Expanding Eligibility to Under 55 at-risk populations Revised Regulation due this summer 13

14 CMS: Updating MMC Regulations At a Medicaid symposium in May, CMS staffer said the agency is investigating whether states have an adequate process for establishing payment rates in the managed care program. Government Accountability Office (GAO) issued a May 2014 report suggesting that state and federal Medicaid auditors increase oversight of MCOs - Recommends CMS require states to audit payments to and by MCOs CMS Asking for Input in Advance of Regulations Expected in Fall 14

15 Ongoing Concerns with MLTSS Trends Adequate readiness assessment and transition time Sufficient financial incentives to support/sustain: Successful community transition, care coordination, other HCBS Adequately trained and experienced staff within MCOs Network adequacy and continuity of service providers Financial sustainability of MCO structure/contractor risk Accountability of MCO leadership and state to CMS and individual participants 15

16 ACCSES: Next Steps Update MLTSS recommendations and lessons learned Set up meeting with CMS in Summer in advance of updated MMC regulations Consider position on PACE program expansion 16

Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States

Long-Term Services and Supports (LTSS): Medicaid s Role and Options for States Erica L. Reaves, Policy Analyst State Variation in Long-Term Services and Supports: Location, Location, Location National