Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities. 7.3. Challenges, Obstacles, and Limitations of Managed Care


7.3.1. The “Usual” Managed Care Organizations Are Not Geared to Serving Chronically Homeless People

Typical MCOs do not have significant experience or staff expertise in providing care to chronically homeless people, and they may not have established contracts or payment mechanisms that support the intensity, frequency, and types of services involved. For example, some MCOs have established programs that rely on case managers or nurses who provide health education or case management services by telephone, an approach not adapted to working with people with complex health and behavioral health needs.

7.3.2. Services May Be Much More Limited for People Who Are “Dually-Eligible” for Medicare and Medicaid

Homeless or formerly homeless “dual-eligibles” (people who are enrolled in both Medicare and Medicaid) typically begin coverage with Medicaid only. While covered by Medicaid, dually-eligible chronically homeless people and PSH residents in Massachusetts are served through MBHP’s behavioral health carve-out. However, once Medicare eligibility begins, people must switch to FFS care. When this happens they lose behavioral health coverage for services such as ACT through MBHP and instead get coverage under Medicare for limited inpatient, outpatient, and injectable drug treatment. They supplement this coverage with what can be covered under Medicaid’s FFS care, which is more limited and often requires people to change their primary provider relationship.

Massachusetts recently received an award from a grant program administered by the newly-created federal Coordinated Care Office, to demonstrate integrated care for people who are dually-eligible for Medicare and Medicaid. The Coordinated Care Office was established by the ACA with the goal of improving coordination among federal and state governments and supporting innovations in care delivery and financing for “dual-eligibles.” One focus of these efforts is the most chronically ill and costly segments of the populations enrolled in both programs. Massachusetts is including people who are chronically homeless in the demonstration.

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