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 expenditures go toward long-term services and supports (LTSS) for both institutional and home-based care.
Because LTSS programs often span multiple waiver authorities, eligibility pathways, delivery systems, and community partners, creating a seamless beneficiary experience can be operationally complex. Many states are balancing modernization efforts with evolving federal requirements, workforce considerations, and the need to preserve continuity of care for vulnerable populations.
As part of these ongoing modernization efforts, some State Medicaid Agencies (SMAs) are exploring opportunities to further align enrollment and assessment processes to support both operational efficiency and person-centered care. Because eligibility and assessment requirements often vary across programs, beneficiaries and caregivers may experience multiple touchpoints during enrollment and reassessment.
To help LTSS beneficiaries access services that support them in living as independently and safely as possible in the setting of their choice, many SMAs are exploring ways to further align and streamline enrollment and assessment processes. These modernization efforts can enhance person-centered care while also helping states improve coordination and administrative efficiency.
Improving Enrollment and Assessments with Technology Advances and Person-Centered Care
When states implement a unified enrollment and assessment process, they can create more coordinated access points where assessors determine eligibility and beneficiaries receive consistent information and support across programs and regions. This approach can help streamline communication while maintaining a person-centered experience regardless of a beneficiary’s location, provider, or circumstances.
In a system like this, beneficiaries can access the program and connect 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 technology-enabled decision support tools, 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:
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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.
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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.
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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.
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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.
Across the country, SMAs are continuing to modernize LTSS access and eligibility processes to better support beneficiaries, caregivers, and providers. Many states have already implemented innovative approaches to person-centered assessments, HCBS expansion, and coordinated service delivery. Unified assessment models can build on these efforts by helping create a more consistent experience across programs and populations.
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.
