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Medicaid Managed Long-Term Services and Supports: Are More Caution and Oversight Needed?

Friday, August 03, 2012

Medicaid can be as much as 25 percent or more of a state's expenditures -- a share that appears to be rising, not shrinking. In 2011 Medicaid accounted for 24 percent of total state spending, including federal grants. To address their budgetary challenges, an increasing number of states are turning to Medicaid managed care. As of 2009, 47 percent of all Medicaid beneficiaries were enrolled in a managed care plan. Looking to save money in categories where the most is being spent, more states are starting to enroll older beneficiaries and those with disabilities in such plans, not just for acute care services, but for long-term services and supports (LTSS).

Consumer advocates are concerned about the level of consumer engagement in this process, as well as the content and quality of the managed care plans. Though there is state oversight of managed LTSS, it differs from state to state.

Who is being served by Medicaid managed care? How is enrollment determined? Does it cover a full range of long-term services and supports including home and community based services? Are these programs providing high quality, efficient care? Is there sufficient state oversight of these programs? How do the different models of state oversight vary from one another? Is Medicaid managed care as a strategy part of state plans for 2014 and the challenges and opportunities presented under the Affordable Care Act?

To address these questions and more, the Alliance for Health Reform and AARP are sponsoring an August 3 luncheon briefing. Speakers will be: James Toews, Administration for Community Living, HHS; Lynda Flowers, AARP Public Policy Institute; Patti Killingsworth, TennCare; and Debra Lipson, Mathematica Policy Research. Susan Reinhard of AARP and Ed Howard of the Alliance will co-moderate.


 Ed Howard, Alliance for Health Reform, Moderator
 Susan Reinhard , AARP Public Policy Institute, Moderator
 James Toews, Administration for Community Living, HHS, Speaker
 Lynda Flowers, AARP Public Policy Institute , Speaker
 Patti Killingsworth, TennCare , Speaker
 Debra Lipson, Mathematica Policy Research, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Briefing Transcript (Adobe Acrobat PDF), 8/3/2012
Full Webcast/Podcast: Medicaid Managed Long-Term Services and Supports: Are More Caution and Oversight Needed?

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

James Toews' Presentation (Adobe Acrobat PDF), 8/3/2012
Lynda Flowers' Presentation (Adobe Acrobat PDF), 8/3/2012
Patti Killingsworth's Presentation (Adobe Acrobat PDF), 8/3/2012
Debra Lipson's Presentation (Adobe Acrobat PDF), 8/3/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Source List (Adobe Acrobat PDF), , 8/3/2012
Materials List (Adobe Acrobat PDF), , 8/3/2012
Speaker Biographies (Adobe Acrobat PDF), , 8/3/2012

Offsite Materials (briefing documents saved on other websites)

How States Can Survive the Medicaid Crisis, Web Memo, The Heritage Foundation, 2/28/2011
- Blasé, Brian
Care Management Practices in Integrated Care Models for Dual Eligibles, AARP Public Policy Institute, 10/12/2010
- Burwell, Brian, Paul Saucier, Lina Walker
Keeping Watch: Building State Capacity to Oversee Medicaid Managed Long-Term Services and Supports., AARP Public Policy Institute, 7/15/2012
- Lipson, Debra, Jenna Libersky, Rachel Machta, Lynda Flowers, Wendy Fox-Grage
Medicaid and Long-Term Care Services and Supports, Kaiser Commission on Medicaid and the Uninsured, 6/12/2012
Medicaid Managed Long-Term Services and Supports (MMLTSS): Increasing State Interest and Implications for Consumers, Quality of Care, Providers and Costs (Adobe Acrobat PDF),National Health Policy Forum, 5/11/2012
Examining Medicaid Managed Long-Term Service And Support Programs: Key Issues To Consider, Kaiser Commission on Medicaid and the Uninsured, 10/12/2011
- Summer, Laura
State Scorecard on Long-Term Services and Supports: What Distinguishes High- from Low-Ranking States?, The Commonwealth Fund, 5/9/2012
- Reinhard, Susan and Enid Kassner
The Role of the Aging Network in Medicare Managed Care for LTSS (Adobe Acrobat PDF),National Association of Area Agencies on Aging, 7/16/2012
States embracing Medicaid managed care, American Medical News, 9/30/2011
- Trapp, Doug
Analysis and Recommendations for the Implementation of Managed Care in Medicaid and Medicare Programs for People with Disabilities, National Council on Disability, 2/27/2012
Medicaid Managed Long-Term Services And Supports Expenditures, Thomson Reuters, 4/6/2011
-  Kasten, Jessica, Steve Eiken, and Brian Burwell
Gradual Rebalancing Of Medicaid Long-Term Services And Supports Saves Money And Serves More People, Statistical Model Shows, Health Affairs, 6/15/2012
- Kaye, H. Stephen
Rebalancing Long]Term Services and Supports: Progress to Date and a Research Agenda for the Future, The Hilltop Institute, 6/14/2011
Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Adobe Acrobat PDF),AARP, The Commonwealth Fund, and The SCAN Foundation, 9/9/2011
- Reinhard, Susan, Enid Kassner, Ari Houser, and Robert Mollica


Susan Reinhard of the AARP Public Policy Institute set the stage for a discussion of Medicaid managed long-term services and supports at the Aug. 3 briefing on this topic cosponsored by the institute. (9 min.)

James Toews of the HHS Administration for Community Living discussed the potential benefits of, and concerns about, managed long-term supports and services at the Aug. 3 briefing cosponsored by the AARP Public Policy Institute. (9 min.)


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