Children and adults with disabilities and older adults who need support to perform daily tasks of living must rely on a variety of services and supports over an extended period. Medicaid provides the only coverage for these long-term services and supports (LTSS), other than limited private insurance. Today, Medicaid pays for 60 percent of the paid LTSS provided in the U.S.
States have moved in the last twenty years to provide Medicaid coverage through contracts with managed care plans, but have typically carved out services for older adults and persons with disabilities, leaving LTSS to be provided through traditional “fee-for-service” payments to service providers. Recently, states have moved to bring these populations into managed care. Today, nearly half of the state Medicaid programs provide services for older adults and persons with disabilities through managed long-term services and supports (MLTSS) plans.
MLTSS plans offer substantial value to beneficiaries and their families, to state governments, and to the public, relative to the care provided previously through traditional “fee-for-service” Medicaid. Beneficiaries have a much better experience in MLTSS plans with a greater opportunity to remain independent through increased access to home and community-based living, resulting in improved health and quality of life outcomes. These services are less costly than institutional care, and so states are able to make greater use of limited resources to serve more beneficiaries and achieve better outcomes. The public benefits from lower levels of health care expenditures directed to the people with the most complex care needs.
Read the Association’s full value statement here.