LTCI Watch: Care Quality

A century ago, children were lucky to have a ball or a stick to play with. The idea of setting up a public playground was a relatively new concept.

Then the baby boomers came along, and suddenly communities took a new interest in the construction and quality of playgrounds.

Today, the demographic forces that changed the nation’s playgrounds are starting to change the way the United States thinks about overseeing long-term care (LTC) facilities and home care services — at a time when cost constraints make providing even a cot in a warm, dry warehouse challenging. 

Debra Lipson, an analyst at Mathematica Policy Research, Princeton, N.J., and colleagues look at state efforts to oversee Medicaid managed LTC services in a report posted on the Web by a think tank affiliated with AARP, Washington.

The federal government has been encouraging states to try using managed care contractors to hold down the cost of paying for LTC services for Medicaid enrollees.

Some of these enrollees are just plain poor; some used “Medicaid planning” to make themselves artificially poor, so that they could qualify for Medicaid nursing home benefits; and some are people who bought private long-term care insurance (LTCI) but ended up exhausting the pot of private benefits and qualifying for Medicaid.

LTCI carriers have been experimenting with using managed care strategies of their own to help maximize the benefits bang for the premium buck.

One question has been: How can managed LTC program overseers make sure that the programs provide high-quality care for patients who may have little ability to speak for themselves?

Lipson and the other analysts studied the performance of well-established Medicaid managed LTC programs in 8 states — Arizona, Massachusetts, Minnesota, New Mexico, New York, Tennessee, Texas and Wisconsin. The analysts came up with recommendations about the process state regulators could use to set up effective managed LTC oversight programs.