More than 13 million Americans use long-term services and supports (LTSS) to assist with activities of daily living they are unable to perform as a result of aging, chronic illness, or disability. As the primary payer for LTSS, Medicaid plays a key role in improving care for this vulnerable population — providing LTSS services for nearly five million Medicaid beneficiaries. States are increasingly implementing comprehensive Medicaid managed long-term services and supports (MLTSS) programs to support individuals with LTSS needs. With Medicaid policy deliberations continuing at the national level and 22 states now operating MLTSS programs — up from eight in 2004 — and several others in the works, now is a good time to assess whether these programs are living up to their promise and where they are likely to go in the future.

A new report, Demonstrating the Value of Medicaid Managed Long-Term Services and Supports Programs, written by the Center for Health Care Strategies (CHCS) in partnership with the National Association of States United for Aging and Disabilities (NASUAD), explores states’ progress in achieving key MLTSS program goals. These include: (1) rebalancing Medicaid LTSS spending from institutional care to home- and community-based services; (2) improving consumer experience, quality of life, and health outcomes; (3) reducing waiting lists and improving access to services; and (4) increasing budget predictability and managing costs.

Through a survey of 12 states with MLTSS programs, the report identifies considerable progress states have made toward achieving their MLTSS program goals:

• Tennessee now serves 44 percent of Medicaid consumers with LTSS needs in the community, up from just 17 percent before the start of its MLTSS program TennCare CHOICES;

• In Massachusetts, consumers enrolled in the state’s Senior Care Options program have a 16 percent lower risk of a long-stay nursing facility admission than consumers getting their LTSS through fee-for-service;

• Enrollees in Minnesota’s Senior Health Options program were 48 percent less likely to be hospitalized than similar consumers who chose not to enroll; and

• In a survey of Florida’s MLTSS enrollees, nearly 60 percent reported that their health improved after enrollment in the program.

Using data to advance MLTSS programs

The survey results show the value of MLTSS programs, but they also highlight the need for states to expand the types of data they collect and strengthen health plan monitoring to ensure the best outcomes for consumers. With the information generated by expanded data collection, states can: (1) refine their policy goals and programmatic approaches; (2) fine-tune their rate-setting strategies; and (3) work with health plans to ensure the effectiveness of care management activities. Several efforts are underway to help states and health plans advance their MLTSS programs:

• The MLTSS Institute, a collaboration between NASUAD members and national Medicaid health plans, focuses on improving MLTSS policy and programmatic issues. Also, the recently established National MLTSS Health Plan Association, under the umbrella of the Long-Term Quality Alliance, will pursue legislative and regulatory changes that would help MLTSS plans better serve consumers. The association published a framework for Medicaid MLTSS performance measurement that its member organizations can use to report on their performance, in an effort to encourage consistency and consensus on quality reporting.

• CHCS recently launched a new learning collaborative, Advancing Value in Medicaid MLTSS, in partnership with the West Health Policy Center, to help leading-edge MLTSS states identify payment approaches that drive value in community-based care.

• The 2016 Medicaid managed care final rule included several provisions specific to MLTSS that seek to strengthen programs’ focus on needs assessments, care coordination activities, stakeholder engagement and person-centered care planning. The provisions also support standard performance measures for MLTSS plans to evaluate quality of life, rebalancing, and community integration activities for individuals receiving LTSS.

What’s next for MLTSS?

As states accumulate evidence of MLTSS program outcomes and work to improve program value, they may increasingly use MLTSS programs as a platform to integrate Medicare and Medicaid services for individuals dually eligible for both programs. This creates an opportunity to integrate Medicare and Medicaid in one health plan that is responsible for delivering all covered services. For example, states can require health plans in their MLTSS programs to also offer Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). The converse is also true: D-SNPs can be required to offer MLTSS plans. States like Arizona and Tennessee require beneficiaries needing LTSS to enroll in MLTSS plans and encourage them to also enroll in aligned D-SNPs. By integrating Medicare-Medicaid, states can provide dually eligible beneficiaries with more coordinated, seamless care.

As MLTSS programs expand, it will be increasingly important for states and health plans to continue their quality improvement efforts, effectively coordinate care, and collect data to demonstrate program outcomes for beneficiaries, their families, providers, and other stakeholders. While potential changes to health care policy may affect the trajectory of MLTSS program development as well as Medicaid more broadly, states and stakeholders will, in any case, need to continue to explore opportunities to provide more value in the delivery of Medicaid LTSS.