[NYAPRS Enews] Study: States Moving Long Term Services to Managed Care

[Harvey Rosenthal]

Study Finds States Moving to Managed Care for Older Americans Who Need
Long-Term Services and Supports

 Under Budget Pressure, States Broadly Restructure LTSS 

National Association of States United for Aging and Disabilities
(NASUAD) and Health Management Associates (HMA) 

February 3, 2012

 

WASHINGTON-A new report released today by AARP's Public Policy
Institute, the National Association of States United for Aging and
Disabilities (NASUAD) and Health Management Associates (HMA) shows that
while the recession continues to impact state budgets, more states are
restructuring the way they deliver long-term services and supports
(LTSS) in an effort to prevent cuts to  programs and services.  

 

The report, "On the Verge: The Transformation of Long-Term Services and
Supports," takes a comprehensive look at Medicaid and non-Medicaid
financing of LTSS in each state and provides a snapshot of the status of
LTSS for older Americans and adults with disabilities. It shows 11
states planning to implement Medicaid managed LTSS in 2012-2013, joining
12 states that currently deliver services on a capitated basis.

 

"While many states are hopping on the managed long term care train,"
said AARP senior vice president Susan C. Reinhard, who directs the
Public Policy Institute," they need to understand that while it is a
model with great promise, it also poses real risks for what is a
particularly vulnerable group of individuals.  States should proceed
with caution.  If implemented thoughtfully and with appropriate consumer
protections and assurances that individuals will receive the services
and supports they need, managed long-term care has the potential to
improve care through development of coordinated services, more efficient
use of resources, and increased emphasis on preventive services and home
and community-based care."  

 

The good news, Reinhard said, is that more states are trying to find
ways to deliver these important services and programs under continued
financial challenges.

 

The report found six clear patterns emerging from the states:  

 

States are transforming the financing and delivery of LTSS.  A
significant number of states either have or plan to implement Medicaid
Managed LTSS.  And a majority of states report focusing on better
integrating Medicare and Medicaid services for their "dual eligible"
population.

 

The aftermath of the Great Recession continues to impact state budgets.
States continue to face fiscal challenges following the recession, and
many made cuts to non-Medicaid LTSS funded services such as congregate
meals, transportation and the Senior Community Service Employment
Program (SCSEP). 

 

Demand for publicly- funded services continues to increase.  The vast
majority of states remain concerned about their budgets and their
ability to maintain services in the face of increasing demand for
publicly funded LTSS due to rising numbers of older adults and persons
with disabilities in need of these services.

 

States continue to remain committed to home and community-based services
(HCBS).  The report found that many states continue to use the economic
downturn as an opportunity to balance services from institutional to
non-institutional settings.  In addition, states reported that they
continue to make progress in serving more individuals with LTSS needs in
their homes or communities, as opposed to nursing homes.

 

Changes in LTSS State leadership are at an all-time high.  A record
number of new state officials took policy leadership positions.  In some
states, the state aging and disability director has changed more than
once in the past 12 months.

 

Uncertainty around the Affordable Care Act (ACA) remains.  The ACA
provides states with new options to expand HCBS, but pending litigation
on the ACA's constitutionality makes adoption of these options a
challenge.

 

"As states continue to experience the impact of the recession, they also
continue to respond to these challenges in a variety of  ways, seeking
to preserve current service levels in an environment of decreased
funding and increased demand," said Martha Roherty, NASUAD Executive
Director.  "By capturing a snapshot of the impact of the recession on
state delivered long-term services and supports, this survey has again
highlighted the need for a renewed investment at the federal level that
will allow older adults and individuals with disabilities to maintain
their dignity and independence by receiving services in whatever place
they call home."

 

In addition to a detailed analysis of the six common themes, the report
also includes extensive state-by-state data on budgets, plans for LTSS
expansion, integration of dual eligibles, Medicaid HCBS waivers, and
nursing facility activities.

 

"The growth in Medicaid expenditures and reining in these costs continue
to be primary concerns for states," said Jenna Walls, Senior Consultant
with HMA.  "State Medicaid programs have always been incubators of
innovation, and it is clear from this survey that states are turning
their efforts toward fundamentally changing the way health care is
delivered for seniors and individuals with disabilities. States seek a
two-fold objective - improve quality to drive down cost."

 

The report is a follow up to a 2011 study entitled "Weathering the
Storm:  The Impact of the Great Recession on Long-Term Services and
Supports."

 

For a link to the report, see
http://www.nasuad.org/documentation/nasuad_materials/AARP732_OntheVerge_
REPORTFeb1v33.pdf

 

For additional information, please contact Lindsey Copeland, NASUAD's
Director of Policy and Legislative Affairs at lcopeland at nasuad.org or
202-898-2578, or NASUAD's Policy Associate Karl Cooper at
kcooper at nasuad.org or 202-898-2578. 

 

 

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