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Alabama, Ohio Provide Details on Medicaid MLTSS Program Designs

This week, we reviewed two proposed statewide Medicaid managed long-term services and supports (MLTSS) program designs. Alabama is currently accepting public comments on a plan to implement provider-driven Integrated Care Networks (ICNs) to provide MLTSS statewide to roughly 25,000 beneficiaries who are residing in nursing facilities or receiving home and community based services (HCBS) through three of the state’s Medicaid HCBS waiver programs. Meanwhile, Ohio Governor John Kasich proposed in his upcoming state budget to implement a statewide MLTSS program for more than 100,000 beneficiaries in the state. We review both states’ plans for MLTSS, including market sizes, implementation timing, and existing Medicaid managed care plans in the states.


On April 5, 2017, the Alabama Medicaid Agency published a concept paper for public comment on the planned ICN program. The program would implement MLTSS statewide for around 25,000 Medicaid beneficiaries residing in a nursing facility or enrolled in one of three of the state’s home and community based services (HCBS) waiver programs.

The ICN program targets enrolling just over 16,000 Medicaid beneficiaries who are currently long-term stay nursing home residents. Additionally targeted for inclusion in the ICN program are around 9,000 HCBS waiver enrollees in the Elderly and Disabled Waiver, the HIV/AIDS Waiver, and the Alabama Community Transition Waiver. Nearly all potential ICN HCBS enrollees are in the Elderly and Disabled Waiver. Alabama Medicaid nursing facility spending amounts to around $900 million in recent years, while the three HCBS waiver programs included in the ICN program account for more than $65 million in annual Medicaid HCBS spending.

Per the concept paper, a competitive procurement would be issued in August 2017 to contract with no more than two statewide ICNs, which are organizations of health care providers that will receive monthly risk-based capitation payments.

ICNs can be for-profit or not-for-profit entities, and must have a governing board composed of 20 members: 12 members representing risk-bearing participants in the ICN and eight members who do not represent risk-bearing participants. The state is targeting implementation in July 2018. Comments on the concept paper are due May 4, 2017.

The ICN Concept Paper posted for public comment is available at:


On March 31, 2017, the Ohio Department of Medicaid published a slide presentation including information and updates from a recent stakeholder meeting about the state’s Medicaid Managed Long-Term Services and Supports (MLTSS) procurement. As proposed by Governor John Kasich in his upcoming budget, the state intends to implement MLTSS statewide in 2018. The state’s dual eligible demonstration, known as MyCare, currently provides MLTSS to many dual eligibles in the demonstration regions, and includes mandatory enrollment in MLTSS in the event that an eligible dual opts out of the MyCare program.

Based on the current proposal, which excludes MyCare enrollees, as well as individuals with I/DD, we conservatively estimate the potential MLTSS population at roughly 100,000 members, although eventual enrollment could be as high as 130,000, depending on final program design.  Total Ohio LTSS spending is more than $7 billion, although due to program design, only a portion of this total spending would be moved to the MLTSS program.

Ohio plans to issue a request for applications (RFA) in July 2017 to procure at least three statewide MLTSS plans. Plans will be selected in October 2017 and fee-for-service members will begin transitioning to MLTSS in July 2018, phased in over 6 months, with transitions occurring every 60 days.

Ohio’s MyCare program is currently served by five of the state’s six Medicaid health plans, with enrollment relatively evenly distributed across the five plans.

It was reported on April 7, 2017, that opponents to statewide MLTSS testified on the budget proposal, citing the lack of experience serving individuals with complex needs and less local, independent care management.

The Ohio MLTSS presentation slides are available at:

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