Ohio Managed Long Term Services and Supports (MLTSS)

All Dual-Eligible Ohioans Deserve MyCare Ohio

Ohioans eligible for both Medicare and Medicaid are among the state’s most vulnerable; most have long-term conditions or disabilities or are frail. Since 2014, more than half have chosen to receive their healthcare services, such as long-term services and supports (LTSS), through MyCare Ohio, a pilot project that applies the principles and benefits of managed care to serving beneficiaries eligible for both Medicare and Medicaid or “dual eligibles.”

The project has been a resounding success: Between 2015 and 2019, the portion of Ohio dual-eligibles who were satisfied with their plans rose by 14%. It’s easy to see why; MyCare Ohio members are more likely to be able to use home- and community-based services (HCBS) instead of living in institutions. Most MyCare members prefer to live and receive care in their homes and communities where they are more in charge of their own care and less likely to be hospitalized than people in traditional fee-for-service.

Eighteen other states already provide coverage for MLTSS statewide (Ohio Association of Health Plans, 2021). Ohio should do the same to improve the health outcomes of its dual-eligible population.

Benefits of Managed Care for Long-Term Supports and Services (MLTSS)

  • MLTSS plans work with hospital discharge planners to help with the transition to home- and community-based services (HCBS) and reduce hospital readmissions.
    • States can serve more people who need the same level of LTSS by spending more on HCBS than institutional care (Mathematica, 2020).
    • The number of nursing home residents per capita decreased at a faster rate in MLTSS states than in FFS LTSS states for all 65 and over age groups (Milliman, 2018).
    • MLTSS enrollees had fewer potentially avoidable hospitalizations than FFS in Florida, Kansas, and Tennessee across all three study years (Mathematica, 2020).
  • HCBS helps members be more engaged and integrated into their communities, improving social and employment opportunities.
    • Individuals with intellectual and developmental disabilities enrolled in MLTSS had 33% higher employment rate and worked 23% more hours per week than the national average (Elevance, 2021).
  • Ohio’s dually eligible beneficiaries would benefit from a MLTSS model due to extensive care coordination, which facilitates successful transitions out of institutions and ensures that members maintain the right level of care.
  • Existing data show that members report improved quality of life after enrolling in MLTSS plans.
    • MLTSS beneficiaries were 28% more likely than beneficiaries in a fee-for-service system to be satisfied with their experience of care and quality of life (Mathematica, 2021).
  • States and plans look beyond basic physical and cognitive functions and set goals for benefits such as being able to spend more time with loved ones.
  • Care managers help members set and achieve measurable goals such as attending a grandchild’s birthday party or walking a daughter down the aisle.
  • Many states view care coordination as a key driver of MLTSS programs’ ability to improve consumer experience and their quality of life.
    • ADvancing States reports that “MLTSS program features such as a dedicated care coordinator, better support for family caregivers, higher likelihood of community residence, the ability to live in the setting of one’s choice, and improved connection to the community can all have positive effects on consumer health and well-being.” (2021)
  • Improved care coordination often prevents unnecessary costs and leads to better health outcomes.
  • MLTSS plans reliably deliver HCBS and other caregiver supports that reduce the burden on family members and other unpaid caregivers.
  • Areas of improved satisfaction after joining a MyCare Ohio MLTSS plan include better health, more independence and freedom, effectiveness of care managers and ability to stay at home (Centers for Medicare & Medicaid Services, 2022).
  • MLTSS plans are inherently people-centered, taking into account a member’s entire health picture and personal goals. MLTSS programs can customize offered services based on population needs.
  • A care manager, as a single, trusted point of contact, can coordinate with multiple providers to solve complex problems for members.
  • For LTSS members, keeping consistent providers is critically important, and MLTSS plans are designed to make this possible. Most states with mandatory MLTSS systems allow members to change plans mid-year if their provider leaves the plan’s network (Kaiser Family Foundation, 2017).
  • Through MLTSS, beneficiaries representing diverse populations and needs have benefited from its unique holistic approach to ensuring higher quality care and improved health outcomes.
  • Of the 13 million Americans in need of LTSS, nearly half are younger than age 65 (Open Minds, 2020).
  • More states are offering MLTSS programs for adults with intellectual and developmental disabilities (nine programs in eight states in 2012, vs. 25 programs in 18 states in 2019), and 10 states offer MLTSS programs for children with disabilities (Health Management Associates, 2021).
  • Member testimonials from Ohio:
    • An MLTSS member in OH who has bipolar DX disorder, dementia, depression, and epilepsy experienced an acute worsening of dementia. With her care manager, she was able to remain in her home and community and receive additional personal care services through her The member’s family members were incredibly grateful for the extra time and support for their mother and were very satisfied with the support their mother was provided to help her stay at the home of her choosing for as long as possible.
    • “My care coordinator [is] my guardian angel. She’s there every second and every minute. I have a hard time getting to the things that I need for prescriptions and stuff…so she gets right on it. She’s just there. She’s my best friend.”
  • Fixed-amount payment systems provide states with budget predictability.
  • Managing the use of services and preventing unnecessary hospitalizations and institutional placements helps reduce overall healthcare costs.
  • Managing costs for LTSS is important because MLTSS members (5% of Ohio’s Medicaid population) are disproportionately expensive (accounting for 26% of Ohio’s Medicaid budget) (Ohio Association of Health Plans, 2021).
  • Under a managed care model, states partner with health plans, through a competitive contracting process, to administer and coordinate health care  including LTSS. The state pays the participating health plans a fixed rate, and the health plans are held accountable for delivering care as agreed by the state LTSS program.
  • Managed care models allow far more flexibility to use funds to better address the holistic healthcare and lifestyle needs of each individual through care coordination.
  • Under FFS, states pay providers (including doctors, hospitals, pharmacies, adult day programs, nursing homes, and caregivers) directly for each covered LTSS benefit received by a Medicaid member.
  • Care coordination under FFS is often very limited and does not account for care needs outside of the scope of FFS.