Survey: Managed Care Programs Shifting Patients Away from SNFs

Managed long-term services and support programs (MLTSS) bring a host of benefits to states, including better care outcomes and reduced spending — but could also shift more patients away from institutions to in-home or community programs, according to a new survey.

The National Association of States United for Aging and Disabilities’ (NASUAD) MLTSS Institute sent surveys to all 19 states that operate the programs, which typically include a wide spectrum of services for older folks and people with disabilities—like bathing, transportation and medication management—in nursing facilities, homes and community facilities.

Twelve responded, providing an overall positive outlook of MLTSS programs’ impact on both patients and states’ bottom lines. For instance, officials in Florida said 60% of participants in its MLTSS program reported improvement in their overall health, while a Minnesota study found that participants in its Minnesota Senior Health Options program were 48% less likely to find themselves in the hospital than people with similar health profiles outside of the program. Participants who were hospitalized, meanwhile, logged 26% fewer stays than non-participants.


“Through the Kansas KanCare program, primary care physician visits increased by 80%, ‘costly hospital stays’ decreased by 29%, and emergency department use decreased by 7%,” the report states.
The survey also found states reducing or entirely eliminating waitlists for home- and community-based services, expanding the types of care offered under MLTSS programs—such as vision insurance and non-medical transportation options in Florida, or dental services in Massachusetts—and slashing costs.

A Shift Away from SNFs

The Sunshine State, for example, claims that it saved $284 million in 2014-2015 by shifting patients from nursing facilities to community programs under its MLTSS program, with an additional $432 million in savings in 2015-2016 and $200 million each year in the future.
The transition from institution to community remains a major goal for many of the states with MLTSS programs, with eight of the 19 identifying a rebalance of Medicaid spending away from nursing facilities as a top priority.


“New Mexico views this shift as supporting the person-centered goals of its Centennial Care program and improving consumers’ qualify of life,” the report notes.

In the long run, Florida hopes to cap the nursing-home population of its MLTSS program at 35%, and has already seen a 12% drop in the amount of Medicaid patients in nursing facilities. In Tennessee, meanwhile, the percentage of Medicaid consumers using community facilities rose from 17% to 44% since its TennCare CHOICES program was implemented, while New Jersey reported a 1,000-resident decline in its nursing population since it rolled out its MLTSS program in 2014.

The report cautions that attributing these results solely to the implementation of MLTSS isn’t entirely accurate, as a variety of different programs and agencies conspire to affect health care and budget outcomes—and, as the report notes, many states rely on potentially inaccurate self-reported data or small sample sizes.

In its conclusion, NASUAD recommends that states collect detailed baseline health data from program participants to provide a better reference point for long-term changes, and that governments also include information-collection requirements in contracts with managed care organizations.

Written by Alex Spanko