Experts say reform needed to alleviate LTC strain on Medicaid

James W. Lytle
James W. Lytle

An increasing reliance on Medicaid to pay for long-term care supports and services has put the sustainability of the system in jeopardy, experts warned Wednesday.

But individual states are becoming laboratories to test reform measures that could provide a rescue, they added during the webinar “Medicaid Trends to Watch: Driving Transformation in 2015 and Beyond.”

In order to alleviate some of the fiscal pressure on Medicaid, states are turning to new long-term care delivery and payment models, especially managed care, experts from Los Angeles-based Manatt, Phelps & Phillips said. More than half of states have moved, or are planning to move, LTSS into managed care, they noted.

Manatt government and healthcare partner Jim Lytle pointed to New York as a good example of a managed Medicare testing ground. He also referred to programs such as the Program of All-Inclusive Care for the Elderly and Medicaid Advantage Plus. On the payment reform front, Lytle gave examples such as New York's Delivery System Reform Incentive Payment program, and Massachusetts' ongoing development of a comprehensive Medicaid payment reform strategy.

While states experiment with LTSS reform, the Manatt experts said the federal government also is paying attention and may take action.

Additional trends outlined during the webinar include the important role information technology will have as the LTSS system evolves, and the need for reforms to support informal care. The latter serves as the backbone for LTSS but has been under pressure from the decline of potential family caregivers for the elderly.

As the number of Americans in need of LTC services has grown — an estimated 27 million people will require long-term care in 2050, up from 12 million in 2010 — Medicaid has become the default. Some 51% of long-term payments came from Medicaid in 2013, compared to 21% from other public sources, 19% out of pocket and 8% private insurance.