Long Term Services and Supports target individuals over 65, individuals with physical disabilities, individuals with intellectual disabilities, chronically ill children, and individuals eligible for both Medicaid and Medicare (“dual eligibles”). Medicaid covers certain services available to these participants based on medical necessity and technical and financial eligibility.
Long Term Services and Supports are provided in home and community-based settings, as well as in institutions. Institutional settings include nursing facilities and intermediate care facilities for individuals with intellectual disabilities. Home and community-based services vary by program and may include, but are not limited to, personal assistance, nursing, nurse monitoring, medical day care, case management, transportation, medical supplies and medical equipment. Long Term Services and Supports are mostly paid fee-for-service and are not covered by HealthChoice managed care organizations.
For the over 42,000 individuals receiving Long Term Services and Supports, Maryland Medicaid is dedicated to providing choice and autonomy in the provision of care. The Centers for Medicare and Medicaid Services recently issued new rules to ensure individuals receiving Long Term Services and Supports have choices regarding their setting, services, and service providers. The rules aim to guarantee rights of privacy, dignity, and respect, by optimizing autonomy and independence in making life choices, and ensuring that participants in home and community-based service programs are able to fully participate in their communities to the extent that they desire and are able.
In service of these goals, Maryland Medicaid has adopted a person-centered planning approach to Long Term Services and Supports administration, which is designed to promote not only optimal health outcomes, but also greater independence and better quality of life for participants. To that end, Medicaid is increasingly moving away from institutional-based care toward home and community-based services.
The Affordable Care Act established the Community First Choice program option to make it easier for Medicaid participants who require institutional-levels of care to receive services in home and community-based settings. Maryland was one of the first states to implement Community First Choice. Under Community First Choice, Maryland is more efficiently managing personal assistance services, enhancing the means to provide services where participants feel more comfortable.