Medicaid Managed Care - U.S. Senate Special Committee on Aging

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contractor collect spenddown payments and adjust the contractor's rates. Most states
have excluded this group from managed care because the eligibility status is largely
used to qualify for nursing home services, and to date, only a few states include long
term care populations or services in their managed care programs.
Dual eligibility raises several complications (discussed in more detail later in this
chapter), and many states have excluded dually eligible people from their managed
care programs. Given the significant incidence of dual eligibility, however,
excluding dually eligible people places a serious limitation on enrollment.
Age
Another important criterion is age. A few states (Minnesota, Nevada) have created
programs that serve older people but not people with disabilities under 65. Others
(Delaware, Georgia, Ohio) include younger people with disabilities but not those
over 65.
Long Term <strong>Care</strong> Services Need
States have taken many approaches to people who require long term care (LTC)
services. Although LTC includes home- and community-based care, states generally
define the need for LTC as meeting a state's criteria for nursing facility certification.
In most states, people in this category are excluded from managed care altogether,
since only a few states include extended LTC benefits in their capitated payments to
contractors. Some states (such as Oregon) do not include extended LTC in their
managed care programs, but still enroll people with LTC needs. In those states,
managed care contractors are responsible for primary and acute care needs, and for
coordinating their services with LTC providers, who are paid directly by the state on
a fee-for-service basis.
Some states have developed programs targeted exclusively to people with long term
care needs. These include the Arizona Long Term <strong>Care</strong> System, pilot projects in
California and Florida, the Wisconsin Partnership Program, and several PACE sites
(Program of All-inclusive <strong>Care</strong> for the Elderly) around the country.
Type of Disability
Finally, states must decide whether to target particular disabilities and/or
conditions. A number of states (Missouri, Ohio, Wisconsin) have developed
programs serving predominately people with physical disabilities. Others (Arizona,
New York, Rhode Island) have or are developing programs targeted to people with
developmental disabilities. Though several states have mental health "carve-out"
programs, none have focused exclusively on people with severe and prolonged
mental illness. Rather, they have been constructed as service carve-outs, available
to a broad range of people with mental health needs, including TANF beneficiaries.
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