Understanding Medicaid-Based Long-Term Services and Supports in Pennsylvania

Understanding Medicaid-Based Long-Term Services and Supports in Pennsylvania

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Dennis Gill: Right. So welcome to CareSmartz360 On Air, a Home Care Podcast. I’m Dennis Gill, a Senior Sales Consultant at Caresmartz.

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Dennis Gill: So, in today’s episode we are thrilled to have Kevin Hancock, the mastermind behind Kevin Hancock Consulting LLC.

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Dennis Gill: With over 30 years of experience in Medicaid LTSS managed care and strategic planning, Kevin brings unparalleled insights into the complexities of long-term care.

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Dennis Gill: So from his key role as special advisor to the Secretary for the Pennsylvania Department of aging to oversee the 15 billion dollars Community Health Choices program as deputy Secretary for the office of long-term living.

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Dennis Gill: Kevin has been at the forefront of transforming long-term care systems.

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Dennis Gill: Get ready to unravel the mysteries of Medicaid’s LTSS programs. Understand the impact of strategic planning and hear firsthand from the man who helped shape, Pennsylvania’s aging our way initiative.

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Dennis Gill: Trust us, this episode is the one you won’t want to miss.

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Dennis Gill: So welcome to the Podcast Kevin.

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Kevin Hancock: Thank you very much for the opportunity. Dennis.

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Dennis Gill: Oh, we are really thrilled to have you over here, and hopefully our listeners. They’ll be thrilled. And to listen, whatever you will be letting us know about that.

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Dennis Gill: Okay, right? So let’s straight away to the 1st question that I have for you. So, Kevin, in many states, including Pennsylvania, they have moved forward, manage long-term care services and supports Mltss. What are the biggest benefits and the challenges of the shift.

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Kevin Hancock: So, approximately 24 States in in the United States that have moved their Medicaid long term care program to to a managed care, configuration.

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Kevin Hancock: Those States have almost universally cited the same reasons to move in that direction. The 1st is budget predictability. They create a degree of of

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Kevin Hancock: predictability in how much long-term care is going to cost in the Medicaid program in fee for service. It’s a little bit more difficult to make that type of prediction because of fluid costs. Managed care is more predictable because you pay a per member per month, and you set that per member per month in payments to the managed care organizations, and that is one of the primary reasons why States

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Kevin Hancock: think that managed care is a better model. And another very important reason is that you have more control over quality than you do with a direct relationship between a state and providers. If you contract with multiple managed care organizations.

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Kevin Hancock: those managed care organizations have a little bit more control over the quality of services that are delivered, and they are a little bit closer to the providers, which means that they have more opportunity for interaction and monitoring of quality of services.

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Kevin Hancock: So budget predictability and potential opportunities for quality of services are the 2 main reasons why States have moved in this direction.

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Kevin Hancock: and a 3rd reason is that many State governments just don’t have the staff to be able to manage big, long-term care operations that are funded by Medicaid. And a 3rd consideration is, it’s just administratively easier for states.

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Dennis Gill: Okay, okay? And any specific challenge that you say for this shift.

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Kevin Hancock: So the biggest challenges is at least in the beginning is implementation. it’s a big enterprise. And then a lot of states don’t have this type of experience with big project management. So sometimes implementation can be pretty bumpy making sure that the managed care organizations have the right number of providers, making sure that they have the right organizational configuration in place.

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Kevin Hancock: and also making sure that beneficiaries understand what this change means that they’re going to be working with a managed care organization now rather than with the State directly, so implementation could be one of the biggest challenges another challenge could be ongoing, monitoring, managed care. Organizations can be pretty big organizations, and, as I mentioned earlier, State governments may just not be staffed to be able to do the type of monitoring that’s needed to be able to make sure that delivery delivered in a quality like manner.

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Dennis Gill: Okay, so those can be the challenges.

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Dennis Gill: And as the architect of aging away Pennsylvania, what are some of the most critical strategies States should adopt to better serve older adults in their Ltss programs.

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Kevin Hancock: Sure. So aging Rypa is Pennsylvania’s 10 Year Multi-sector Plan for older adults. It was developed by the Pennsylvania Department of Aging and multiple agencies under the Governor’s jurisdiction in Pennsylvania to address the needs

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Kevin Hancock: of dramatically growing older adult population in the State. Many States have developed these type of plans and their primary objective is to create goals, objectives, and initiatives that support the needs of older adults in terms of health, well-being, and quality of life. Some of the most critical strategies that relate to Ltss

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Kevin Hancock: are making sure that they’re available, not just to a Medicaid population, but to a broader population. The reality is that most older adults at some point need support in our home to be able to age in place, and many people don’t have access or may not qualify for the Medicaid program, so making sure that those services are available, not just to the Medicaid population and not just to the wealthy population, but to those people in between.

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Kevin Hancock: That’s the largest largest challenge making Ltss affordable for people who may not be qualified for Medicaid, and may not have the financial means to be able to pay for it themselves.

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Dennis Gill: Okay? And continuing with this thing only, like with Medicaid budgets, you see under pressure, how can States ensure all Tss programs remain sustainable while still providing quality, care.

