Transcript The State Perspective: Rebalancing Long-Term Services and Supports Cynthia H. Woodcock Alliance for Health Reform Briefing October 3, 2011

The State Perspective: Rebalancing
Long-Term Services and Supports
Cynthia H. Woodcock
Alliance for Health Reform Briefing
October 3, 2011
States are committed to rebalancing … but efforts
are driven by the need to reduce budget deficits.
 What is rebalancing?
Moving away from a dependency on institutional care
towards a system of comprehensive community-based
long-term services and supports (LTSS).
 As of Spring 2011, 33 states projected $75.1 billion in
budget gaps for FY 2012 (with forecasts yet to come from
many states) and Medicaid cost containment is a
dominant theme in FY 2012 budgets.*
*National Governors Association and National Association of State Budget Officers. The Fiscal Survey of States, Spring
2011.
Progress has been made in rebalancing, but
tremendous variation remains across states.
Source: National and State Long-Term Care Spending for Adults Ages 65 and Over and Persons with Physical
Disabilities. 2011. Analysis of Thompson Reuters data by The Hilltop Institute, UMBC.
Managed long-term services and supports (MLTSS)
is the strategy many states are choosing to pursue.
 What is MLTSS?
A plan in which a contractor is accountable for providing beneficiaries with
a defined set of LTSS in exchange for a prepaid capitation payment. Some
plans include just Medicaid benefits; others include Medicare and
Medicaid benefits (“integrated care”).
 Enrollment in MLTSS estimated at 250,000 in 2009
 15 states have one or more MLTSS programs; 8 of these
have multi-region or statewide programs
 15 demonstration sites funded in spring 2011 by CMS
Medicare-Medicaid Coordination Office
 A number of other states are considering MLTSS as a
way to better manage their Medicaid budgets
Source: L&M Policy Research, LLC
These states have MLTSS programs:
One or more state-designed MLTSS programs
Multi-region or statewide MLTSS program(s)
Source: L&M Policy Research, LLC
States with mature MLTSS programs tend to rank
high on LTSS system performance, but there are
challenges ahead for other states.
 Few evaluations of MLTSS programs
 Limited literature on best practices
 States are in a hurry to implement MLTSS and
expect immediate cost savings
Some of the challenges in implementing
MLTSS include:
 Ensuring consumer choice and person-centered
care in a managed care environment
 Aligning incentives across payers (Medicare and
Medicaid) and systems (LTSS, primary/ acute
care, behavioral health)
 Ensuring effective service delivery
 Preserving and growing provider networks
 Managing “woodwork”—the unanticipated
demand for new services
The Affordable Care Act (ACA) offers new
opportunities for LTSS …
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Medicare-Medicaid Coordination Office (§2602)
Community First Choice (§2401)
State Balancing Incentive Payments (§10202)
Medicaid Health Homes (§2703)
Money Follows the Person (§2403)
1915(i) State Plan Amendment (§2402)
Community Living Assistance Services and
Supports (CLASS) (§8002)
… but some requirements in the ACA are likely
to deter state participation.
 Community First Choice: Maintenance of effort
requirement (expenditures for attendant care in
first year must be maintained at or exceed prior
year’s spending)
 State Balancing Incentive Payments: Required
structural changes (single point of entry, conflictfree case management, core standardized
assessment tool)
 1915(i) State Plan Amendment: Eligibility
requirements (required to be statewide, cannot
limit number of participants)
Contact Information
Cynthia H. Woodcock
IMPAQ International, LLC
443.718.4343
[email protected]
www.impaqint.com