How Medicaid Managed Care Organizations Can Improve Long-Term Care

To streamline care and improve quality monitoring, a new AHIP report calls for the expansion of states that contract with managed care organizations (MCO) to deliver Medicaid long-term services and supports (LTSS).

MCOs work with 1.7 million LTSS enrollees and their care teams nationwide to guarantee patients receive needed services in a timely manner. LTSS is not medical care but a support system that helps Medicaid members carry out day-to-day tasks, such as bathing, grooming, dressing, meal prep, and medication assistance.

States can choose to contract with MCOs to provide LTSS care for a variety of reasons, including  budgetary certainty. Under the contract, states give a capitation payment to MCOs to cover all LTSS, which is a predetermined amount per each member, every month.  

States can also contract with MCOs to streamline care, which allows populations with higher needs to access all of their services, both medical and LTSS, through a single entity. This also gives states an opportunity to improve care quality monitoring.

However, while 39 states and the District of Columbia contract with MCOs to provide all or some Medicaid benefits, just 24 states use MCOs to deliver long-term care services. LTSS services managed by MCOs are provided through a variety of state waivers included in the state Medicaid contract.

“Removing the patient’s burden of coordinating care and offering states budgetary certainty makes managed care a positive choice that should be more widely expanded to include all Medicaid populations,” according to the report.

“While a state may have several waivers, most states move some of the waivers into managed care while the others remain in fee for service (FFS). For the waivers remaining in FFS, the state continues to manage the LTSS services while a health insurance provider covers medical care,” the report continued.

This division of services results in difficulties for MCO payers who are trying to manage care and provide quality care coordination for enrollees.

Further, MCOs welcome the ability to demonstrate LTSS quality and participate in current efforts to define measures beyond processes, including patient satisfaction and the value of delivered services.

These groups encourage policymakers to complete a comprehensive review of existing quality measures used by states, such as the quality assessment tools, burden to patients, and intended goals of quality measures prior to implementation requirements.

For example AmeriHealth Caritas Delaware is an MCO  providing both LTSS services and housing support to eligible members of the state’s Medicaid population.

The members who receive LTSS are assigned to an individual case manager to evaluate their needs, which includes an assessment of  social determinants of health. From there, the case manager develops a care plan and makes arrangements for services to fulfill the care plan.

“Individuals with housing needs are identified during interdisciplinary care team rounds, weekly meetings with the largest local hospital systems, and routine care monitoring meetings with nursing facilities. When an individual is found to need housing assistance, the case manager enlists the help of the housing coordinator to join the member’s care team,” the report authors explained.

Instead of an enrollee receiving LTSS and housing assistance from separate groups, the housing coordinator becomes a part of the team to ensure streamlined assistance as part of AmeriHealth Caritas Delaware’s holistic approach to providing services.

The housing coordinator assists enrollees with housing applications, finds income-based subsidies, searches for housing in preferred areas,, and connects the member to community-based organizations that can provide financial assistance with security deposits, rent, and utility assistance.

Housing coordinators also have local relationships with the Delaware Housing Alliance, which manages the intake of homeless shelters across the state.

Once a member is in a stable living arrangement, the housing coordinator serves as a resource to the member as well as the property manager to help address health issues, safety concerns, and other supports to avoid eviction.

“Unlike traditional Medicaid, Medicaid MCOs ensure a streamlined, patient centered approach to care. Medicaid MCOs provide LTSS to more than 1.7 million Americans, helping them maintain their independence and quality of life and acting as responsible stewards of taxpayer dollars,” the report authors noted.