Long-term care Medicaid Your Coverage Options

Evidence suggests privatized Medicaid long-term care may put people at serious risk

Written by Diane Archer

The US health insurance system has become increasingly privatized. One big trend is in the Medicaid program. More than two dozen states have contracted with for-profit health insurance companies to deliver home and community-based services to people with Medicaid, crowding out mission-driven non-profit providers. The available evidence suggests that privatized Medicaid long-term care may put people at serious risk.

Researchers at the Claude Pepper Center express concern both for people with Medicaid and for taxpayers. These large commercial insurers need to drive profits. And, in the health care space, they can do so relatively easily by delaying and denying people needed care. What’s happening to health care access, quality and costs for people with Medicaid needing long-term services and supports in states that have moved to for-profit Medicaid long-term care?

Today, more than 1.7 million people with Medicaid are in managed long-term care (MLTC) programs operated by for-profit companies or private equity firms. There is precious little evidence to suggest that these programs are more efficient or deliver better care than the non-profits which had been delivering LTC services. There is simply a mindset among some policymakers that for-profit competition is the better model.

What do we know? AARP has assessed states with the best LTC programs for people with Medicaid. And, the states which rely most heavily on for-profit long-term care (MLTC) rank at the bottom. Two studies conducted in Texas, which has extremely high MLTC enrollment, found poor quality and a system in need of major intervention. Access to network doctors was inadequate. And, the state has little if any ability to monitor or assess performance by the for-profit insurers.

The federal government, in partnership with powerful corporations who wield undue influence in Congress and in the states, has pushed this move away from the non-profit model of LTC and towards the for-profit model. The GAO has investigated and found serious cause for concern and a lack of needed oversight. The Centers for Medicare and Medicaid Services (CMS) is doing little to ensure appropriate oversight.

According to AARP, Washington, Oregon, Vermont, Minnesota, Arkansas, Wisconsin and Colorado have the best long-term care programs. None are MLTC. These states should resist a move to for-profit managed long-term care.

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