1. The Future of Medicaid Managed Care:
Long Term Services and Supports & Home and Community Based Services
Presentation for the New York State Association of Community and Residential Agencies
December 4, 2015

2. Rapid Change in Health Care and Medicaid

3. LTSS Account for Over One-Third of Medicaid Spending and Spending on Home and Community-Based Services (HCBS) Is Rapidly Rising
2013 marked the first time that HCBS accounted for the majority of national Medicaid LTSS dollars (51%)
Data Source: Medicaid Expenditures for Long-term Services and Supports in FFY 2013, CMS, June 30, 2015.

4. HCBS Spending Varies Greatly by State
The historical bias towards institutional care has shifted greatly over the last decade
NY --and 22 other states plus DC-- spent more than half of all LTSS dollars for HCBS in 2013.
Proportion of Medicaid LTSS Spending for HCBS by State, 2013 WA NH MT ND ME VT OR MN ID MA SD WI NY WY RI MI CT NV NE IA PA NJ UT IL OH DE CO IN CA WV DC KS VA MO KY MD NC AZ NM OK TN AR SC
>50% (23 states + DC) MS GA AL
41-50% (17 states) TX LA
31-40% (9 states) AK FL HI
<30% (1 state)
Data unavailable
Data Source: Medicaid Expenditures for Long-term Services and Supports in FFY 2013, CMS, June 30, 2015.

5. Making Sure the “H” and the “C” are Real
It starts with person-centered planning
And it anticipates settings that:
Are integrated in and support access to the community.
Provide opportunities to work, engage in community life and to exercise personal control.
Optimize individual initiative, autonomy and independence including with respect to choice of services, supports and setting.
Ensure privacy, dignity, and respect.

6. Managed Medicaid LTSS (MMLTSS)– A New York State of Mind
New York has a broad range of managed care initiatives targeting different healthcare needs.
Managed LTC
Long-Term Care
PACE
Acute Care and Long-Term Care
Mainstream Managed Care
Physical Acute Care
MAP
Acute Care and Long-Term Care
FIDA
Acute Care and Long-Term Care
Behavioral Health Organizations
Behavioral Health

7. States are Moving LTSS Populations and Services into Managed Care
Over half of the states have or are planning to implement Managed Medicaid LTSS (MMLTSS).
Managed Medicaid LTSS Programs, 2015 WA NH MT ND ME VT OR MN ID MA SD WI NY WY RI MI CT NV NE IA PA NJ UT IL OH DE CO IN CA WV DC KS VA MO MD KY NC AZ NM OK TN AR SC
Current MMLTSS program MS GA AL TX LA
MMLTSS being planned or implemented (2016 and beyond) AK FL HI
Duals demo only
Data Source: NASUAD – November 2015

8. Managed Medicaid LTSS (MMLTSS)– A New York State of Mind
Mandatory Managed Long Term Care (MLTC) enrollment began in the Summer of 2012 in New York City and expanded to suburban and Upstate counties over the course of three years. There are limited and comprehensive benefit packages available to individuals with LTC needs.
1985
2000
2011
2012
PHSP Authorizing Legislation is Enacted
Mandatory MMC Enrollment Begins
Mandatory MLTC Enrollment Is Approved
Mandatory MLTC Enrollment Begins in NYC
2015
Statewide Rollout and Transition of Populations into MLTC is Complete.
Limited Benefit Packages
Managed Long Term Care (MLTC)
Does not cover acute care hospital and physician services but provides care coordination for all health benefits for members
Comprehensive Benefit Packages
Program of All-Inclusive Care for the Elderly (PACE)
Operate adult day health centers where enrollees go regularly and receive many services
Medicaid Advantage Plus (MAP)
Newer program to provide long-term and acute care services to duals
Fully Integrated Duals Advantage Program (FIDA)
Newest program to provide long-term and acute care services to duals
Single, blended capitation rate to cover Medicare and Medicaid services

9. “If you come to a fork in the road, take it.”
Staying Focused
“If you come to a fork in the road, take it.”
- Yogi Berra

10. THANK YOU
Cindy Mann 10