Archive for Medicaid long-term services and supports



The Medicaid and CHIP Payment and Access Commission met last week in Washington, D.C. to discuss a variety of Medicaid and Children’s Health Insurance Program issues.

MACPAC, the non-partisan legislative branch agency that performs policy and data analysis and makes recommendations to Congress, the administration, and the states, addressed a number of issues during the meeting.  Among them it discussed Medicaid managed long-term services and supports (MLTSS) and voted to recommend that states be given the opportunity to seek permission to make Medicaid beneficiary enrollment in managed care plans mandatory through revisions of their state plan amendment rather than by seeking Medicaid waivers.

The commission also heard presentations on and discussed:

  • the integration of substance use disorder treatment with other Medicaid-covered services
  • residential substance abuse treatment and the exclusion of institutions for mental disease from treatment options
  • stakeholder experiences with MLTSS
  • Medicaid hospital payments
  • Medicaid managed care
  • the “Money Follows the Person” demonstration program
  • appeals for the dually eligible

Go here for a summary of the meeting and links to the presentations used for these subjects.


Conflicts of Interest Mar HCBS

States’ efforts to provide home- and community-based services to elderly and disabled Medicaid beneficiaries who need assistance to continue living independently continue to be plagued with conflicts of interest that the Centers for Medicare & Medicaid Services is not adequately addressing.

Or so concludes a new study published by the U.S. Government Accountability Office.

According to the GAO,

…conflict of interest remain in regard to HCBS providers and managed care plans.  HCBS providers may have a financial interest in the outcome of needs assessments, which could lead to overstating needs and overprovision of services.  CMS has addressed risks associated with HCBS provider conflicts, such as by requiring states to establish standards for conducting certain needs assessments, but these requirements do not cover all types of HCBS programs.

To address this problem, the GAO recommends

…that all Medicaid HCBS programs have requirements for states to address both service providers’ and managed care plans’ potential for conflicts of interest in conducing assessment.

The study notes that the U.S. Department of Health and Human Services concurs with the GAO recommendations.

Learn more about the challenges facing the delivery of home and community-based services in the GAO report CMS Should Take Additional Steps to

GAO: Improvement Needed in MLTSS Oversight

The Centers for Medicare & Medicaid Services needs to improve the job it does overseeing state Medicaid programs of managed long-term services and supports.

According to a new report by the U.S. Government Accountability Office, 22 states use MLTSS programs to help qualified seniors continue living independently in the community and to save money on nursing home costs.  CMS’s oversight of these efforts, and of the use of federal funds, is inconsistent and often falls short when monitoring key considerations such as provider network adequacy, critical incidents, and appeals and grievances.

To address these concerns, the GAO recommends that CMS

…take steps to identify and obtain information to oversee key aspects of MLTSS access and quality, including network adequacy, critical incidents, and appeals and grievances.

According to the GAO report, the U.S. Department of Health and Human Services agrees with these recommendations.

Learn about MLTSS oversight, what the GAO found, how it conducted its study, and what it recommended in the GAO report Medicaid Managed Care:  CMS Should Improve Oversight of Access and Quality in States’ Long-Term Services and Supports Program, which can be found here.


States Lag in Reducing Nursing Home Utilization

States are not making adequate progress toward keeping seniors and the disabled out of nursing homes by making greater use of home and community-based services.

Or so concludes a new study from AARP.

According to the study, only nine states and Washington, D.C. spend more on home and community-based services and long-term services and supports than on nursing homes.  Minnesota leads the nation, spending 69 percent of its long-term-care money on home and community-based services.  Other leaders include Washington state (65 percent), New Mexico (64 percent), and Alaska (63 percent).

Alabama pulls up the rear with only 14 percent.

The national average rose from 39 percent in 2011 to 41 percent in 2014.

Learn more about why this transition is considered important and what the obstacles to greater progress are in this Kaiser Health News report.