To rein in rising Medicaid costs, states are increasingly requiring their frailest and most expensive patients--the elderly and disabled who need long-term care--to enroll in managed care plans, Kaiser Health News/USA Today report.
So far, six states have such requirements. Another 10, including Florida, Maryland and New Jersey, are looking into expanding the use of managed long-term care, igniting opposition from the nursing home industry and some patient advocates, including AARP. They worry that managed care plans' focus on keeping costs down willmake it hard for patients to get the care they need.
While states traditionally pay Medicaid providers, such as doctors and nursing homes, directly for their services, officials say the system makes it hard to anticipate and control Medicaid spending.
By contrast, with managed care, states pay health insurers a fixed monthly fee for each Medicaid patient. The lump sum goes toward all the patient's costs, including physician and nursing home care.
Managed care cuts states' costs by keeping Medicaid patients with long-term care needs at home, when possible, rather than in more costly nursing homes.
Amerigroup, the insurer for a brain-damaged former dancer who needs help eating, bathing and getting dressed, estimates a year's care for her at home will cost $37,000 compared with $55,000 in a nursing home. Such savings should help keep Medicaid costs down and benefit both the state and taxpayers, Pattie Killingsworth, Tennessee's chief of Medicaid Long-term care, said.
To learn more:
- read the Kaiser Health News/USA Today article
- here's the Hill's blog
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