Funder: West Health Policy Center

Author: Michelle Herman Soper, Center for Health Care Strategies; Debra Lipson, Mathematica Policy Research; and Maria Dominiak, Airam Actuarial Consulting

December 2018 | Technical Assistance Tool


State Medicaid agencies, and their contracted managed care plans, are shifting away from fee-for-service systems to value-based payment (VBP) models that tie provider payment to better outcomes. Although most Medicaid VBP models target medical care, states are beginning to explore payment reforms that encourage quality and outcomes for long-term services and supports.

This checklist identifies four issues that states may want to explore as they develop and adopt VBP models for home- and community-based services (HCBS) within managed long-term services and supports programs, including: (1) assessing available support from the state policy environment; (2) selecting the right performance measures to reward HCBS providers; (3) selecting payment models that create the right financial incentives for improved value; and (4) addressing operational issues faced by plans and providers. It also suggests opportunities for ongoing engagement with key stakeholders throughout a program, from design through evaluation.

This tool is adapted from the guide, Achieving Value in Medicaid Home- and Community-Based Care: Options and Considerations for Managed Long-Term Services and Supports Programs, which shares considerations for selecting and implementing quality metrics and payment models, as well as common challenges that states may face in adopting these models. It includes lessons from five states — Minnesota, New York, Tennessee, Texas, and Virginia — that participated in Advancing Value in Medicaid Managed Long-Term Services and Supports, an initiative led by the Center for Health Care Strategies, in partnership with Mathematica Policy Research and Airam Actuarial Consulting, and supported by the West Health Policy Center.