How Medicaid Managed Care Is Handled in Delaware

As a home care owner, you might be familiar with Medicaid waiver programs. Medicaid Managed care are similar but with a twist. In this article, we’ll share more about: 

• What is MLTSS?
• The history of MLTSS in Delaware
• Who qualifies for Medicaid managed care in Delaware?
• How you can get involved 

What is MLTSS?

Medicaid itself was introduced in 1965, however, Medicaid managed care was first implemented by Arizona in 1988. 

What is Medicaid-managed care? The formal name is Managed Long Term Supports and Services (MLTSS). Programs vary widely in terms of benefits and the population groups they serve. One group that hasn’t been served as much as others are people living with intellectual and developmental disabilities. 

To be more specific, MLTSS offers more comprehensive and cost-reducing care, that consistently turn to new technology and interventions to improve member outcomes. 

Did you know that 72% of Medicaid beneficiaries receive care through a risk-based MCO? 

This growing number demonstrates a commitment to aligning payers and providers to improve outcomes while reducing overall care costs. 

Home-based care has proven to be more cost-effective. What’s more, is that aging in place and the ability to stay in one’s home is what consumers prefer across their lifespan. 

Researchers found that “In a systematic review of patients with chronic diseases who went to the emergency department, [home care] lowered the risk of hospital readmission and long-term care admission compared to in-hospital care.” Though the outcomes were similar, the cost differences and ability to increase quality of life are invaluable. 

The history of MLTSS in Delaware

There are currently 20 states with an active MLTSS program, Delaware included. Delaware’s MLTSS program began in 2012, called: Diamond State Health Plan Plus. 

The program was approved via an 1115 demonstration waiver in 1995. 

Demonstration Waiver: “Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program.” With the flexibility in program design, each state’s program looks a little bit different to better fit their population’s needs. READ MORE.

The program was implemented in 1996 as a Medicaid managed care program. In 2012, following CMS approval, the Diamond State Health Plan Plus program was born. What this change accomplished was: 

1. Sunset the trio of waiver programs that members were using.
2. Streamline care through one program. 

Historically there has been (and some still maintain) a perception of programs favoring institutional care. Investments in MLTSS programs like the one Delaware adopted have expanded access to home and community-based services (HCBS) that allow members of all ages to receive care where they want to live.

With this shift toward home care in mind, Delaware set forth other goals to achieve with the implementation and usage of this new program. Some of them included: 

• Increasing coordination of care and support
• Giving members more choice and control over care
• Expanding care coverage for lower-income individuals 

Who qualifies for Medicaid managed care in Delaware?

MLTSS programs across different states serve different groups. For Delaware, their program serves: 

• Seniors
• Disabled adults 
• People living with HIV/AIDS
• Adults and children (with incomes 250% below the Federal Benefit Rate)

Casting a wide net helps to increase care access and reduce barriers, especially those that stem from social determinants of health like food insecurity and social inclusion. 

What does this look like for you as a home care owner? 

Here are a few statistics: 

• Almost 21% of Delaware’s population is age 65+. 
• Approximately 12% of the state’s population is living with a disability.

Most home care agencies may only think of seniors as their target demographic, but there are many people who would benefit from your assistance to live within their home and community.

What’s great about this program is that members gain access to a network of support and resources like: 

• Home modifications
• Meal delivery 
• Acute and primary care

How you can get involved

Are you interested in adding Medicaid managed care to your agency’s payer source mix? This will open the doors to 3 MCOs. Those include: 

• Amerihealth Caritas of Delaware
• Delaware First Health (Centene)
• Highmark Health Options Blue Cross Blue Shield

You can join the provider network by going to the Medicaid DHHS page and filling out an application. You can also check on the status of your application too.

Make sure that you utilize an agency management system that is built to grow with your payer mix.

Most home care software platforms are built with private pay at the center. As private pay continues to decrease, you’ll need to expand to more third-party payers. 

Manual billing processes can get out of hand especially when adding multiple payers and entities into the equation. If your home care software is hard to navigate or difficult to bill with, consider making a switch to CareTime today.