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:
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.
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.
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:
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:
MLTSS programs across different states serve different groups. For Delaware, their program serves:
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.
Here are a few statistics:
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:
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:
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.
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.