Medicaid-Managed Long-Term Care - dummies

By Carol Levine

Copyright © 2014 AARP. All rights reserved.

Many states are now setting up managed long-term care programs to provide better coordination of services, more efficient program administration, and better monitoring of quality, and (it is hoped) reduced costs. These programs are run by private companies under contract to the state that typically receive a per-member, per-month fee for care.

In some states, some groups of people who have been receiving long-term services and supports are being moved into managed long-term care programs, and newly eligible individuals will start out in this kind of plan. Some states offer a choice of managed care plans, while others do not.

These programs are evolving, and their characteristics vary by the length of time the program has been in operation, the population included, the types of services provided, program oversight, and the number of plans allowed within a state.

Proponents claim that managed long-term care programs provide better integration of physical and behavioral health. Critics worry that managed long-term care plans will avoid enrolling the sickest and most vulnerable people or will fail to provide the extensive and costly care they need. Vigilant monitoring is needed to ensure that plans meet their obligations to all clients.

Depending on the competition among plans within an area, people eligible for Medicaid long-term care services can choose from several plans. Here are some questions to ask whether you are the person choosing a plan or a family member:

  • Will someone come to the home to assess the person’s needs?

  • Will the person and family be able to participate in the development of the care plan and raise concerns ?

  • If a family member is involved in care, will that person’s needs for training and support be evaluated?

  • Will the same aide who has been caring for the person be allowed to stay on?

  • Is there a number to call when problems arise?

  • How are complaints or grievances resolved?

  • How does the person change plans?

To keep informed about Medicaid managed-care plans in your community, contact the state’s Medicaid office, the state’s long-term care ombudsman (who investigates complaints), or a legal-aid organization that advocates for low-income people. Some states have set up special ombudsmen for Medicaid managed long-term care.

You can find the ombudsman office in your state on the map at The National Long-Term Care Ombudsman Resource Center.