Many states are overhauling the delivery of long-term supports and services (LTSS) for consumers in Medicaid who are living with chronic illnesses and disabilities. They are shifting from fee-for-service models to contracting with Medicaid managed care organizations (MCOs) for some or all LTSS. In some states, this change is happening as part of demonstration projects to coordinate care for people eligible for both Medicaid and Medicare. Nineteen states are now managing LTSS and a handful more are actively planning for this change in 2014, according to Truven Health Analytics.
At its best, managed care could reduce fragmentation of care, expand access to community based services and increase the quality and efficiency of services. But there are significant risks for consumers if states or MCOs use managed care to cut services, squeeze out community providers or medicalize support services.
To help minimize the risks and maximize the benefits of this overhaul, consumer advocates and other stakeholders can assess and work to shape state programs using this tool, which combines a checklist with examples of good practice. The checklist draws from federal guidance, Community Catalyst’s paper on states’ best practices and expert advice from other stakeholders, including agencies serving people who are aging and/or have disabilities.
Strengthening Long-Term Services and Supports | Community Catalyst
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