IDD Managed Care Plans – What has changed in 2023?
Seven states had IDD Managed Care Changes in 2022
THE VBP Blog
February 9, 2023 – There are ten states with I/DD Medicaid Managed Care programs and we have covered them extensively on the VBP blog. As we open up 2023, there are inevitable changes to these programs we wanted to cover. While some states had substantial changes and future initiatives, others only had small adjustments. We are energized by the commitment from these states to continue these programs and show other legislations the benefits of offering additional resources to these communities.
North Carolina Managed Care Tailored Plans
We have covered NC a few times in the VBP Blog. In 2020, we discussed how their fresh approach to shift to a whole-person care program was delayed due to covid challenges. Then in July of 2021, we saw the launch of that program take shape to the 1.6 million Medicaid beneficiaries in the state. For the behavioral health I/DD community, the program is offering an integrated health solution they dubbed Tailored Plans. These tailored plans are targeted primarily for those with complicated health problems, severe mental health needs, intellectual and developmental disabilities, and traumatic brain injuries.
The Tailored Plans will operate much differently than the Standard Plans that were created for the rest of the state. The IDD community is automatically enrolled to a regional behavioral health organization called Local Management Entities (LME-MCO), eliminating the options given to the Standard Plan participants. Originally, these plans were set to launch in December but have been pushed until April of 2023. This extended timeline should offer more member choices. The Tailored Care Management did launch this December allowing beneficiaries to get a designated care manager who will support integrated, whole-person care. The Local Management Entities
Iowa Commits to Value-based Managed Care
Iowa has had a turbulent road to managed care launches. In a previous blog, we discussed how IA Health Link left both providers and consumers frustrated. They prioritized budgets over quality care, and it showed. Then in October of last year, we broke down what changes Iowa has made.
First, the integration of services has improved leaning on selected MCO’s to deliver benefits. Second, a commitment to value-based care. MCO’s must have 40% of members in a VBP arrangement within the first year with high requirements in subsequent years. Lastly, there is a pay-for-performance initiative that focuses on MCO performance in administrative processes and quality of care measures.
Tennessee Managed Care Launches New Program
The volunteer state has had a ton of success with its Employment and Community First (ECF) CHOICES program. One of the main goals of their program is to put the I/DD community to work under an initiative called TennesseeWorks. Now, ten years in, TennesseeWorks has been incredible successful in creating opportunities for those with disabilities in the workforce. You can see all the highlights of the past ten years on their blog.
Tennessee is also preparing to launch a new program called Medicaid Alternative Pathways to Independence (MAPs). MAPs started last month and are continuing to roll out through 2023. According to their website, “MAPs is a program that will set people with intellectual and developmental disabilities on a path to learn skills to help them work, live independently, learn about their neighborhoods, and find hobbies that interest them. MAPs service gives people in the program the tools, technology, and support they need to meet the goal they set for themselves.” This type of program serves as a bridge for those waiting for Home and Community Based Services through the ECF program.
Texas Preps for SP3 launch in 2024
In our first review of Texas’ we went into detail about their STAR+PLUS program which was still in the early phases and with undetermined success. In 2022, the lone star state announced STAR+PLUS Pilot Program (SP3) which will test a managed care delivery model for the LTSS and IDD communities. With a phased implementation planned for early 2024, the SP3 program will be accessible to those who do not qualify for any of the current waivers. According to the Texas Health and Human Services Commission (HHSC) the SP3 program will offer additional services not found in other waivers such as remote monitoring, housing supports, and enhanced behavioral services.
Kansas Managed Care Has Issues
Kansas’ program, KanCare started in 2013 and had big financial targets from the get-go. The governor promised to save the state $1 billion in five years. In our 2020 blog, our research said the program was under performing for the IDD community. As of January of 2023, there are still issues including an extensive waitlist (4,814 people across the state). Many advocates in the state are continuing to push for expanded resources for challenged communities with little movement in 2022.
Wisconsin focuses on managed care expansion
The major change in Wisconsin came in the form of an acquisition. Inclusa, Inc. offers long-term care coverage and support to over 16,000 individuals and partners with more than 6,000 service providers across 68 counties. Humana acquired Inclusa in August 2022 stating, “For decades, Humana has been focused on improving the health and wellbeing of the people of Wisconsin and we are pleased to expand both our geographic presence and the scope of services we can offer through the acquisition of Inclusa,” said John Barger, Humana Medicaid president, in a statement.
Arkansas PASSE Managed Care Program
In 2020, we first covered the basics of the Arkansas PASSE program and in 2021 we provided an update on all the progress the program has made with their whole-person approach and groundbreaking model. The Arkansas PASSE provider-led managed care program is one of our favorites because it truly puts the consumer first and demonstrates what value-based care can do. As a reminder, provider-led means it must be owned 51% or more of Arkansas Medicaid Providers.
Oklahoma’s New SoonerSelect Managed Care
Oklahoma’s Medicaid managed care program is set to launch in October 2023. At the initial launch, the goals of the legislation are to improve health outcomes, ensure budget predictability through shared risk and accountability, increased access to care, create cost-effective structures, and focus on a provider-led delivery system. In December, we touched on the new Oklahoma’s managed care program SoonerSelect and their blocked attempt to award contracts on the first round. The state previously said they would prioritize provider-led entities to when choosing who would win contracts for the new managed care program. We will keep a close eye on how this program rolls out.
Advocates Perspective
IDD Managed Care is still in the preliminary stages of success. With only 11 states embracing the initiative, there is obvious work to do for expansion. With that said, the states covered above are actively committed to helping the IDD consumers be a part of the community and have access to resources for their care. As advocate’s we look to ensure that these programs are continually growing and providing foundational work for further expansion.
Onward!
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About the Author
Fady Sahhar brings over 30 years of senior management experience working with major multinational companies including Sara Lee, Mobil Oil, Tenneco Packaging, Pactiv, Progressive Insurance, Transitions Optical, PPG Industries and Essilor (France).
His corporate responsibilities included new product development, strategic planning, marketing management, and global sales. He has developed a number of global communications networks, launched products in over 45 countries, and managed a number of branded patented products.
About the Co-Author
Mandy Sahhar provides experience in digital marketing, event management, and business development. Her background has allowed her to get in on the ground floor of marketing efforts including website design, content marketing, and trade show planning. Through her modern approach, she focuses on bringing businesses into the new digital age of marketing through unique approaches and focused content creation. With a passion for communications, she can bring a fresh perspective to an ever-changing industry. Mandy has an MBA with a marketing concentration from Canisius College.