Medicaid Managed Care and Long-Term Services and Supports

Medicaid managed care for persons who needed acute care, doctors,
prescriptions, etc. has been around for years. In the past, States
“carved out” persons with disabilities for, at least, “long-term services
and supports,” i.e., nursing home institutions and community-based
waivers, personal care options and home health.

Recently, the AARP and National Assn. of States United for Aging and
Disabilities issued a report entitled “On the Verge: The Transformation of
Long-Term Services and Supports.” In this Information Bulletin, we try to
highlight some important points raised in this report. One important
caveat is that not all States responded to the AARP/NASUAD survey.

1. 12 states already have Medicaid Managed Care for Long-Term Services
and Supports, and another 11 states have plans for implementation in 2012
or 2013.

a. 13 have or require mandatory enrollment; 4 have not yet decided.
b. 4 States plan to expand statewide or to larger areas.
c. 5 States have or will require mandatory enrollment with opt-out, 2
states a voluntary opt-in, and 1 state both opt-in and opt-out.
d. 6 states have a mandatory enrollment and no opt-out.
e. Home and community-based services included in 18 States (10 of the 18
will include 1915(i) services), but 4 States excluded HCBS.
f. 15 states include nursing facilities in MMLTSS. Some states with
existing MMLTSS include nursing facilities within their capitation
g. 16 include self-directed personal care servies.

2. 28 states are focusing on integrating Medicare and Medicaid services
for the dual eligibles — MA and Medicare. “On the Verge” wrote that
“these individuals typically are poorer and sicker than other Medicare
beneficiaries, use more health care services and thus account for a
disproportionate share of both Medicare and Medicaid spending.”

a. 13 states integrate services for dual eligibles or have definite
plans to do so. 8 are considering integrating.

3. Fewer states made cuts to Medicaid LTSS in 2011 than in 2010.

a. 6 states restricted HCBS benefits in 2011 and 2012.
b. 10 states increased HCBS Waiver expenditures by less than 5%,
and 17 by more than 5%.

4. Of 36 responding States, 20 reported declines in MA nursing
facility residents, 9 expected the number unchanged and 7 States had
increases in the number of nursing home residents in 2010-11. In
2011-12, 17 reported a decrease, 15 stayed the same and 5 reported an

5. With regards to taking advantage of various provisions in the
Affordable Care Act, there was a lot of uncertainty due to the pending
litigation. Nevertheless,

a. 21 States were considering the Balancing Incentive Program, 9 “don’t
know,” and 3 decided to take advantage of the extra federal match.
b. 22 States were considering the 1915(i) State Plan Option, 3 decided
they would definitely implement it, and 7 States reported they would
not pursue it.
c. Despite the 6 enhanced federal percentage points, 18 States reported
they were considering the Community First Choice Option, and 5
States indicated they definitely would implement.

6. In 2010, of the 39 States reporting, 17 increase nursing home
provider reimbursement, 7 increased personal care and 9 waiver provider
reimbursements. In 2011, of the 36 States reporting, 26 increased
nursing home provider reimbursements, 3 States increased personal care,
and 9 increased waivers.

7. In 2011, of the 36 States reporting, 25 decreased nursing home
provider reimbursements, 6 decreased personal care and 8 decreased
waiver provider reimbursements

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my
blog located at
To contact Steve Gold directly, write to or
call 215-627-7100. Ext 227