Community-based resources may address the needs of members dually eligible for Medicare and Medicaid that are sometimes not met through formal relationships with providers. This is particularly relevant for health plans deploying navigation, care coordination, and peer support programs in-house.

Behavioral health long-term services and supports (LTSS), such as health navigation, peer support, and developmental therapy, assist members in maintaining independence by coordinating resources and care, serving as mentors and personal models of recovery, and integrating appropriate developmental supports.  As

Home and community-based services (HCBS) encompass a broad range of services and supports designed to help older adults and people with disabilities live in their homes and communities rather than in institutional settings. If your health plan operates in states

As your health plan becomes engaged with persons eligible for both Medicare and Medicaid – particularly those with behavioral health needs, developmental disabilities, or substance abuse challenges – you may find it necessary to provide behavioral health long-term services and

Many states are implementing managed long-term services and supports (LTSS) for their Medicaid populations, including those experiencing mental illness, addiction, or intellectual and developmental disabilities. For this reason, health plans in your area may be seeking providers who can deliver

More states are contracting with health plans to manage Medicaid long-term services and supports (LTSS). As a result, you may find yourself working with health plans instead of the state to provide care for your Medicaid clients. Contracting with a

Many states are implementing managed long-term services and supports (LTSS) to better coordinate care for Medicaid recipients. This may change the way your organization provides Medicaid services by requiring you to contract or enter into an agreement with one or

As more states expand managed long-term services and supports (LTSS) options, there will be new opportunities to integrate acute and long-term care. This will require plans, which may already have considerable experience contracting with acute care providers, to negotiate agreements

Adequate oversight of the delivery of personal care services in participant-directed programs is vital so that members’ individual service plans are carried out correctly and prevent fraud and abuse. However, monitoring the provision of services in participant-directed programs can be

Health plans increasingly will be required to manage, monitor, and oversee a broader range of services as more states contract for managed long-term services and supports (LTSS).  Oversight includes preventing fraud and abuse, which requires ensuring that the services billed