Managed Care in Medicaid's Long-Term Services and Supports

The American healthcare system and care economy face growing demands from an aging population, raising important questions regarding the organization, delivery, and funding for services in these two sectors. Long-term services and supports (LTSS) include medical and personal care services for individuals requiring assistance with daily activities. Over the last two decades, Medicaid—which pays for more than half of all LTSS delivery—has shifted away from traditional fee-for-service (FFS) payment models toward managed care systems in which private insurers cover LTSS in exchange for capitated payments from the government. However, empirical evidence on the effects of Medicaid managed care on costs and patient health outcomes is mixed and focuses on relatively young and healthy populations. This project will advance knowledge on by measuring the impacts of the transition from FFS to managed care in LTSS among individuals who are dual-eligible for Medicaid and Medicare and aged 65 and above in two states: New York and Florida. For these beneficiaries, Medicaid pays for LTSS, while Medicare is the primary payer for other types of healthcare services, including hospitalizations, office visits with primary care providers (PCPs) and specialists, and emergency department (ED) visits. The analysis will use several administrative claims datasets covering years 2008-2019 to compare changes in outcomes of beneficiaries from before to after MLTSS was implemented in New York and Florida counties to those among beneficiaries in never-treated counties in two control states—Pennsylvania and California—over the same period. As outcomes, the project will study care in outpatient, inpatient, and ED settings, as well as mortality. Since this care is not covered by Medicaid, any changes in them can be understood as spillovers of the managed care model in Medicaid LTSS on other types of healthcare not included under that model. The project will also identify subgroups who are most impacted by the shift to MLTSS in Medicaid and examine the role of managed care plan features in health care utilization and outcomes. Results will help policymakers, healthcare organizations, providers, and patients to understand the implications of the MLTSS model in Medicaid on patient care and health.