More States Move to Managed Care for Medicaid Long-Term Care

  • Medicaid
March 15, 2017

In an attempt to cut costs, nearly half of the states in the country are now embracing a managed care healthcare model in lieu of the previously preferred, state-run home health programs. While some embrace this new change, citing more affordable home care and more accessible home services, others complain about a loss of amenities and other, less favorable, changes.

For Medicaid long-term care patients, the extensive care required to sustain their well-being has, in the past, been seen as too complex for the managed care model. However, more than 20 states have now accepted this very model in their long-term healthcare. What does this mean? Well, whereas the state previously deferred to state-run home health programs to care for the elderly or disabled, they now hire private insurance companies and other managed care organizations to provide services at a fixed monthly fee. Each individual’s care is evaluated and includes either medical or care management, or a combination of the two.

These private programs, referred to as managed long-term services and supports (MLTSS), aim to cut state costs. How will they do this? While some long-term care patients require services that cost the organizations less than their fixed monthly rate, others will cost them more, but the deficit will fall to the organizations rather than the state. The fear of rising fees will, in turn, theoretically provide those organizations with incentive to provide superior care.

On the upside, some of the MLTSS programs will afford long-term care patients who would otherwise have to stay in a nursing home, care facility, or other institution with at-home care. As the demand for home health care has increased, this rise in affordable and attainable long-term home care could benefit many. An article in Modern Healthcare states that New Jersey has seen the number of Medicaid beneficiaries able to stay in their communities rise 12% since the launch of the MLTSS programs.

However, beneficiaries who flourished under the previous care options are complaining about the loss of services the new MLTSS program change has brought about. According to Modern Healthcare, some long-term care services have been cut without explanation to the affected beneficiaries. In addition to these issues, some say their previous nurses were not allowed under the new plan, and hours of service changed.

To learn more about the Medicaid managed care from Modern Healthcare, click here.

Click here to check out the toolkit state advocates can use for patient protections against the MLTSS programs, provided by the advocacy group, Justice in Aging.

Contact Jorgensen, Brownell & Pepin, P.C. today if you think you have a case.

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