Approximately 4.8 million Medicaid beneficiaries received long-term services and supports (LTSS) in 2011.1 Further, people with LTSS needs account for about one third of all Medicaid expenditures.2 Through the Medicaid Innovation Accelerator Program (IAP), The Center for Medicaid and CHIP Services (CMCS) offers targeted program support to Medicaid agencies seeking to promote community integration for Medicaid beneficiaries using LTSS.
Based on state and stakeholder feedback, IAP is offering program support to states in two distinct areas: Housing-Related Services and Partnerships as well as Value-Based Payment in community-based LTSS programs. Selected states in these two areas share common interests and goals that align with IAP’s broader goals for Community Integration- Long-Term Services and Supports:
- Increase state adoption of individual tenancy sustaining services to assist Medicaid beneficiaries.
- Facilitate partnerships with housing agencies.
- Increase state adoption of strategies that tie together quality, cost, and outcomes in support of community-based services LTSS programs.
Medicaid Housing-Related Services and Partnerships (HRSP)
In 2016 and 2017, IAP is supported two cohorts of the State Medicaid-Housing Agency Partnerships. In 2016, IAP also supported a related track of Supporting Housing Tenancy webinars.
- Track 1: Supporting Housing Tenancy: This track, which ran from February 2016 through April 2016, focused on providing states with innovative strategies that are being used, or which could be used by states to support housing tenancy services for community-based LTSS Medicaid beneficiaries. Thirty-one state Medicaid agencies were invited to participate in this webinar series:
- Webinar 1: Description of Housing-related Services and Complimentary Medicaid Authorities
- Webinar 2: State Examples of Medicaid Coverage and Housing-related Services
- Webinar 3: Implementation Planning Based on Lessons Learned from Experienced States
- Track 2: State Medicaid-Housing Agency Partnerships: The goals of the State Medicaid-Housing Agency Partnerships Track are to: 1. develop public and private partnerships between the Medicaid and housing systems; and 2. to support states in the creation of detailed action plans that foster additional community living opportunities for Medicaid beneficiaries. IAP is working closely with its federal partners: the US Department of Housing and Urban Development; the Substance Abuse and Mental Health Services Administration; the Office of the Assistant Secretary for Planning and Evaluation; and the US Interagency Council on Homelessness on planning and coordination of this program support. IAP leverages its collaboration with federal agencies to promote partnerships between state Medicaid agencies, state housing finance agencies, public housing agencies, state and local service agencies, and providers. Consistent with statute, CMS does not provide Federal Financial Participation for room and board in home and community-based services.
- Starting in April 2016, selected states California, Connecticut, Hawaii, Illinois, Kentucky, New Jersey, Nevada, and Oregon participated in the track for a six month period. Additional information about the program support offered and these states’ specific focus areas can be found in the Medicaid IAP State Medicaid-Housing Agency Partnerships Factsheet (PDF, 39.79 KB) .
- Starting in August 2017, selected states Alaska, Massachusetts, Michigan, Minnesota, Nebraska, Texas, Utah, and Virginia participated in the track for a nine month period. Additional information about the program support offered and these states’ specific focus areas can be found in the Community Integration through Long-Term Services and Supports State Medicaid-Housing Agency Partnerships Factsheet (PDF, 79.88 KB) .
- Starting in January 2019, selected states Maine, Montana, North Dakota, and Virginia participated in the track for a 6-9 month period.
State Medicaid-Housing Agency Partnerships Toolkit
This IAP State Medicaid-Housing Agency Partnerships Toolkit (PDF, 750.92 KB) is designed to assist states as they consider systems-level changes that further community integration, including the intersection between health care and housing. This toolkit is based on the tools used to provide program support to 16 states that participated in the IAP State Medicaid-Housing Agency Partnerships Tracks between 2016 and 2018.
The toolkit contains the following resources and instructions for states’ use:
- The driver diagram articulates the high-level plan for systems change.
- The housing-related services crosswalk maps out programmatic and funding information for currently-available housing-related services.
- The housing assessment maps out programmatic and funding information for currently available affordable housing resources and helps identify opportunities to improve capacity.
- The gap analysis prompts discussion to help state teams determine what is needed to reach the state’s goals related to housing and community integration.
