The National Council on Medicaid Home Care Releases Survey Results on Medicaid Managed Care in Home Care
Survey of Council members highlights trends and concerns on the adoption of Medicaid managed care in home care
August 25, 2014 09:45 AM
In July and August, NAHC’s affiliate, the National Council on Medicaid Home Care, surveyed its members as to the status of their adoption of Medicaid managed care in home care. The Council conducted two surveys. The first had 45 respondents, and the second, a modified and more detailed version of the first survey, had 67 respondents, for a total of 112 respondents. The Council discusses the results of these surveys in a new report, available here.
The survey results are based on the responses received from agencies and associations, and are not stratified by state. Therefore, some states may be represented by multiple responses. The survey results represent only a small cross-section of those adopting Medicaid managed care in home care nationally. The total number of states and enrollees adopting Medicaid long-term services and supports (MLTSS) is shown in tables 1 and 2 of the report that is linked above.
Affiliation. Most respondents were representatives of home care agencies rather than hospice companies or the Forum of State Associations. Out of both surveys, 81 stated that they represented a home care agency, 16 stated that they represented an agency that provides both home care and hospice, 13 stated they represented a member of the Forum of State Associations, and three stated that they represented a hospice company. Since the first survey did not delineate “hospice” as an independent category, one of the three that represented a hospice company indicated so in the “other” category in the first survey (in addition to responding that he/she represented a home care agency), so these numbers total 113 and not 112.
Current Implementation of Managed Care. Out of the total of those surveyed, 53 stated that their state now has managed care in home care, four stated that they have Medicaid managed care through coordination of dual eligibles, and 51 stated that their state has both Medicaid managed care in home care and through coordination of dual eligibles. Only three of those surveyed stated that their state does not have Medicaid managed care at all.
Services. The most popular services that respondents noted were already in Medicaid managed care in their states were: home health services (94), home and community based waiver services (67), personal care services (46), and hospice (42). The most popular services pending transition were: home and community based waiver services (11), private duty nursing (10), mental health services (9), and personal care services (9).
Patient populations. The most common patient populations that respondents noted were already in Medicaid managed care in their states were: dual eligibles (73), elderly (68), physically disabled (54), and pediatric (46). The most common patient populations that were pending transition were: dual eligibles (16), intellectual or developmentally disabled (I/DD) (11), and physically disabled (9).
Level of Satisfaction with Managed Care. In both surveys, the Council asked respondents to rank numerous aspects of their transition to managed care on a scale of 1 to 5, with 1 being a very negative experience and 5 being a very positive experience. In both surveys, none of the aspects averaged a score of three (neutral) or higher. All of the responses averaged between a 2 (negative) and 3 (neutral score). This was true both looking at the two surveys independently of each other, as well as aggregating the results.
The survey results reflect a reaction to managed care from home care agencies, joint home care/hospice agencies, and state associations that can be described as lukewarm at best. While the transition to Medicaid managed care is filled with challenges, stakeholders are not powerless or voiceless in the matter. Agencies and associations alike should take opportunities to learn from previous experience. The Council provided key lessons regarding managed care in NAHC’s March on Washington, as well in its recently released toolkit on the transition to Medicaid managed care.
Stakeholders can be very useful in improving a state’s transition to managed care in Medicaid. Likewise, if these stakeholders have outright opposition to using managed care in Medicaid, or otherwise need to navigate their transition to managed care, they should consult with both their state associations and the Council. Home care providers are encouraged to keep abreast of managed care transitions in their states, advocate on a state level, and to contact the Council with any questions or concerns.
To read the full report, please click here.