As both presidential campaigns turned up the heat on the future of Medicare and Medicaid, the Center for Medicaid and CHIP Services (CMCS) recently announced a strategy for expanding home- and community-based services by offering two new resources regarding its Medicaid managed long-term services and supports (MLTSS) programs.

In making the announcement, CMCS Director Cindy Mann said the first of the two resources is a report on the results of a national environmental scan the agency conducted between January and June of 2012. Writing in an informational bulletin published on Aug. 6, Mann said that the number of states using MLTSS — a system that delivers long-term care through capitated Medicaid managed care programs — had doubled from 2004 to 2012.

“Increasingly, states have been seeking technical assistance on design and implementation of these services,” Mann said.  

According to Mann, the recent scan involved an inventory of all MLTSS programs that had been implemented as of June 2012 and a projection of future programs established through January 2014. State-by-state results were included for current and projected programs. She noted that the report synthesizes the findings across states, reporting national enrollment, characteristics of contractors and multiple program features.

Key highlights include significant growth in MLTSS, from eight states in 2004 to 16 in 2012. In addition to the number of states with MLTSS programs doubling, the number of people receiving LTSS through managed care programs increased from 105,000 to 389,000.

By 2014, a total of 26 states are projected to have MLTSS programs. The report describes the varying ways in which states have designed MLTSS arrangements: some states, for example, have chosen to include or exclude different sub-population groups and have chosen varying degrees of integration across multiple services. Some states have implemented capitated payments for limited Medicaid benefits, some for comprehensive Medicaid

benefits, and others for comprehensive Medicaid and Medicare benefits.

Mann said states and stakeholders have expressed interest in learning more about MLTSS, and she described how new long-term service and support opportunities outlined in the Patient Protection and Affordable Care Act may be incorporated into an existing MLTSS program.

Online Resource

Mann also announced that CMS is releasing an online tool offering states guidance on program design and other information relevant to the effective management of MLTSS programs.

“This online resource provides consistent, accessible technical assistance, which will be updated as policy and practice in the growing field of MLTSS evolves,” Mann said. “It also features links to information such as sample contracts, state examples of effective organizational structure to manage MLTSS, and other useful sources of information.”

Medicaid Expenditures

Medicaid is among the nation’s most active purchasers of healthcare, spending $432 billion in the 2011 fiscal year to meet the health and long-term services supports (LTSS) needs of an estimated 70 million enrollees, according to a June 15 report released to Congress by the Medicaid and CHIP Payment and Access Commission (MACPAC). The report also noted that, in the same year, CHIP expenditures for more than 8 million children amounted to nearly $12 billion.

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Chuck Buck is the publisher of RACmonitor.

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