The marriage of Medicaid and managed long-term care might require an ironclad “pre-nuptial” agreement, according to a Kaiser Family Foundation study. “Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues to Consider” talks about states’ interest in farming out operations of Medicaid long-term services and support (MLTSS) to health insurance plans.
The study relies on literature and discussions in the spring and summer with federal and state officials, representatives of health insurance plans, consumer advocates, and providers. Some respondents worry that health plans “could accept low capitation payments but then fail to provide adequate services, particularly community-based services. Some interviewees are wary of the involvement of for-profit plans in the MLTSS programs.”
Most respondents want the plans’ responsibilities laid out in contracts that also mandate how results are to be reported and what the states will look at in determining performance.
“Plan representatives say they are particularly eager to understand states’ expectations, and several interviewees warn against generic contracts, advising states instead to write contracts that reflect their particular circumstances and expectations,” the study says. “In guidance prepared by CMS, the agency notes that managed care arrangements can promote the use of community-based services and provide data to measure quality, but also cautions that such accomplishments require that carefully constructed contract language and incentives are in place.”
The number of MLTSS beneficiaries covered by managed care was about 173,600 in 2008. Only 11 states operate capitated MLTSS programs.