Serving Medicaid Beneficiaries Who Need Long-Term Services and Supports: Better Outcomes at Lower Costs

In the past two decades, many federal and state Medicaid initiatives have been designed to rebalance the long-term services and supports (LTSS) system by increasing access to home and community-based services (HCBS) in order to reduce the use of expensive institutional care. Despite considerable success, challenges remain in meeting the diverse needs of people who use HCBS while lowering the cost of their care. The path toward a sustainable LTSS system must be focused on how to better serve users of expensive HCBS, who often face significant disabilities that require intensive levels of service over extended periods of time.

Mathematica’s Center for Studying Disability Policy hosted a discussion of the needs of people whose HCBS services are the most costly and strategies for cost-effectively serving them on June 5, 2019, from noon to 1:30 p.m. (ET). Carey Appold, Mathematica, moderated a discussion with the following speakers:

• Victoria Peebles, Mathematica, shared the results of an in-depth study of the characteristics of people with the highest HCBS costs and the services driving the high costs.
• Carol Irving, Mathematica, discussed key findings from an evaluation of the Money Follows the Person demonstration. The demonstration saved money and improved quality of life as it helped institutional residents return to the community.
• Patti Killingsworth, Tennessee Medicaid, reported on a new program, Employment and Community First CHOICES, which helps LTSS beneficiaries with the highest expenses—people with intellectual or development disabilities—to find and keep a job and live independently. 
• Debra Lipson, Mathematica, discussed the implications of these findings for state Medicaid programs seeking to improve outcomes and control costs for high-need LTSS enrollees.