Demonstrating the Value of Medicaid MLTSS Programs

Almost half of the states are operating Medicaid managed long-term services and supports (MLTSS) programs, but there has historically been limited evidence of their value. To help fill this gap, this report presents updated results from states responding to ADvancing States’ survey, as well as new research on states with MLTSS programs. The 12 states responding to the surveys — Arizona, Florida, Iowa, Kansas, Massachusetts, Minnesota, New Jersey, New Mexico, Tennessee, Texas, Virginia, and Wisconsin — account for more than half of the states who are operating MLTSS programs. States were asked about their goals in implementing MLTSS programs, what progress they had made in attaining those goals, and if they faced any challenges collecting data to document progress. In addition, new research has documented additional value from MLTSS programs in the following areas:

• Rebalancing Medicaid LTSS Spending. Rebalancing Medicaid long-term services and supports spending toward home- and community-based settings and providing more options for people to live in and receive services in the community was a key goal for all states. Many states have specific rebalancing targets, as well as financial incentives for MLTSS plans to meet them.
• Improving Member Experience, Quality of Life, and Health Outcomes. All states wanted to improve consumer health and satisfaction/quality of life. While it can be challenging to attribute improvements in health outcomes solely to MLTSS programs, seven states reported improved consumer health. Eleven states said that they collect data on the quality of life; from those reporting outcomes, MLTSS consumers had improved quality of life and high levels of satisfaction compared to fee-for-service programs. One challenge highlighted by states was that the fielding the surveys used to collect these data is time and labor-intensive.
• Reducing Waiver Waiting Lists and Increasing Access to Services. MLTSS programs may reduce or eliminate waiting lists for waiver services. Seven states said they wanted to reduce waiting lists, while others focused on increasing access to services. Some states successfully eliminated waiting lists, while other states addressed waiting lists through prioritizing applicants by level of need. Some states reinvested savings achieved through implementing MLTSS to decrease the number of people on waiting lists.
• Increasing Budget Predictability and Managing Costs. MLTSS programs’ use of capitated payments can help improve budget predictability. The programs also have the potential to achieve savings by: rebalancing LTSS spending, managing service use, and avoiding unnecessary hospitalizations or institutional placements. While states report they are “bending the cost curve,” inadequate data are a barrier to states’ ability to demonstrate these outcomes. The state surveys and recent research provide compelling examples demonstrating that states are meeting their MLTSS program goals. It also underscores the importance of expanding the scope and amount of data collected on program impacts. Health plan contracts with strong data reporting and performance monitoring requirements are important tools for states to build stakeholder support and demonstrate program viability over time.