The Impact of Introducing Managed Care Intermediaries for Long-Term Services and Supports

To study the impact of managed long-term services and supports (MLTSS) on the use of long-term care, as well as acute care.

We use a staggered difference-in-differences (DiDs) regression design, exploiting the variation in timing of the rollout of MLTSS programs across states between 2004 and 2018. We compared individuals in states that implemented MLTSS with individuals in states that did not implement MLTSS. Our outcomes included formal home care use, nursing home status, informal care use, hospitalizations, overnight nursing home visits, and falls.

This study uses secondary data from the Health and Retirement Study data, linked with state identifiers. The sample includes adults aged 65 and older who report at least one functional limitation.

The shift to MLTSS leads to a 2.5 percentage point (pp) increase (95% CI: 0.8 pp, 4.3 pp) in home care users, a 3-percentage point decrease (95% CI: -5.38 pp, -0.25 pp) in informal care users, and no statistically significant change in nursing home occupancy or health outcomes. We also find suggestive evidence of reductions in the number of home care individuals living in MLTSS states receive, with a 7.02-h (95% CI: -12.96, -1.07), or nearly 27% decrease, in monthly formal care received by this population.

These findings suggest that MLTSS increased the share of home and community-based services (HCBS) users but restricted the amount of HCBS used per beneficiary, with ambiguity around whether this occurred at the expense of beneficiaries.