Strengthening Long-Term Services and Supports
A Tool to Assess and Improve Medicaid Managed Care
Sections in this tool:
Managed care is becoming the new normal for delivery of long-term services and supports (LTSS) to consumers in Medicaid who are living with chronic illnesses and disabilities. Twenty-two states have already moved their LTSS from fee-for-service models to contracting with Medicaid managed care organizations (MCOs), including two new states in 2016. Another six states have definitive plans to join the trend soon. (These totals exclude states that are only managing LTSS for people with intellectual and developmental disabilities, since those programs are significantly different.)
At its best, managed care could expand access to quality community based services and provide more efficient and coordinated care. But there are big risks for consumers if states or MCOs use managed care to cut services, squeeze out community providers or medicalize support services.
This tool is designed to help consumer advocates and other stakeholders maximize the benefits and minimize the risks. It combines a checklist with examples of good practice. The tool draws from federal guidance, states’ best practices and expert advice from stakeholders, including Community Catalyst and agencies serving people who are aging and/or have disabilities.
Each of the sections provides a robust set of criteria for assessing and shaping your state’s program paired with examples of practices, policies or contract language that implement the criteria. We chose examples from the states that best meet a particular criterion. No one state meets all the criteria, and the lack of mention of a program does not necessarily mean it needs overhaul. Advocates can draw on these examples to improve practices in their states. However, good contract language or policies are only effective if they are enforced, so it is essential that advocates and other stakeholders actively monitor LTSS programs.
We welcome suggestions to improve this tool, including examples of promising practices and policies, as well as information on how recommended policies are being implemented. We also welcome feedback on how the tool has helped to shape your state’s managed care program. Contact Alice Dembner at firstname.lastname@example.org.
In addition to the resources and examples provided in the the sections of the toolkit, you can download a long or short PDF version of the checklist, which do not include the examples provided in this tool. The short PDF version contains the most critical elements for consumers.
To access the tool, please click on a section below:
- Adequate Planning
- Stakeholder Engagement in Design, Implementation and Oversight
- Consumer Support and Protections
- Enhancing Home and Community Based Services
- Person-Centered Processes
- Comprehensive Integrated Service Package
- Provider Quality, Quantity and Continuity
- Overall Quality
Supported by a grant from The SCAN Foundation - advancing a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence.