1. 0 Medicaid Managed Long Term Care Lisa Alecxih Vice President

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3. 2 Market Size $98.0 B in total Medicaid expenditures for LTC users; $2.8 B are in managed care 3.4 M people receive LTC services; ~95,000 are in managed long term care Opportunities High-cost population with little management suggesting potential savings. Challenges Difficult to manage special needs, particularly without prior experience. Key Observations Source: CMS MSIS Reports, 2082 Data, 2003. CMS 64 Reports, 2005. Burwell 2005 LTC Expenditure Analysis. State websites. Lewin Analysis. Aged & Disabled Medicaid LTC Users & Expenditures, 2005 Broken out by Managed vs. Unmanaged 3% 2.6% 98.5% = Unmanaged LTC = Managed LTC 97% 3.4 M Total Enrollees $98 B Total Expenditures Managed Long Term Care Relatively Small

4. 3 The majority of LTC expenditures are in institutional care. However, use of community based care through waivers and personal care is growing. Medicaid Expenditures for A/D LTC Users, 2005 Expenditures Broken out by Service Area $98 B in Total Expenditures 54% 46% $47.2B in Nursing Facilities Remaining $50.8B Spread Across a Variety of Services Home and Community Based Waiver Services, $5.2B Personal Care, $6.0B Inpatient Services, $15.8B Outpatient Services, $15.5B Source: 2005 MedStat LTC Data, CMS MSIS 2082 Data, Lewin Analysis. Total= $50.8B Nursing Facility Primary Service to Manage Prescribed Medication, $8.3B 16.3% 10.2% 11.8% 30.5% 31.1%

5. 4 A few well established programs and numerous start-ups. Top Managed Care Programs: Arizona – 42,125 lives (8/2006)* Includes DD Minnesota – 21,000 lives (1/2006)* New York – 16,224 lives (8/2006) Florida – 13,600 lives (8/2006) Wisconsin – 12,545 lives (8/2006) Remaining Programs: Massachusetts – 7,000 lives (1/2007) Vermont – 4,090 (12/2006)* Texas – 3,300 lives (4/2006) California -- unknown *Entire State New Programs: Kentucky Hawaii Idaho Maryland New Mexico North Carolina South Carolina Washington Active & Pending Programs Potential Expansions/Pilots LTC Programs Many States Looking to Managed Long Term Care to Rebalance Medicaid

6. 5 Medicaid Managed Care Design Issues u Target population u Benefits u Delivery system u Approaches (1115 waiver, 1915(b)/(c) waiver) u Enrollment process u Case management and coordination u Capitation u Quality assurance

7. 6 Benefits and Medicare Coordination State A/D Enrollm ent Acute/ Primary?HCBS?NF? Medicare Capitated? Arizona24,433Yes Voluntary Florida13,582Yes No Massachusetts7,000Yes Minnesota21,000Yes limited to 6 mo. in MnDHOYes New York16,224NoYes No Texas3,300Yes limited to 1 mo. Voluntary - better Rx coverage Vermont4,096NoYes No Wisconsin10,593 Partnership OnlyYes Partnership only

8. 7 Role of Aging Network in Managed LTC u Aging and Disability Resource Centers (ADRCs) serve as options counselors and initiate enrollment into managed care  Wisconsin and planned for Kentucky  Possibly Maryland, Michigan and South Carolina u AAAs provide case management for managed care organizations  Massachusetts u Aging Network must engage Medicaid  Medicaid will not automatically think of you or invite you to the planning

9. 8 Resources u Medicare Advantage Special Needs Plans Site visits, MPR (June 2006) -- www.medipac.govwww.medipac.gov u The Impact of Medicare Special Needs Plans on State Procurement Strategies for Dually Eligible Beneficiaries in Long-Term Care (January 2007) -- http://www.hcbs.org/files/102/5058/SNPFinalReport. pdf http://www.hcbs.org/files/102/5058/SNPFinalReport. pdf u The Past, Present and Future of Managed Long-Term Care (April 2005) -- http://aspe.hhs.gov/daltcp/reports/mltc.htm http://aspe.hhs.gov/daltcp/reports/mltc.htm u Role of ADRCs in Managed Care (forthcoming) on Aging and Disability Resource Center Technical Assistance Exchanged website – www.adrc-tae.orgwww.adrc-tae.org