State Trends in the Delivery of Medicaid Long-Term Services and Supports

Ensslin B, Kruse A
Publication Year: 2016
Patient Need Addressed: Long-term services and supports
Population Focus: Dual eligible, Medicaid beneficiaries
Intervention Type: Service redesign
Type of Literature: Grey
link: https://www.chcs.org/resource/state-trends-delivery-medicaid-long-term-services-supports/
Abstract

States are increasingly partnering with managed care organizations, providers, and consumers to develop Medicaid managed long-term services and supports (MLTSS) programs. Their objective is to meet individuals’ medical, behavioral health, long-term services and supports (LTSS), and social support needs while delivering quality, coordinated, person-centered, and cost-effective care. To meet the diverse needs of beneficiaries using LTSS, states are using various strategies to refine their MLTSS programs and create a more innovative, person-centered, and value-based delivery system. This brief, made possible through The SCAN Foundation, draws from interviews with states operating both new and long-standing MLTSS programs to identify six major trends in the refinement of MLTSS and underlying LTSS delivery systems nationally:

  • Increasing Medicare and Medicaid alignment for dually eligible individuals;
  • Broadening enrollment to serve individuals with intellectual and developmental disabilities;
  • Leveraging housing resources and other social services to keep people in the community;
  • Focusing on workforce development and expanding scope of practice;
  • Advancing value-based purchasing with LTSS providers; and
  • Providing ongoing, comprehensive stakeholder engagement. The states examined in this brief are strengthening their Medicaid MLTSS programs to serve more LTSS beneficiaries and facilitate the development of integrated care programs that reduce service fragmentation for Medicare-Medicaid enrollees, particularly through Medicare Advantage Dual Eligible Special Needs Plans.
    • Insights Results

    Overview of article

    • States are increasingly partnering with managed care organizations, providers, and consumers to develop Medicaid managed long-term services and supports (MLTSS) programs. Their objective is to meet individuals’ medical, behavioral health, long-term services and supports (LTSS), and social support needs while delivering quality, coordinated, person-centered, and cost-effective care. To meet the diverse needs of beneficiaries using LTSS, states are using various strategies to refine their MLTSS programs and create a more innovative, person-centered, and value-based delivery system
      Methodology
    • This brief draws from interviews with states operating both new and long-standing MLTSS programs to identify 6 major trends in the refinement of MLTSS and underlying LTSS delivery systems nationally

    Results

    • Trends include: 1) Increasing Medicare and Medicaid alignment for dually eligible individuals; 2) Broadening enrollment to serve individuals with intellectual and developmental disabilities; 3) Leveraging housing resources and other social services to keep people in the community; 4) Focusing on workforce development and expanding scope of practice; 5) Advancing value-based purchasing with LTSS providers; and 6) Providing ongoing, comprehensive stakeholder engagement
    • Medicaid MLTSS programs are far from static and the states represented in this scan – Arizona, California, Kansas, Minnesota, New Jersey, Tennessee, and Texas – are pursuing many different reforms to improve underlying LTSS systems and expand the potential for both new and existing MLTSS programs to deliver high quality care and services to the growing number of Medicaid beneficiaries in need of LTSS
    • States may be limited by the capacity of the current LTSS workforce to meet the needs of a growing population of LTSS beneficiaries, so the expansion of scope of practices for LTSS providers, including nursing staff and other direct support professionals, can also influence service delivery. As a result, states are focusing on LTSS provider workforce development and expanding the scope of practice for direct support professionals
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