The Interaction of the Long-Term Care System and Medicaid Managed Care in Oregon
This paper is one of a series of reports about the Oregon Health Plan, resulting from the HCFA and ASPE funded evaluation of this section 1115 Medicaid waiver program. The focus of this report is on the interaction of OHP and the separately administered long-term care service system. After describing the two systems and how they interact, we describe operational issues related to managed care implementation affecting both the state long-term care system and long-term care providers. We also examine growth in long-term care expenditures in relation to OHP implementation for evidence of cost-shifting from the managed care organizations to the long-term care system. Our data sources include extensive case studies, survey analyses and claims analyses. We constructed and analyzed a rich and unique longitudinal analytic file that includes detailed functional status and demographic information about each long-term care user, managed care and Medicaid enrollment information, and Medicaid claims for long-term care services (home and community-based services, nursing facility care, and home health). While many of the details are specific to Oregon, the basic issues of boundaries, overlap and coordination apply to any state implementing managed care for the long-term care population. In our concluding chapter we discuss the implications of Oregon’s experience for programs coordinating or integrating acute and long-term care, and suggest further applications of the database used in this study.