Michiganders eligible for Medicaid are among the state’s most vulnerable which is why providing fully integrated, quality care to those who need it is more important than ever. As part of Medicaid coverage, long-term services and supports (LTSS) covers a broad range of day-to-day services for Michigan’s most vulnerable, most of whom have long-term conditions or disabilities. However, Michigan’s current program has resulted in lower beneficiary satisfaction and quality of life, and higher costs for the state’s Medicaid program.
But now the state has the opportunity to adopt managed long-term services and supports (MLTSS) programs that offer dedicated and coordinated care to LTSS beneficiaries, helping them get back into their homes and communities and improve health outcomes for all beneficiaries.
Since implementing its first Medicaid managed care program in 1996, managed care in Michigan has brought benefits such as reduced unnecessary services, positive health outcomes, and efficient and quality care to more than 2.2 million Michiganders (or roughly 22 percent of the state population).
Through the MLTSS model, health plans in Michigan can better support LTSS beneficiaries and provide them with fully integrated, high quality, and coordinated care
Initial MLTSS pilot programs in Michigan have shown results. MI Health Link, the state’s managed care demonstration program has delivered:
- high member satisfaction
- quality improvement, and
- improved care coordination of Medicaid services (Research Triangle Institute International, 2022).
Transitioning all LTSS-eligible populations into managed care is right for Michigan—and beneficiaries.
Importance of Integration
- Integration of healthcare services leads to better care and health for the whole person and is long overdue for Michigan’s vulnerable Medicaid beneficiaries.
- Health plans are advancing innovative value-based payment models in Michigan’s Medicaid program. These payment strategies are driving greater efficiencies and better health outcomes and stand in stark contrast to antiquated FFS, volume based only, models.
- Managed care in Michigan saved (compared to Fee-For-Service – FFS) taxpayers over $400 million per year since 2000, over $9 billion.
Benefits of Home and Community-Based Services (HCBS)
- Americans increasingly wish to be cared for in their homes and with their families. Individuals live longer, healthier, happier lives when they are in their homes and communities, with the right support in place.
- HCBS helps members be more engaged and integrated into their communities, improving social and employment opportunities.
- Individuals with intellectual and developmental disabilities enrolled in MLTSS had 33% higher employment rate and worked 23% more hours per week than the national average (Elevance, 2021).
- Michigan’s dually eligible beneficiaries would benefit from an MLTSS model due to extensive care coordination, which facilitates successful transitions out of institutions and ensures that members maintain the right level of care.
- Michigan was one of five states with the lowest share of spending on HCBS in FY 2019 compared to spending on institutional care (Centers for Medicare & Medicaid Services, 2021).
- The low spending on HCBS underscores the need to adopt MLTSS to “rebalance” the share of spending.
- Nursing home care is more expensive than HCBS (Genworth, 2020); HCBS is generally more cost-effective than serving the same person in an institution. Consequently, states can serve more people who need the same level of LTSS by spending more on HCBS than institutional care (Mathematica, 2021).
- MLTSS programs provide extensive care coordination, which facilitates successful transitions out of institutions and ensures that members maintain the right level of care.
The Need for Coordinated Care
- To ensure more comprehensive care coordination of physical and behavioral needs of LTSS beneficiaries, Michigan should follow other states in moving toward an MLTSS model.
- MLTSS plans use a dedicated care manager to coordinate care across a range of providers and services, with a focus on treating the whole person. The care manager acts as a single, trusted point of contact to coordinate or modify care, support caregivers, and monitor progress.
- Care coordination greatly reduces the burden on beneficiaries and their families related to arranging and managing services individually and helps to ensure a seamless care experience for each beneficiary.
- Improved care coordination often leads to improved health outcomes while preventing unnecessary costs by encouraging care in the most appropriate and least restrictive setting.
- Having a comprehensive view of a beneficiary’s services also ensures that each beneficiary receives the right level of care for their needs and goals.
- Because of Michigan’s current FFS model for LTSS, care coordination is very limited and does not account for care needs outside of the scope of traditional FFS. Unlike FFS, managed care is always based on a holistic view of a beneficiary’s needs and is centered on ensuring every beneficiary receives the care they need when they need it.
- Managed care organizations bring private sector innovation, expertise, and agility to help states in the delivery of LTSS, spurring competition to offer the best program for the needs of the state’s Medicaid beneficiaries.
- If Michigan adopts MLTSS, plans would be able to offer innovative services to their beneficiaries and adapt care plans to changing circumstances more quickly than FFS, such as offering community housing options, enhancing the LTSS direct care workforce, leveraging technology to empower and support beneficiaries, and securing employment opportunities for those seeking employment.
- MLTSS health plans engage in advocacy efforts to advance the needs of the LTSS community and improve care. For example, some plans are helping to support and expand the direct care workforce and to address disability access barriers.
- Some health plans are supporting states to invest in LTSS workforce development programs. These can build infrastructure and retention among LTSS service providers through retraining, redeployment, and skill enhancement. These programs are designed to anticipate need and reduce the provider to patient ratio, which often leads to better care outcomes. (Kaiser Family Foundation, 2019).
Providing Strong Member Satisfaction
- Areas of improved satisfaction after joining a MI Health Link plan include better health, more independence and freedom, effectiveness of care managers and ability to stay at home (Centers for Medicare & Medicaid Services, 2022).
- MLTSS plans are inherently people-centered, taking into account a member’s entire health picture and personal goals. MLTSS programs can customize offered services based on population needs.
- A care manager, as a single, trusted point of contact, can coordinate with multiple providers to solve complex problems for members.
- For LTSS members, keeping consistent providers is critically important, and MLTSS plans are designed to make this possible. Most states with mandatory MLTSS systems allow members to change plans mid-year if their provider leaves the plan’s network (Kaiser Family Foundation, 2017).