“Managed care delivery systems also raise the potential for adverse effects on care adequacy and quality if capitated payments incentivize health plans to limit spending by restricting services, reducing provider payments, or limiting provider networks.” Gold M., Jacobson G., and Garfield R. (2012). There is little experience and limited data to support policy making on integrated care for dual eligibles. Health Affairs, 31(6):1176-85.

Long Term Care (LTC) can be incredibly expensive. The primary payer for LTC is Medicaid. Fiscal pressures and tightened budgets have resulted in the transition to managed LTC. Managed LTC plans are designed to control costs while maintaining access to services. However, despite the potential benefits of managed LTC programs, continued shifts toward these programs should not be made without caution. Additionally, the role of the aging network should be considered in the transition to managed LTC. The hasty growth of managed LTC systems has had major impacts on a significant number of people, e.g. consumers, caregivers, providers, etc. The potential positive and negative outcomes of these programs must be carefully examined.

The following reports and presentations provide extensive information on these issues. The last report included here is a brief analysis of Florida’s Medicaid Managed LTC program as it has unfolded over the last four years. The review centers on several concerns that were originally raised when the state Medicaid waiver request for Medicaid Managed LTC was submitted to the Centers for Medicare and Medicaid Services (CMS) in 2012. We do not think that these concerns have been adequately addressed over the last four years. Available information indicates that the critics of the CMS waiver request were largely on target in raising them at the beginning of the transition to Medicaid Managed LTC.

We welcome comments, critical or otherwise, from readers, which we will use to improve future versions of the reports and other materials as we update them on a continuing basis.

Issue Briefs:

• Aging Services key informants’ discussion summaries from 2017-18 (2018)
• Medicaid Managed Long Term Care in Florida (Dec 2017)

Reports:

• Neoliberal Long-Term Care: From Community to Corporate Control (2017)
• Managed Long-Term Care (2014)
• Medicaid Managed Long-Term Care in Florida – A Roadmap (2011)
• The Aging Network and Managed Long-Term Care (2008)

GAO Reports:

• CMS Should Improve Oversight of Access and Quality in State’s Long-Term Services and Supports Programs (Aug 2017)
• Improved Oversight Needed of Payment Rates for Long-Term Services and Supports (Jan 2017)
• CMS Needs Better Data to Monitor the Provision of and Spending on Personal Care Services (Jan 2017)

Important Links:

• Georgetown University Brief Misleading about Long-Term Care Transition (Dec 2013)

PowerPoint Presentations:

• Integrated Care A New Beginning or the Beginning of the End (PPT)
• Managed Long-Term Care and the Future of the Aging Network Wisconsin Family Care (PPT)
• Medicaid Managed Long-Term Care in Florida A Roadmap (PPT)
• Public LTC Today and Tomorrow; From the Aging Network to Corporate Managed Care (PPT)