By Susan Baker, Executive Vice President and General Manager, Integrated Health Solutions
States have developed a wide range of services to help individuals who have disabilities or chronic conditions and need long-term care. Over 30% of Medicaid expendituresi go toward long-term services and supports (LTSS) for both institutional and home-based care.
However, connecting eligible individuals to the right LTSS programs can be difficult for many state Medicaid agencies (SMAs). Inefficient and siloed enrollment processes cause repetitive assessments, confusion about which programs a beneficiary qualifies for, and long wait times for care.
To empower LTSS beneficiaries with full access to the services they need to live a full, healthy, and independent life — not to mention help states save time and resources — SMAs should consider ways to improve and unify their enrollment and assessment processes.
Improving Enrollment and Assessments with Technology Advances and Person-Centered Care
When states implement a unified enrollment and assessment process, they can rely on one central access point where assessors can determine each individual’s eligibility. SMAs can consolidate call centers and personnel to a unified, trusted source, knowing all their beneficiaries will receive the same information about programs they are eligible for, regardless of their location, provider, or circumstances.
In a system like this, beneficiaries can call into a consolidated call center with well-trained and well-informed staff who offer person-centered interaction that seeks to understand each individual’s needs and respects the dignity of each beneficiary.
The staff are equipped with a technology platform that gives them accurate and in-depth information for each potential program. A variety of assessments, which incorporate branching logic, appropriate eligibility requirements, and AI-powered search, help them pinpoint the right programs for each beneficiary. The platform also offers seamless access to beneficiaries’ records and physicians when pre-authorizations are needed.
Enrollment and Assessment Improvements Have Specific Benefits for LTSS Beneficiaries
It’s clear that there are benefits to a streamlined enrollment and assessment process for all types of Medicaid beneficiaries. But LTSS beneficiaries in particular gain key advantages:
-
Beneficiary Stories are Captured by a Single Assessment: Beneficiaries, or their caregivers, only need to tell their story once, since enrollment staff have all available program information at their fingertips and can find suitable options that will fit beneficiary needs without a need for referrals or multiple assessments.
-
All Living Conditions are Factored into Program Options: LTSS beneficiaries have a range of living conditions and support network variables that can make a big difference in their ability to access care, such as the presence or absence of live-in caregivers. Person-centered unified assessments take all living conditions into consideration to offer the best fit for that beneficiary’s unique situation.
-
Independence is Encouraged Through Home- and Community-Based Services: Although LTSS includes institutional care when needed, states strive to help beneficiaries live in their homes and communities in the least restrictive environment possible. Streamlined enrollment gives beneficiaries access to the full range of available home- and community-based services (HCBS) that fit their circumstances.
-
Assessments Evaluate Both Short- and Long-Term Needs: Comprehensive assessments help LTSS beneficiaries access care for their immediate needs and also take into consideration future options to help meet their long-term goals and adapt to changes in health and circumstances over time. This is also enabled by annual reassessments.
By transforming Medicaid program enrollment through streamlined assessments that are backed by trained frontline staff and advanced technology, SMAs can offer their LTSS beneficiaries the comprehensive care options they need to live their best independent, healthy lives.
Acentra Health works with states to create unified assessment systems customized to each state’s unique programs and circumstances. Learn how Acentra Health can help your beneficiaries access fast, equitable care through a unified assessment program.
