States ready for Medicaid managed care expansion, but long-term care remains a worry, report says

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Stakeholders in Medicaid managed care programs feel prepared for the enrollment surge that will follow the full implementation of the Affordable Care Act, but there are ongoing concerns related to long-term care and provider capacity, according to a new report.

From January to March of this year, researchers from the Robert Wood Johnson Foundation and the Urban Institute conducted interviews with healthcare stakeholders in eight states undertaking Medicaid managed care expansions.

The eight states — Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia — are all expanding Medicaid eligibility, which is optional under the ACA. In all, 19 states are expected to increase managed care enrollment by 2014, according to Avalere Health. Post-acute providers participating in managed care have had mixed experiences, and this latest report reinforces that skilled providers may feel the pinch of growing pains.

All eight states in the RWJF/Urban Institute analysis have taken steps to prepare for an influx of new managed care beneficiaries, such as shifting from voluntary to mandatory managed care enrollment and modifying payment systems. Thanks to these preparations, officials in these states feel ready for the enrollment growth that will begin in 2014, the researchers found. However, the stakeholders are not so confident when it comes to long-term care. In particular, states such as Rhode Island, which is integrating long-term services and supports in a managed care plan in 2013, are facing uncertainty.

“While health plans feel ready to enroll the ACA Medicaid expansion population, they are concerned about some of the broader Medicaid managed care program changes that many of the states are undertaking simultaneously, such as the inclusion of new services (particularly long-term care) and populations (such as the dual eligibles) in managed care,” the report authors wrote.

Provider capacity is a common anxiety among all the states, according to the researchers. One concern is that low Medicaid reimbursement rates could make it hard to recruit providers not already participating in Medicaid managed care, while current providers may not be accepting new Medicaid patients. Capacity issues will be especially dramatic if newly eligible Medicaid beneficiaries enroll quickly next year, although stakeholders often qualified their concerns about this, saying it would not be an “insurmountable” challenge, the researchers noted.

The full analysis is available here.