Case Study 2: Conclusion
About 12 months after beginning the planning process Connie and the HSSS presented their final plan and recommendations to the Governor’s Office. The plan was ultimately approved by the legislature.
Under the plan, the state will expand its current managed care program, which already included older persons and persons with disabilities but does not yet include LTSS. The state will amend its existing Section 1915(b) waiver to include LTSS services in the managed care program and will use the authority concurrently with existing Section 1915(c) waivers for LTSS across population groups.
The state is including Medicare and will seek permission to passively enroll Medicare-Medicaid enrollees for its Medicare, though it understands it cannot mandate enrollment for Medicare services, with or without waivers.
The state does not currently have a personal care service. Rather than adopt the optional service, it will work with its contractors to have them offer personal care as a value-added service to people who would otherwise be at risk of becoming nursing home eligible. The contractors would pay for these extra services with savings generated by reducing nursing home and hospital use.
The state will continue to offer self-directed options when it converts from fee-for-service to managed MLTSS, using the same authority is has used to date.