- The action plan sets forth the goals, objectives, deliverables, and action steps in the state’s effort around systems change.
- The glossary defines key terms in housing and Medicaid to help partners understand each other’s language.
National Dissemination Webinars
- 2016 State-Medicaid Housing Partnerships: State Examples (PDF, 1.35 MB) (audio (MP3, 7.71 MB) , transcript (PDF, 318.87 KB) ) (June 2017)
- Using Data to Identify Housing Needs and Target Resources (PDF, 2.47 MB) (audio (MP3, 10.42 MB) , transcript (PDF, 217.39 KB) ) (November 2018)
- Demonstrating the Impact of Supportive Housing (PDF, 1.37 MB) (audio (MP3, 12.43 MB) , transcript (PDF, 370.59 KB) ) (August 2019)
- Tools and Resources for Building State Medicaid-Housing Agency Partnerships (PDF, 1.53 MB) (audio (MP3, 9.53 MB) , transcript (PDF, 347.37 KB) ) (September 2019)
Value-Based Payment for Home and Community-Based Services
Efforts to incentivize quality and outcomes have been utilized more for acute care than for home and community-based services (HCBS), except in states that have incorporated quality measures in their payment methodologies for nursing facilities. Therefore, IAP is building the knowledge base and capacity of states to begin increasing state adoption of strategies that tie together quality, cost, and outcomes in support of community-based LTSS through one-on-one technical support focused on designing and implementing value-based payment (VBP) strategies for HCBS.
- Planning a VBP HCBS Strategy: This track, which began in April 2016 and ran for a six month period, provided selected states, Indiana, Maryland, Mississippi, North Carolina, Nebraska, Nevada, Ohio, Pennsylvania, and Virginia with strategic planning support in developing an VBP approach for community-based LTSS.
- Implementation of a VBP HCBS Strategy: This track, which began in September 2016 and ran for a six month period, provided support to selected states, Massachusetts, New Jersey, Virginia, and Washington with the early stages of their implementation activities. Learn more about the participating states and their IAP work (PDF, 80.36 KB) .
- Designing a VBP HCBS strategy: This track, which began in May 2018 and ran for a 12 month period, provided support to selected states, Hawaii, Indiana, Kentucky, Louisiana, Minnesota, Missouri, New Jersey, Ohio, Texas, Washington with designing a VBP HCBS strategy and moving states toward implementation. To learn more, please review the VBP HCBS Program Overview (PDF, 177 KB) and Information Session Slides (PDF, 1.57 MB) .
- Value-Based Payment for Fee-for-Service Home and Community-Based Services Technical Assistance: IAP is providing technical assistance to Medicaid agencies in California, Indiana, Maryland, and Maine to improve HCBS options for individuals receiving LTSS. This track will have a special focus on shared savings and non-financial incentives in addition to pay-for-performance and quality incentive payment models. Review the Technical Assistance Program Overview (PDF, 158.24 KB) and Information Session Slides (PDF, 1.43 MB) .
National Dissemination Resources
- Value-Based Payment for Home and Community-Based Services: Strategies, Progress and Accomplishments of Participating IAP States (PDF, 1.24 MB) (audio (MP3, 9.46 MB) , transcript (PDF, 260.52 KB) ) (September 2019)
- Value-Based Payment for Home and Community-Based Services: Intellectual and Developmental Disability Systems (PDF, 187.34 KB) (October 2019)
May 18, 2017 Information Session Slides (PDF, 1.52 MB)
October 22, 2015 Information Session (PDF, 2.5 MB)
States should submit additional questions via e-mail with the subject line "CI-LTSS" to the IAP mailbox: MedicaidIAP@cms.hhs.gov.
1 Eiken S, Sredl K, Saucier P, and Burwell B. Medicaid Long-Term Services and Supports Beneficiaries in 2011 Truven Health Analytics, September 22, 2015 and Saucier P, Kasten J, Burwell B, and Gold L. The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update Truven Health Analytics, July 2012.
2 Eiken S, Sredl K, Burwell B, and Saucier P. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013: Home and Community-Based Services were a Majority of LTSS Spending Truven Health Analytics, June 30, 2015.