Home Health & Hospice

Home health stakeholders give "lukewarm" reception to Medicaid managed care, new report shows

Homecare Insider, August 25, 2014

A new report from the National Council on Medicaid Home Care reveals a less-than-enthusiastic reception of Medicaid managed care from the home health industry.
“The survey results reflect a reaction to managed care from home care agencies, joint home care/hospice agencies, and state associations that can be described as lukewarm at best,” the Council, which does national- and federal-level advocacy work related to homecare Medicaid issues, summed in its rundown of the survey findings.
In July and August, the Council asked its members (which include forums of state associations, homecare agencies, hospice agencies, and joint homecare/hospice providers) about the status of their Medicaid managed care adoption through two surveys. They received input from a combined total of 112 respondents, an overwhelming proportion of which were home health agencies. Still, the Council notes that this is only a small cross-section of affected parties, as there are an estimated 23 states and over one million enrollees currently embarking on such initiatives.
Of those surveyed, 53 reported that their state now has managed care in home health, four reported that they have Medicaid managed care through coordination of dual eligibles, and 51 reported that their state has both types. Only three of those surveyed reported that their state does not have Medicaid managed care at all.
In both surveys, the Council asked respondents to rank many aspects of their transition to managed care on a scale of 1 to 5, with 1 being a very negative experience and 5 being a very positive experience. In both surveys, none of the aspects averaged a score of three (neutral) or higher. All of the responses averaged between a 2 (negative) and 3 (neutral score).
When results of both surveys were combined, the highest satisfaction scores went to enrollment (2.81), joining provider networks (2.71), and breadth and depth of covered services (2.68), while the lowest scores befell stakeholder input opportunity prior to implementation (2.13), timely payment of claims (2.20), and prior care authorizations (2.20).
Despite these underwhelming responses in regards to the effectiveness of transitions to Medicaid managed care programs, the Council and its survey respondents provided some advice to ease the process.
“While the transition to Medicaid managed care is filled with challenges, stakeholders are not powerless or voiceless in the matter. Agencies and associations alike should take opportunities to learn from previous experience,” the Council wrote, citing its contributions to the National Association for Home Care & Hospice’s March on Washington and its recently released toolkit for managed care transitions.
When respondents were asked to provide advice for stakeholders transitioning to managed care, the most popular responses included starting dialogues with health plans early in the process, insisting that all processes are the same if there is more than one managed care plan involved, starting a dialogue with the state early in the process, and training staff.
In addition, homecare providers who oppose the use of Medicaid managed care or who need additional guidance related to the transition should consult their state associations and the Council, the Council concluded.