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Medicaid Managed LTC

The Medicaid population is steadily aging. Even though people are generally living longer, it is a statistical fact that as people age, the prevalence of disabilities and disease increases. Typically, individuals with disabilities require more assistance and supportive services — whether from unpaid or paid caregivers, private health insurance, or government sponsored programs such as Medicaid. As state populations age and Medicaid budgets continue to expand, states are faced with increasing costs from this growing cohort but have limited resources to meet the growing need.

Consumer studies show that people prefer to remain in their homes and communities rather than be institutionalized. However, because of public funding or policy preferences, they may be directed towards institutional services. Many policymakers look to managed care as a tool to help improve LTC systems.

Mercer can help!

With an interdisciplinary team of policy consultants, actuaries, accountants, clinicians, and information technology experts, Mercer can help bring an entirely new managed care program to reality or assist states in expanding or improving existing programs.

Let's Look at a Case Study

The state governor and Medicaid agency had approved exploration of a statewide Medicaid managed care model to serve Medicaid eligibles, with full service coordination including acute and LTC services. The costs for LTC services were rapidly increasing, creating additional strains on the state Medicaid budget.

The Challenge

The state policymakers wanted to started managed LTC for Medicaid eligibles very quickly after obtaining approval. The state already provided Medicaid managed care for physical health services.

Mercer's Role

We worked with the state, potential managed care plans and CMS to make the Medicaid managed LTC program fully operational. The project included:

  • Developing an options paper for review by state policymakers
  • Facilitating an options discussion regarding implications
  • Developing the concept paper, waiver application and participating in CMS/state negotiations
  • Revising contract language
  • Conducting readiness reviews
  • Calculating the actuarially-sound rates
  • Creating strategies to overcome implementation and operational challenges

The Result

The state successfully implemented the Medicaid managed care model, meeting state policymaker requirements. The state received approval from CMS on the waiver and was able to add the additional services to currently functional managed care plans.  

Interested in discussing Medicaid Managed LTC - email us today!

LTC Services Provided

  • Actuarial Analysis and/or Rate Setting
  • Benefit and Eligibility Change Analysis
  • Developmental Disabilities
  • Health Plan Reviews and/or Compliance Audits
  • Long-Term Care/Home and Community Based Services
  • Procurement/Solicitation Assistance
  • Program Implementation
  • Risk Adjustment

 Download our Intellectual Disability/Developmental Disability, Quality in MLTSS, LTSS System Reform, Resource Allocation, and Program Strategy Fact Sheets