Spending on long-term services and supports accounts for a significant share of total federal and state Medicaid expenditures, particularly for Medicare-Medicaid enrollees. Many states are creating or expanding Medicaid managed long-term services and supports (MLTSS) programs or Medicare-Medicaid integrated care programs to control costs while improving quality of care. To accomplish these goals, MLTSS and other integrated care programs need to use capitation rate-setting methods that address the diverse needs of the enrolled populations and establish incentives to promote higher quality services and more cost-effective care.

Through the Medicaid Managed Long-Term Services and Supports Rate-Setting Initiative, the Center for Health Care Strategies (CHCS) and its partners at Mathematica Policy Research and Airam Actuarial Consulting are working with eight states — Arizona, Kansas, Massachusetts, Minnesota, Tennessee, Texas, Virginia and Wisconsin — and national experts to develop or refine rate-setting strategies for MLTSS or Medicare-Medicaid integrated care programs. The project, made possible by the West Health Policy Center, is working with states to test new rate-setting, risk adjustment, and data collection approaches with a focus on using functional assessment and other relevant data to inform reimbursement strategies.

The effort will generate practical resources and recommended best practices for states and other key stakeholders to use in improving rate methodologies for MLTSS programs that serve Medicare-Medicaid enrollees. Identified best practices will be compiled in an online toolkit as part of a resource library to help states at different phases of designing, implementing or administering Medicaid managed LTSS programs use rate-setting approaches to drive care improvements for beneficiaries.

The Gary and Mary West Health Policy Center is a nonprofit, nonpartisan resource in Washington, D.C. wholly funded by philanthropists Gary and Mary West. The West Health Policy Center provides education, expertise and policy proposals to make successful aging a reality for all seniors in America.