Surge of Medicaid Managed Care is Fraught with Probelms Unless Root Concerns are Addressed

Surge of Medicaid Managed Care is Fraught with Problems Unless Root Concerns are Addressed

New Analysis Showing Potential Growth Reveals Potential Problems for Older Adults in Nursing Centers, says Parkinson


Washington, DCIn light of a new report issued this week forecasting the continued rise of Medicaid managed care plans, the American Health Care Association (AHCA) today called on state and federal agencies to carefully weigh and consider the needs of older adults as they implement new payment structures under Medicaid.  Specifically, the Association is concerned that long term services and supports (LTSS) will be managed by groups with little-to-no experience in the vastly complex needs of Medicaid’s older adult population in nursing centers.

“Too much is at stake here, with too many moving parts,” said Mark Parkinson, President and CEO of AHCA.  “Our members are concerned that Medicaid managed care adoption is occurring without placing the needs of the older adults in these programs at the forefront of this effort.  Managed care organizations have laudable goals of enhancing care coordination and saving state dollars, but the managed LTSS model as it stands today has unclear and mixed quality and cost savings outcomes for patients and states themselves. Any new programs must be implemented with consideration of what works best for those receiving care.”

Conducted by Avalere Health and released earlier this week, the comprehensive analysis projects a 20 percent increase in managed care enrollment in 2014.  The report credits this to states’ managed care expansion efforts and growth in new Medicaid beneficiaries through the Affordable Care Act (ACA). While most of the growth is attributed to enrollment of the ACA Medicaid expansion targeted to working age, childless adults, a notable number of older adults and persons with disabilities also will be enrolled as a dozen states move forward with expanding or implementing Medicaid managed LTSS.  The addition of 12 states to the ranks of Medicaid managed LTSS states will bring the total number of states using such approaches to 28 while evidence of savings and quality remains weak.

Late last year, AHCA issued 3 broad principles and a report of its own designed to help state policymakers review and better implement managed LTSS.  The principles focused primarily on ensuring patients’ access, improving care quality and enhancing patient choice in a managed care environment.