https://orcid.org/0000-0002-5342-5091
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Lori Gonzalez, LuMarie Polivka-West, Larry Polivka, Failures of Regulation and Policy in Medicaid-Managed Long-Term Care and Medicare Advantage, Public Policy & Aging Report, Volume 31, Issue 2, 2021, Pages 57–61, https://doi.org/10.1093/ppar/prab002
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We, like many long-term care (LTC) researchers and policy analysts, are concerned about the chronic inadequacy, from a LTC recipient perspective, of the LTC regulatory framework at the federal and state levels. Our concern, however, grew in 2012 when the Centers for Medicare and Medicaid Services (CMS) approved the Florida request for a waiver permitting the state to convert its Medicaid LTC program from a broadly fee-for-service model of funding and administration, with the extensive involvement of nonprofit, community-embedded aging network agencies in the home and community-based services (HCBS) LTC sector, to a capitated, managed LTC model administered largely through for-profit insurance company Health Maintenance Organizations (HMOs). This move was made by the Florida Legislature and approved by CMS in 2012 even though multiple evaluations had decisively demonstrated that the nonprofit aging network−based Medicaid waiver−funded community LTC programs were more cost-effective than the for-profit alternative administered by insurance companies (Mitchell et al., 2006).
