How does Virginia’s change to Managed Care for Long-Term Services and Supports fare compared to other states? What could Virginia be doing better for it’s citizens with IDD? Read “SERVICE DISRUPTED: Managed Long-Term Services and Supports Falling Short for Adults with Intellectual and Developmental Disabilities” and learn how eight other states are supporting people with IDD. (From the Community Catalyst’s Center for Consumer Engagement in Health Innovation, November 2019)
Faced with the rapid advance of managed care in Medicaid, many advocates across the country are fighting to
maintain the intellectual and developmental disability (IDD) service systems that they worked so hard to build.
The existing fee-for-service (FFS) system provides many consumers extensive home and community based
long-term services and supports (LTSS), although the range of services and ease of access varies state to state.
Improvements are needed to ensure adults get the services they want and that are essential to living well in their
communities. Commercial (for-profit) managed care offers states the siren-song combination of service
improvement, better coordination of LTSS with other health care and program savings. However, there are other
means of achieving integration, quality care and value for public spending that may work better for this
population than managed care.
The eight states evaluated in this paper are using different models of managed LTSS for adults, with results
ranging from somewhat beneficial to terrible. In no state have consumers resoundingly gained better access to
the full range of high-quality, coordinated services they need.
The models used range from for-profit companies managing LTSS integrated with all other Medicaid services, to
government managed LTSS only, to a mix of public and nonprofit regional plans that cover LTSS and some other
health care. In the for-profit models, the plans are fully financially responsible for providing services for a fixed
fee. In the other models, the plans’ financial responsibility ranges from full-risk to shared-risk with the state.
In several of the states with nonprofit or public managed care, long-existing wait lists for home and community
based services (HCBS) were eliminated or greatly reduced, and consumers gained access to employment and
services such as respite care and community living supports. However, turnover of providers and care managers,
extreme variation of service availability from county to county, and other problems are common.
In Kansas and Iowa, the rollout of commercial managed care for LTSS plus physical and behavioral health was
disastrous for IDD consumers and their families. These two states hastily shifted services for all populations from
FFS to managed care simultaneously. During the rocky transition and implementation, consumers suffered
hardship and injury from service cuts and severed longstanding relationships with trusted providers. Care
coordination failed, leaving families navigating new systems almost entirely on their own.
Individuals with IDD require stability, and the chaos caused by managed care in these states left an indelible
mark. Across the country IDD consumers now approach managed care with strong fact-based skepticism and
fear, even in states where managed care has been around for decades and is not run by for-profit companies.
Several states are reconsidering their approaches to IDD LTSS system improvements and whether managed care
via commercial plans is an appropriate model. For example, Texas has delayed the transition of IDD services to
managed care from 2021 to 20271. Arizona and Wisconsin also dropped plans for commercial managed LTSS
when faced with strong consumer opposition. In this moment of rethinking, there is a prime opportunity for
advocates to jump in and steer these conversations in a positive direction, whether that is barring a transition to
managed long-term services and supports (MLTSS) for this population or fighting to make MLTSS systems better.
In this paper, Community Catalyst presents findings from an assessment of how IDD consumers are faring in
MLTSS, and recommends strategies for ensuring consumers are better served.
For more information on Virginia’s Medicaid Long-Term Support Services, contact the dRC.