Capitated Payment Approaches for Medicaid-Financed Long-Term Care Services

Health Care Financing Review, Fall, 1999 by Noemi V. Rudolph, James Lubitz

BENEFITS COVERED IN THE CAPITATION

LTC benefit coverage for the different programs integrates institutional and community-based services with an emphasis on the latter. A summary of benefits covered by the programs included in the Medicaid capitation is provided in Table 1.

Table 1 Summary of Covered Long-Term Care and Other Benefits, by Service Type and Program

                                                            Texas
Service Type                             PACE    ALTCS    STAR PLUS

Medicaid

Mandatory Benefit
 Nursing Facility                         C        C          C
 Home Health Services                     C        C         NC
Optional Benefit
 Institutions for Mental Disease         NC        C         NC
 Hospice                                 NC        C         NC
 Rehabilitation Services                  C        C         NC
 Personal Care Services(1,2)              C        C         NC
 Therapy Services                         C       NC          C

Home and Community-Based
 Waiver Services

Case Management(l,2)                      C       NC          C
Homemaker Services(1)                    NC        C         NC
Home Health Aid Services(1)              NC       NC         NC
Adult Day Health(1)                       C        C          C
Habiliation Services(1)                  NC        C         NC
Respite Care(1)                          NC        C          C
Transportation(3)                         C        C         NC
In-Home Support Services(3)              NC        C         NC
Meal Services(3)                          C        C         NC
Adult Day Care(3)                         C        C          C

Other Services

Prescribed Drugs                          C        C          C
Adaptive Aids/Non-Covered DME             C       NC          C
Dental Benefits                           C        C         NC
Optometry                                 C       NC         NC
Minor Home Modifications                  NC      NC          C

                                                 Monroe County
Service Type                             MSHO         CCN

Medicaid

Mandatory Benefit
 Nursing Facility                         C            C
 Home Health Services                     C            C
Optional Benefit
 Institutions for Mental Disease         NC            C
 Hospice                                 NC            C
 Rehabilitation Services                 NC          CCB
 Personal Care Services(1,2)              C          CCB
 Therapy Services                         C           NC

Home and Community-Based
 Waiver Services

Case Management(1,2)                     NC            C
Homemaker Services(1)                     C           NC
Home Health Aid Services(1)               C          CCB
Adult Day Health(1)                      NC           NC
Habiliation Services(1)                  NC           NC
Respite Care(1)                           C          CCB
Transportation(3)                        NC          CCB
In-Home Support Services(3)               C           NC
Meal Services(3)                          C          CCB
Adult Day Care(3)                         C          CCB

Other Services

Prescribed Drugs                         NC           NC
Adaptive Aids/Non-Covered DME             C          CCB
Dental Benefits                          NC          CCB
Optometry                                NC          CCB
Minor Home Modifications                 NC          CCB