Medi-Cal managed care and long-term services and supports: opportunities and considerations under CalAIM
- Collection:
- Health Policy and Services Research
- Author(s):
- Chapman, Athena, author Evenson, Elizabeth, (Of Chapman Consulting), author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, CA] : California Health Care Foundation, March 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Services Accessibility Long-Term Care Medicaid State Health Plans California
- Genre(s):
- Technical Report
- Abstract:
- Millions of Californians live with disabling conditions or chronic illnesses that require them to seek assistance with common activities of daily living, such as bathing, dressing, and eating. Others need help with services such as transportation, housekeeping, meal preparation, or other assistance to live safely and independently at home. Some need these types of supportive services to thrive in a nursing home, assisted living community, or other facility setting. To address these needs, a patchwork of programs across the state provides what are collectively known as long-term services and supports (LTSS); for many Californians with low incomes, some LTSS are provided through Medi-Cal, the state’s Medicaid program. California’s Medicaid agency, the Department of Health Care Services (DHCS), seeks to improve the state’s current approach to providing LTSS as part of its ambitious, multiyear set of reforms known as the CalAIM (California Advancing and Innovating Medi-Cal) initiative. The broad goals of CalAIM are to implement whole-person care approaches that address social drivers of health, improve quality outcomes, reduce health disparities, and create more consistent and seamless statewide Medi-Cal benefits that are easier for enrollees to navigate. One of the strategies that the state is using to achieve these goals is putting more responsibility for provision or coordination of services on its contracted Medi-Cal managed care plans (MCPs). While a variety of approaches could help California achieve more standardized LTSS benefits and improve the enrollee experience, DHCS has stated its intent to move toward a delivery system referred to as statewide Managed Long-Term Services and Supports (MLTSS) by 2027. The CalAIM proposal defines MLTSS as “the delivery of long-term services and supports through capitated Medi-Cal managed care programs.” DHCS has not yet defined its vision for the full scope of LTSS services that would be the direct responsibility of Medi-Cal MCPs under statewide MLTSS, but has stated its intent to keep the In-Home Supportive Services (IHSS) program - the largest LTSS program - outside of managed care for the foreseeable future. It is likely that other LTSS benefits also would remain outside the managed care benefit, so Medi-Cal enrollees would receive some LTSS benefits through managed care and some outside the managed care system, with MCPs serving as the single point of accountability for referral, coordination, and delivery of services. Through various reforms and programs, CalAIM increases the responsibility of MCPs for additional benefits, services, and populations that may increase the role of managed care in delivery of LTSS. Because of the sheer amount of activity under CalAIM, this report does not examine every CalAIM initiative that will impact MLTSS. However, it is important to understand that many components of CalAIM are interdependent, and many of these components increase the types of LTSS that MCPs can provide to enrollees. This report explores some design options for implementing MLTSS that policymakers, agency leaders, advocates, and other stakeholders can consider as planning for this work unfolds. The information provided is based on research of existing LTSS in California and other states, more than 20 stakeholder interviews, and input from an advisory committee composed of regulators and subject matter experts. The report provides an overview of the challenges of the current system of supports and describes the potential benefits of statewide MLTSS. It also offers perspectives and lessons learned that can inform how the system could be developed, an overview of the improvements that a new system could provide as well as different scenarios for implementation. The analysis should help highlight viable options for the further development and implementation of statewide MLTSS in Medi-Cal managed care. The hope is to help ensure a smooth transition to this new approach to LTSS, and to advance and align with the larger goals of CalAIM.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (21 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918645975806676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918645975806676