What Options Are Available for Managed Long Term Care?

Managed long term care is a movement, largely promoted through Medicaid and Medicare, toward a value-based, managed care approach to long term care for elderly and disabled adults. If you're an Alabama healthcare consumer who needs long term care, you probably have questions about how managed care may work for you. What options are available to you under a managed long term care system?

What is Managed Long Term Care?

These are programs that are designed to offer alternatives to the traditional fee-for-service model of healthcare reimbursement. Typically, they offer a range of specified long term care services to healthcare consumers on an as-needed basis, with healthcare providers paid a single, preset fee for providing that package of services. The goal is to provide comprehensive care that is well-coordinated and efficient, helping to reduce or control costs while maintaining or improving quality of care.

Program of All-Inclusive Care for the Elderly (PACE)

PACE is a program open to Medicare and Medicaid-eligible individuals who have been determined to be in need of the same level of long term care and services provided by nursing homes. It offers participants comprehensive medical and social services designed to provide the care they need in the community as an alternative to nursing home placement. Services available available under PACE managed long term care programs include:

• Primary care

• Hospital care

• Medical specialty services

• Prescription drugs

• Dental services

• Personal care

• Physical therapy

• Adult day care

• Nursing home care

• Nutritional counseling

• Lab and medical imaging services

• Social services

• Transportation

Medicaid Integrated Care Networks (ICNs)

This is an up and coming payment model for long term care, which is scheduled to be launched by October 2018. It is designed as a coordinated long term care system, according to Alabama Medicaid. ICNs under this managed long term care program will be healthcare providers who assume responsibility for providing comprehensive care to older and disabled adults, coordinating both nursing home and community based care for Medicaid recipients, according to their specific long term care needs. Medicaid recipients eligible to participate will include:

• All Medicaid recipients who live in nursing homes

• All Medicaid recipients receiving home and community based services under Medicaid waiver programs that include the Elderly & Disabled Waiver, State of Alabama Independent (SAIL) Living Waiver, Technology Assisted Waiver, HIV/AIDS Waiver, and Alabama Community Transition (ACT) Waiver.

Since about two of every three nursing home residents rely on Medicaid to pay for their care and many more depend on Medicare and/or Medicaid for other long term care services, these are the primary options available for managed long term care. However, there are private managed care options as well, generally linked to long-term care insurance policies.