Medicaid Long-Term Services and Supports, and Home and CommunityBased Services: The Changing Landscape

Healthcare and LTSS mechanisms and financing for low-income people with disabilities of all ages have been undergoing significant changes in recent years. States are increasingly requiring that Medicaid beneficiaries with disabilities and seniors mandatorily enroll in managed care with the dual goals of cost saving and improved health outcomes.
The 2010 Affordable Care Act (ACA) authorized a multistate demonstration to enroll people who are dually eligible for Medicare and full Medicaid benefits in managed care plans. Some of the demonstrations will also transition LTSS services into the managed care system. Slated to begin in 2013 in some states, the demonstrations aim to generate savings as well as address the gaps and instances of financial and service misalignment between Medicare and Medicaid. Moreover, beginning in 2014, the ACA will expand Medicaid to cover millions of low income, uninsured individuals, including many with disabilities. Some states that participate in the expansion will likely require
that these new Medicaid beneficiaries also enroll in managed care.
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