HMA Publications

As state Medicaid programs are increasingly shifting beneficiaries into managed care organizations (MCOs), some MCOs are expanding their traditional role to better meet the needs of their vulnerable members and communities.

In a new Commonwealth Fund report, Health Management Associates Managing Principal Sharon Silow-Carroll and Consultant Diana Rodin, report on the efforts of four managed care organizations (MCOs) that are forging community partnerships to meet the needs of vulnerable Medicaid patients and others in their communities.

They developed four case studies:

• Gateway Health Plan
• HealthPartners
• L.A. Care
• Neighborhood Health Plan

These case studies describe the "how" and the "why" when it comes to MCOs addressing barriers and changing the way care is delivered, including internal and state policy drivers, leveraging partnerships and key take-aways.

Authored with: Wendy Fox-Grage and Kathleen Ujvari of the AARP Public Policy Institute; and Diana Scully, Eunhee (Grace) Cho, John Michael Hall of the National Association of States United for Aging and Disabilities

This report finds that two-thirds of the states either have or will launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services, the so-called "duals," over the next two years.  To contain the growth of costs and improve care, many of them are moving to risk-based managed long-term services and supports models.

A template for helping states transform their healthcare delivery systems.

Wendy Fox-Grage, AARP Public Policy Institute

Jenna Walls, Senior Consultant, Health Management Associates

The vast majority of people who need long-term services and support want to live in their own homes and communities as long as possible. States have made progress in providing greater access to home and community-based services (HCBS) for people with low incomes.

This research collected state studies about the cost effectiveness of HCBS. The 38 studies, published from 2005 to 2012, include state-specific analyses by public and other organizations. Major findings include:

• The studies that evaluated the cost effectiveness of HCBS supported Medicaid balancing and other efforts to move more resources toward home and community services rather than institutional care.

• The studies consistently showed lower average costs per individual for HCBS compared to institutional care. In California, for example, spending on nursing home care per person was three times higher than for HCBS—$32,406 for nursing facility care versus $9,129 for HCBS in 2008.

• The findings show cost reductions by diverting people from nursing home care to HCBS. In Nevada, the monthly average number of older adults who opted for HCBS waivers grew 58 percent from 2001 to 2007, while the nursing home caseload decreased 8.5 percent.

The New York State Department of Health enlisted Health Management Associates (HMA) to analyze available options for selecting a Medicaid benchmark benefit for people eligible for Medicaid’s new mandated adult category established by the Affordable Care Act (ACA).

This analysis reviews the revisions to Medicaid eligibility established by the ACA as it affects populations already covered under New York’s Medicaid and Family Health Plus programs, as well as those currently ineligible for public coverage. HMA colleagues identify and describe the options for a Medicaid benchmark benefit as defined by the ACA. The report also reviews the current Medicaid benefit package against the Essential Health Benefit standard and compares it with each of the Medicaid benchmark options.

The report concludes by discussing the implications of selecting a Medicaid benchmark in terms of the impact on currently covered groups and the comprehensiveness of the scope of benefits offered.