Managed Long-Term Care - Definition, Services Covered, Healthcare Administration Careers

Medicaid’s managed long-term care (MLTC) system gives services and support to people with a long-lasting problem or disability. If someone over 21 has both Medicaid and Medicare, and they need home care, adult day healthcare, or other long-term care for more than four months, their state may require them to join an MLTC plan. This in no way impacts the Medicaid services someone is already receiving; it’s just used to facilitate long-term care services. In person-centered MLTC, each patient plays an active role in planning which services they receive, with help from a care manager.

As of 2016, over a million patients were enrolled in an MLTC plan. Currently, 24 states operate managed long-term services and supports (MLTSS), in which state Medicaid agencies coordinate with managed care plans to deliver long-term care. Both these stats signal a trend of moving long-term care away from long-term care facilities, and allowing older Americans to receive services from their homes instead.

On one hand, this a huge added value for Americans who need long-term care. People get to stay in their homes and continue living their lives in comfort, with the benefit of extra support. As the retirement of the Baby Boomers brings with it an aging population, the outsourcing of services such as these can take the burden off of long-term care facilities. Greater coordination and improved maturity among MLTC plans should be a boon to all involved stakeholders.

On the other hand, the migration to MLTC can seem like an enormously complex process. Since service providers are paid a flat rate by a state’s Medicaid agency, they only make a profit if they’re able to provide those services for less than that flat rate. Since many states are still relatively new to MLTC, care providers may not yet have figured out equitable ways of lowering costs and increasing coordination. Fraud remains a concern for state agencies, and in 2018 a New York nursing provider paid $1.65 million to settle allegations of billing for services that were never provided.

The path forward requires more oversight, more participation, and more collaboration. In short, it requires well-educated and passionate healthcare administrators. To learn more details about how managed long-term care works, and how healthcare administrators can play a role in it, read on.

Services and Supports Covered by Managed Long-Term Care

The exact coverage will vary based on one’s geographical region and individual context, but all MLTC plans generally arrange and pay for the following supports and services:

  • Adult day healthcare
  • Audiology
  • Care management
  • Dental services
  • Home care (i.e., home health aides and occupational, physical, and speech therapists)
  • Home-delivered meals
  • Medical social services
  • Non-emergency transportation
  • Nursing home care
  • Nutrition
  • Optometry
  • Personal emergency response system
  • Personal care (i.e., assistance with bathing, eating, and dressing)
  • Podiatry
  • Prostheses
  • Rehabilitation therapy
  • Respiratory therapy
  • Social daycare

Healthcare Administration Careers in Managed Long-Term Care

Coordinating managed long-term care is no simple task, and as the eligible population grows, so do the number of participating states—the need for healthcare administrators will grow in tandem. Currently, there are many roles and titles within the administration of managed long-term care, each of which connotes a different level of responsibility and scope.

Healthcare careers in managed long-term care can include being an administrator of any facility or organization providing long-term care service. There’s also a need for policy researchers and state agency executives. In some cases, a healthcare administrator working in managed long-term care will be focused on balancing budgets and streamlining services. In other roles, they may be asked to work with marketing, outreach, and referrals. Those working as care managers will work with patients to connect them with individual services. Each of these positions will require a strong understanding of MLTC policies, and the ability to navigate bureaucratic policies while also prioritizing patient needs.

Degree Options for Working in Managed Long-Term Care

For those looking to boost their skills in coordinating managed long-term care plans and services, a master’s of healthcare administration is a good start. These graduate-level programs offer the organizational and management skills of a master’s of business administration, but through a healthcare lens that takes into account the unique populations and policies that go with it. Further specializations of one’s MHA program can prepare a graduate for the particular needs of managed long-term care.

Utica College offers an MHA with a specialization in long-term care at its Utica, New York campus. While originally geared towards those seeking careers in nursing home administration, most of the added electives directly apply to coordinating managed long-term care. Students will take classes such as public healthcare policies of aging; perspectives in gerontology; and ethical and legal issues in long-term care.

USC’s Sol Price School of Public Policy offers a dual-degree program that provides both an MHA and an MS in gerontology. Graduates will be well equipped to manage agencies providing long-term care services to the aging. The MHA program covers the financial, legal, and organizational intricacies of healthcare systems, and the gerontology program takes the same in-depth look at aging. The gerontology courses include life span developmental sociology; administration and systems management in programs for older adults; social policy and aging; and a multidisciplinary approach to integrating gerontology.

Another option is Maryville University’s MHA program, where students can add a specialization in either senior services or healthcare strategies. The foundational curriculum covers several key areas, including classes such as the healthcare industry and its impact on healthcare management; healthcare operations; and healthcare quality and performance improvement. A specialization in healthcare strategies involves electives in healthcare marketing and healthcare policy, while a specialization in senior services includes electives in gerontology and senior services management.

Matt Zbrog
Matt Zbrog

Matt Zbrog is a writer and researcher from Southern California. Since 2018, he’s written extensively about emerging issues in healthcare administration and public health, with a particular focus on progressive policies that empower communities and reduce health disparities. His work centers around detailed interviews with researchers, professors, and practitioners, as well as with subject matter experts from professional associations such as the American Health Care Association / National Center for Assisted Living (AHCA/NCAL) and the American College of Health Care Executives (ACHCA).

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