Filed Under:Health Insurance, Ltci

Exec: Medicaid managed LTC may be harder than you think

What if
What if "managing care" just means rearranging too few chairs on the deck of the Titanic?

Putting New York state residents who need nursing home care in managed long-term care (LTC) programs could cause new problems if the state fails to expand the supply of nursing home beds.

James Clyne Jr., president of LeadingAge New York, a trade group for nonprofit LTC providers, gave that warning at a recent New York State Legislature hearing on a move to impose mandatory care management on Medicaid enrollees who are getting LTC services.

The state Department of Health is trying to get all Medicaid enrollees into managed care plans within three years.

LeadingAge posted a written version of Clyne's testimony on its website.

LeadingAge supports the concept of shifting to care management for most Medicaid enrollees, but it now sees how the shift to mandatory managed LTC is working and has concerns, Clyne said, according to the written version of his testimony.

"The state has established what are seen as very aggressive timeframes for accomplishing the transition to care management for the LTC population," Clyne said. 

In April, he said, New York state had 34,000 Medicaid enrollees in managed LTC plans. In three years, that number is supposed to increase to about 300,000.

Today, the state has mandatory managed LTC only for home care.

The state is hoping increased use of care management for nursing home residents will lead to better care coordination, lower rates of institutional use and increased consumer satisfaction, but the mandatory Medicaid managed LTC enrollees may be much different from other Medicaid enrollees and from the original volunary managed LTC program enrollees, Clyne said.

New York state does not have enough nursing home beds today, many nursing homes are financially vulnerable, and Medicaid premiums cover only half of the cost of keeping an enrollee in a nursing home for a month, Clyne said.

The state also has to work on expanding the supply of apartments that provide some services for seniors, Clyne said.

"The best managed care service available is useless if the individual does not have a  safe,  affordable  place to live," Clye said."While congregate senior housing is an ideal location for low-income seniors to  remain independent and receive supportive services, there is a severe and growing shortage of  this much needed resource, especially in downstate communities. In addition, much of the  current infrastructure needs rehabilitation."

The state also needs to make it easier for managed care providers to work with assisted living facilities, Clyne said.

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