By Doug Golub, MediSked President and Co-founder

As an increasing number of states transition individuals with intellectual and developmental disabilities (I/DD) to managed care, provider agencies are faced with additional complexities to work with Managed Care Organizations (MCOs), including new billing systems, requirements and expectations.

Provider agencies must also ensure that the process of moving to managed care for long term services and supports (LTSS) is based on the principles of self-determination, person-centered planning, and individualized supports. Under the new structure, there are strategies to be utilized to ensure that the benefits available can be translated into a service offering that reflect each individual’s desired outcomes, goals, and lives.

Understanding Managed Care
Managed care is a model of health care delivery that in theory is meant to lower costs and offer budget predictability for states, improve care coordination with providers, and increase quality and outcomes for individuals. Managed care plans are a type of health insurance plan, in which states contract with MCOs and pay a capitated (fixed) payment on a per member per month basis. Capitated Payments can be made on a full or partial basis. “Full capitation” is managed care for all service types (health, welfare, and safety supports) whereas partial capitation may only cover a portion of the Medicaid services offered to individuals.

Under this model, MCOs assume responsibility and accountability for providing coverage of services and improving outcomes for individuals served. Managed care is the predominant delivery system for Medicaid health care services. A large portion of people with I/DD rely on Medicaid to live their lives in the community. Some states have made the move to begin including long term services and supports in the managed care system, which they are referred to as Managed Long Term Services and Supports (MLTSS). Several states are using MLTSS to expand home and community based services using different models. Managed care for LTSS is likely to continue to grow.

As of June 2017, more than half of all Medicaid beneficiaries (waiver and non-waiver) receive their health care from MCOs. As illustrated in Figure 1,19 states currently operate MLTSS programs, with three additional states operating MLTSS within a Financial Alignment Initiative demonstration.[1] Only nine states (Arizona, Iowa, Kansas, Michigan, New York, North Carolina, Tennessee, Texas, and Wisconsin) have I/DD populations enrolled in managed care as they are typically the last group to be integrated into MCOs.[2]


Figures 1 & 2. [MLTSS Programs[3], MLTSS Program with I/DD Populations Enrolled, – 2017]

MLTSS Programs-April 2017MLTSS Programs-IDD Pop


How this Affects Chapters of The Arc

As more states transition to managed care, provider agencies must be aware of t he how this change will impact them, and be a part of the implementation process at every level from selecting the MCOs to drafting the contracts. Providers must work to:

  • Be engaged in the process as states move to enroll individuals with intellectual and developmental disability (I/DD) into MCOs
  • Prevent the disruption of care
  • Examine the benefits available and translate them to service offerings that reflect what individuals they support want and need
Interoperability 101
Interoperability refers to the ability of systems and devices to exchange data. This allows a fuller picture of a person’s health history to improve outcomes, increase transparency and efficiency, and empower individuals.Interoperability

Providers are responsible for providing a unique set of services and supports to individuals that must be integrated into the 360-degree view of the individual. A large part of the managed care delivery system requires interoperability throughout the network – agencies must have access to information technology, billing, and systems operations to make the transition to MLTSS.[4]

This required move to electronic health records (EHRs) will allow for more frequent and timely communication between the individual’s network with the ability to share information about demographics, enrollments, authorizations, claims, and assessments. The top priority, however, must be to increase quality of care – and ensure there is no reduction in the quality of supports for the individuals.

Providers will be essential for reporting on health and wellness of the individual and providing quality data reporting by analyzing patterns of service utilization, integrating Quality Assurance measures and functions, and generating quality management reports.

Supporting the Transition
MediSked’s dedicated team of subject matter experts have experience transitioning providers into a managed care model to ensure organizations meet the expectations and have the ability to be technologically sound and compliant. Over 29% of MediSked clients currently bill to MCOs across nine states and the District of Columbia. MediSked is working to provide care coordination and business intelligence tools to MCOs across the country, including Partners Health Plan, the nation’s first Fully Integrated Duals Advantage (FIDA) designed explicitly for individuals with I/DD and those that support them.