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Kevin Hancock: This is a great question, and this is the fundamental challenge right now for Medicaid, especially with a lot of Federal changes that are being discussed that will include cutting costs or constraining costs. The reality is that States will be challenged to be able to manage Medicaid budgets in a much more constrained environment. And

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Kevin Hancock: what can States do to ensure Ltss programs are sustainable is a question I really can’t answer, because the reality is that that

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Kevin Hancock: right now States are already constrained in their budgets. They may face higher constraints, and they may not have the funds to be able to pay for the services to the level they need to be provided. One thing that they could do is to potentially look for ways to be able to ration services, which is something that they’re likely going to have to do, a way that that would translate to long term services and supports

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Kevin Hancock: could be like caps on personal assistance services or other home and community-based services. The risk with caps is that you may end up having people needing to be institutionalized in a nursing facility because the home and community-based services aren’t really covering their needs

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Kevin Hancock: to the level that they need to cover those needs. But this is the fundamental challenge that we’re all facing right now with potential Federal budget cuts on the horizon. States are going to face dire circumstances, to be able to afford the cost of long-term services and supports.

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Dennis Gill: Okay, okay, okay? And I think my next question would also be a continuation of this one. Like with evolving Federal and State regulations, the biggest compliance challenges for Lts. Providers in Pennsylvania, and how can they navigate these complexities effectively?

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Kevin Hancock: No, I mean, I would have said, 2 months ago the biggest

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Kevin Hancock: compliance challenge was workforce. Actually finding a workforce for long term services and supports has been a challenge. A generational challenge. Pay is low for these types of services, and often the workforce is unstable, and States have been doing all kinds of different and creative ways, including raising wages, benefits, and training for the long-term care workforce to be able to make it more stable. But in this environment of budget

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Kevin Hancock: constraints and and potential cuts to the Medicaid program. I would say that that now will create the biggest compliance challenge. You can’t really solve a workforce challenge without money, and if you have less money available to be able to solve the workforce challenge it’s very likely the case that it’s just going to get worse.

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Kevin Hancock: I don’t mean to be so negative. But but that’s the environment we’re working in right now.

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Dennis Gill: Yeah, definitely, I, trying to understand that point

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Dennis Gill: and looking ahead, what major trends or policy changes. Do you foresee shaping the future of Medicaid-funded Ltss. Over the next decade.

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Kevin Hancock: Once again. If this was a couple of months ago, I would have said that that the biggest changes

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Kevin Hancock: that reflect the future of long-term services and supports would be population growth. The older adult population is growing dramatically in this country right now. By 2035, more than 1 3rd of the population will be over the age of 60, and there’ll be more older adults over the age of 60 than there are children under the age of 18

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Kevin Hancock: so I would have said that that would have been the biggest

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Kevin Hancock: policy change requiring a significant shift to be able to address the needs of that growing population. But the way things are now the biggest policy challenge

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Kevin Hancock: will be funding for Medicaid long-term services and supports. If some of the Federal cuts actually come into fruition through Congress, that policy challenge will require States to really rethink what services they’re going to be able to offer if those cuts are brought to fruition, and it’s likely going to mean less services available for people. Even with this dramatically growing older adult population.

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Dennis Gill: Okay, okay, got that got that point. And finally, how much Medicaid block grants and potential Federal budget cuts impact Pennsylvania’s home care industry, particularly in funding and service delivery. And what steps can state policymakers take to mitigate these risks?

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Kevin Hancock: Well, I mean, one of the proposals at the Federal level would be to convert Medicaid from just a little bit of background. The Medicaid programs are funded as a Federal and State partnership where the Federal Government provides 50% or more of the funding based on a formula related to state poverty levels.

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Kevin Hancock: They’re proposing changing that funding formula to block grants where States will receive a fixed dollar amount where they have to operate all their Medicaid services, including the Medicaid Services funding long-term services and supports.

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Kevin Hancock: That will be a dramatic change simply because of the fact that States will likely find that the funding in those block grants may be insufficient to be able to cover the cost of care, which means that they will have to focus on funding services that are considered to be mandatory or entitlement services like nursing facility services.

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Kevin Hancock: and it’s very likely that they might risk having to cut home and community-based services like home care and personal assistance services. So what can states and policymakers try to do to mitigate these risks? The biggest thing that they could try to do is to continuously voice to the Federal governments that cuts

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Kevin Hancock: that would be forced by a block. Grant may end up costing more for the delivery of Medicaid or long term services and supports, and it might be putting people’s lives at risk. So

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Kevin Hancock: a 1 strategy would be to continue to voice the risks that the Federal Government are creating by these new funding formulas. A second way that they would potentially be able to mitigate these risks is to look for ways to be able to address prospectively or preemptively, as much as possible any real waste.

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Kevin Hancock: fraud, and abuse that could be in the system. There’s always opportunities to be able to be more efficient in any kind of program, including the Medicaid program, looking for ways to maximize efficiency as much as possible, to be able to make sure that those dollars are available and making sure that the dollars are being spent the way they should be spent. But

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Kevin Hancock: the block, grant and other potential costs really do present really difficult challenges for States to be able to address the cost of care in the long-term services and support system if they do come into fruition

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Kevin Hancock: and states, will face really significant challenges to be able to figure out how they’re going to be able to meet some of those those risks, and I do suspect that it will represent

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Kevin Hancock: a series of changes in Medicaid if they actually come to fruition.

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Dennis Gill: So thank you. Thank you, Kevin, for your expertise. And for this knowledgeable session you took out the time today for this. I know you have a very busy schedule, but thank you for your time today, and to our lovely audience. Thank you for tuning in until next time. I’m Dennis Gill, signing off.

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Kevin Hancock: Thank you for the opportunity and good luck. Everybody.

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Dennis Gill: Thank you. Kevin.