The leaders of the Senate Finance Committee are seeking answers about access and quality of states’ long-term services and support (LTSS) programs following a shift in care to non-institutional based services. 

Sens. Chuck Grassley (R-IA) and Bob Casey (D-PA), the committee’s chairman and ranking member, recently sent letters asking questions about Medicaid managed care and LTSS programs to Centers for Medicare & Medicaid Services Administrator Seema Verma and eight external quality review organizations that audit managed care organizations. 

Medicaid has historically been the primary payer for LTSS for seniors and people with disabilities, but over time, beneficiaries are “increasingly” receiving LTSS through home- and community-based services, the senators said. 

They also noted more beneficiaries have looked to managed care for LTSS. In 2004, only eight states had implemented managed care for LTSS beneficiaries. That number was 27 by 2017. 

“This shift in care from institutional settings to HCBS settings has been driven by beneficiary preferences, concerns about the high cost of institutional care, and a Supreme Court case,” the senators wrote. “The move to (home- and community-based services) and to managed care as a payment model have each brought significant changes to the LTSS program the people it services. In order to ensure these changes do not cause disruptions for vulnerable people who tend to have significant health needs, it is incumbent upon CMS and states to ensure adequate oversight.” 

The senators requested that CMS and the external quality review organizations respond to their questions by Sept. 13.