The Arc of the U.S. and MediSked are committed to making the changes to managed care as seamless as they can be. MediSked is a sponsor of The Arc’s national programs.


“The Arc of North Carolina has been in a managed care system since 2012. A managed care system is all about the numbers – MediSked solutions provide the ability to capture, quantify, and measure data of what is happening and when it’s happening. Technology is essential to gather the empirical data to track what is going on. If you can measure it, you can change it.”

– John Nash, Executive Director of The Arc of North Carolina


[1] National Association of States United for Aging and Disabilities, Center for Health Care Strategies. (2017). Demonstrating the Value of Medicaid MLTSS Programs. Retrieved from: https://www.chcs.org/resource/demonstrating-value-medicaid-managed-long-term-services-supports-programs/

[2] Ibid.

[3] National Association of States United for Aging and Disabilities. (2017). June 2017 MLTSS Map. Retrieved from: http://nasuad.org/initiatives/managed-long-term-services-and-supports/mltss-map

[4] Centers for Medicare & Medicaid Services. (2013). Guidance to States Using 1115 Demonstrations or 1915(b) Waivers for Managed Long Term Services and Supports Programs. Retrieved from: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/downloads/1115-and-1915b-mltss-guidance.pdf

53 thoughts on “What Chapters of The Arc Need to Know About Managed Care

  1. I love looking through a post that can make people think. Also, many thanks for permitting me to comment!

  2. I’m the business owner of JustCBD Store company (justcbdstore.com) and I’m presently aiming to broaden my wholesale side of business. I am hoping someone at targetdomain is able to provide some guidance ! I considered that the most suitable way to accomplish this would be to connect to vape shops and cbd retailers. I was really hoping if anybody could suggest a reliable site where I can purchase CBD Shops Business Email Addresses I am presently examining creativebeartech.com, theeliquidboutique.co.uk and wowitloveithaveit.com. Not sure which one would be the very best solution and would appreciate any assistance on this. Or would it be easier for me to scrape my own leads? Ideas?

  3. Great web site you’ve got here.. It’s hard to find good quality writing like yours nowadays. I honestly appreciate individuals like you! Take care!!

  4. After I initially commented I appear to have clicked on the -Notify me when new comments are added- checkbox and from now on each time a comment is added I get 4 emails with the exact same comment. Perhaps there is a means you are able to remove me from that service? Appreciate it!

  5. Nice post. I learn something totally new and challenging on sites I stumbleupon every day. It will always be exciting to read through content from other writers and use something from their web sites.

  6. Everything is very open with a very clear explanation of the challenges. It was definitely informative. Your site is extremely helpful. Many thanks for sharing!

  7. Spot on with this write-up, I seriously feel this website needs a lot more attention. I’ll probably be returning to see more, thanks for the information!

  8. You’re so cool! I do not suppose I have read through anything like this before. So great to discover someone with some unique thoughts on this topic. Really.. thank you for starting this up. This site is something that is needed on the web, someone with some originality!

  9. An impressive share! I have just forwarded this onto a co-worker who had been doing a little research on this. And he actually ordered me lunch because I discovered it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending time to discuss this matter here on your site.

  10. Hi there, I do believe your website might be having web browser compatibility issues. When I look at your website in Safari, it looks fine however, if opening in IE, it has some overlapping issues. I just wanted to give you a quick heads up! Apart from that, wonderful blog!

  11. Having read this I believed it was rather enlightening. I appreciate you taking the time and effort to put this information together. I once again find myself spending a lot of time both reading and posting comments. But so what, it was still worth it!

  12. I’m amazed, I must say. Rarely do I encounter a blog that’s both educative and interesting, and let me tell you, you’ve hit the nail on the head. The issue is something that not enough people are speaking intelligently about. I am very happy I stumbled across this in my hunt for something relating to this.

