Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Recent Trends


Facilitated by the policy changes in the BBA, Medicaid managed care for families and children has continued to grow in the past decade. By June 2008, the Centers for Medicare & Medicaid Services (CMS) reported that 71 percent of Medicaid enrollees were in managed health care of some type in 48 states, including risk-based arrangements and primary care case management.5 As about two-thirds of the managed care enrollment is in risk-based arrangements in 46 states, risk-based arrangements are the dominant form of Medicaid managed care.6 However, populations receiving long-term services have largely continued to be excluded from states’ Medicaid managed care initiatives. For example, one survey showed that 90 percent of states with managed care service delivery models excluded persons in long-term institutional settings, 73 percent excluded dually eligible persons, and 71 percent excluded persons receiving home and community services.7

As a percentage of overall Medicaid managed care programs, MLTC continues to be small, but a number of new Medicaid-only and integrated MLTC initiatives have been implemented since 2000 and some of the early MLTC programs have grown substantially. In 2000, Wisconsin piloted its Medicaid-only Family Care Program in five areas of the State and by 2009 had almost completed its statewide expansion. In 2001, building on its experience with Senior Health Options, Minnesota launched its Disability Health Options, an integrated Medicaid-Medicare program for adults with physical disabilities, and in 2005, expanded Senior Health Options statewide. Texas has also engaged in a multi-region expansion of Star+Plus.

In 2004, Massachusetts implemented the integrated Senior Care Options program, and in 2008, New Mexico began implementing its Coordinated Long Term Services program, a mandatory, statewide Medicaid managed care program with an estimated 38,000 persons enrolled. Hawaii implemented Quest Expanded Access in 2009, adding an estimated 39,000 persons to the national MLTC enrollment.

As of 2009, 11 states were providing long-term care services and supports through risk-based managed care arrangements outside of PACE programs, and one additional state has been approved to implement an MLTC initiative.8 So, although MLTC continues to be the exception rather than the rule, it is slowly being adopted by additional states.

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