Compared to the fee-for-service model, managed care plans serving those with LTSS needs are focused on improving the care experience and quality of life for beneficiaries. Through dedicated care coordinators, MLTSS plans provide a person-centered approach that considers a beneficiary’s entire health picture, including their quality of life and personal goals.
In addition, MLTSS programs must have a state-run member advisory committee that includes consumers, providers, and representatives of Medicaid managed care organizations. Through these committees and ongoing stakeholder engagement by health plans, beneficiary needs and concerns are understood and factored into how the state designs its program.
The managed care model is a public-private partnership, meaning it combines the state’s ability to be a convener and regulator with the private sector’s expertise, innovation, and flexibility. Many states are prioritizing home- and community-based care over institutional care for their LTSS programs. The MLTSS model is well prepared and able to help states achieve this goal through “rebalancing” the share of spending while improving quality of care.
MLTSS programs are designed to protect beneficiaries through choice and education. For LTSS beneficiaries, maintaining providers is critical, and MLTSS programs are structured to enable beneficiaries to keep their provider. Over three-quarters of states that have MLTSS plans and mandatory health plan enrollment allow beneficiaries to switch health plans outside of the annual enrollment period if their provider leaves the plan’s network. The Centers for Medicare and Medicaid Services (CMS) also requires all states to offer plan choice counseling to beneficiaries through an independent beneficiary support system.
Unlike other models of care, MLTSS plans are held to higher standards at both the federal and state level and work closely with their Medicaid partners to achieve quality health outcomes for those they serve. State and federal governments hold MLTSS plans accountable for the quality of the care provided and success in meeting the goals and preferences of the individual.
Many MLTSS plans conduct ongoing engagement with local patient advocacy and stakeholder groups. MLTSS plans are required to report data to the Centers for Medicare and Medicaid Services and to their state related to beneficiary satisfaction and plan performance.