  13. After I initially commented I appear to have clicked on the -Notify me when new comments are added- checkbox and now every time a comment is added I get 4 emails with the exact same comment. Is there a way you can remove me from that service? Thanks!

  14. Good blog you have here.. It’s difficult to find good quality writing like yours these days. I seriously appreciate people like you! Take care!!

  15. After checking out a number of the articles on your website, I really like your way of blogging. I bookmarked it to my bookmark site list and will be checking back soon. Take a look at my website as well and tell me what you think.

  16. After I initially left a comment I appear to have clicked the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I recieve four emails with the same comment. There has to be a means you are able to remove me from that service? Thank you!

  17. Howdy! This post couldn’t be written any better! Looking through this article reminds me of my previous roommate! He always kept preaching about this. I am going to send this post to him. Fairly certain he’s going to have a very good read. Thanks for sharing!

  18. A fascinating discussion is worth comment. I think that you ought to publish more on this issue, it may not be a taboo matter but typically folks don’t speak about these subjects. To the next! All the best!!

  19. You made some good points there. I checked on the internet for more info about the issue and found most people will go along with your views on this website.

  20. An impressive share! I’ve just forwarded this onto a co-worker who was conducting a little homework on this. And he in fact bought me lunch simply because I stumbled upon it for him… lol. So let me reword this…. Thank YOU for the meal!! But yeah, thanx for spending some time to talk about this issue here on your blog.

  21. Aw, this was a very nice post. Taking a few minutes and actual effort to generate a top notch article… but what can I say… I hesitate a whole lot and never seem to get nearly anything done.

  22. Hello! I could have sworn I’ve been to this blog before but after looking at a few of the articles I realized it’s new to me. Anyhow, I’m definitely happy I stumbled upon it and I’ll be book-marking it and checking back regularly!

  23. You’re so cool! I don’t suppose I’ve read through something like this before. So great to find somebody with genuine thoughts on this subject matter. Really.. many thanks for starting this up. This web site is one thing that’s needed on the internet, someone with a little originality!

  24. Hello there! This article could not be written much
    better! Looking at this article reminds me of my previous roommate!
    He always kept preaching about this. I’ll send this article
    to him. Fairly certain he will have a good read. Thank you for sharing!

  25. Hi, I do think this is a great site. I stumbledupon it 😉 I will revisit once again since I saved as a favorite it. Money and freedom is the greatest way to change, may you be rich and continue to help others.

  26. This is the perfect webpage for anyone who wishes to understand this topic. You realize a whole lot its almost tough to argue with you (not that I personally will need to…HaHa). You certainly put a fresh spin on a topic which has been written about for years. Wonderful stuff, just excellent!

  27. Can I simply just say what a comfort to uncover an individual who actually knows what they’re talking about on the web. You certainly realize how to bring an issue to light and make it important. More and more people should check this out and understand this side of your story. I was surprised you are not more popular because you surely have the gift.

  28. Hi there! I could have sworn I’ve visited this website before but after going through some of the posts I realized it’s new to me. Anyhow, I’m definitely happy I found it and I’ll be book-marking it and checking back frequently!

  29. May I simply say what a comfort to find a person that truly understands what they are talking about on the net. You definitely know how to bring an issue to light and make it important. A lot more people must read this and understand this side of your story. I can’t believe you’re not more popular because you surely have the gift.

  30. You’re so awesome! I do not suppose I have read through something like that before. So nice to find someone with a few genuine thoughts on this subject. Seriously.. thanks for starting this up. This website is something that’s needed on the internet, someone with a bit of originality!

  31. Hi, I do think this is a great website. I stumbledupon it 😉 I am going to revisit yet again since I saved as a favorite it. Money and freedom is the best way to change, may you be rich and continue to help others.

  32. I’d like to thank you for the efforts you have put in penning this website. I am hoping to view the same high-grade blog posts from you later on as well. In truth, your creative writing abilities has encouraged me to get my own blog now 😉

Leave a Reply

Your email address will not be published. Required fields are marked *