From the U.S. Government Accountability Office, www.gao.gov Transcript for: Access and Quality Problems with Medicaid Long-Term Services and Supports Description: As the number of older Americans increases, so does the need for long term health services and supports. Medicaid is the nation's primary payer for long-term care. And because of how expensive it is to provide this care, more and more states are moving to managed care delivery models. But there are concerns about access to and the quality of care provided by these managed care organizations. We talk with Carolyn Yocom, an expert on Medicaid policy and a director in our Health Care Team, to learn more. Related GAO Work: GAO-21-49, Medicaid Long-Term Services and Supports: Access and Quality Problems in Managed Care Demand Improved Oversight Released: December 2020 [Intro Music] [Carolyn Yocom:] This is a vulnerable population. So, it's really critical that the prevalence get identified, and that they also get resolved. [Holly Hobbs:] Hi, and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm Holly Hobbs. As the number of older Americans increases, so does the need for long-term health services and supports. Medicaid--a federal and state program that provides health coverage for people who may not otherwise be able to afford it--is the nation's primary payer for long-term care. And because of how expensive it is to provide this care, more and more states are moving to managed care delivery models. This allows states to contract health care services with private organizations in order to manage costs. But there are concerns about access to and the quality of care provided by these managed care organizations. Today, we talk with Carolyn Yocom, an exert on Medicaid policy and a director in our Health Care team about a new report on Medicaid Long-Term Services and Supports. Thank you for joining us, Carolyn. [Carolyn Yocom:] Thank you. It's a pleasure to be here. [Holly Hobbs:] So, Carolyn, what kinds of access and quality problems did we identify in our review? [Carolyn Yocom:] Well, I wanted to start and say we did find some good things. First, they were getting health assessments. They were getting looked at to make sure that the needs that they had could be met. Secondly, there were plans of care developed, which outline the types of services and needs a person had. And then if that individual did end up in the hospital, there's a good coordination between the managed care plan and with the hospital itself. So, that's the good news. What we didn't find were things that were pretty concerning. First of all, we did find evidence of medication errors--people who were given either the wrong amount or the wrong medication. We also identified instances where a need had been identified--for example, a person needed a wheelchair or a walker to get around their home--but no action was taken to fulfill that need. And then lastly, we found that as a person's condition changed--that the decline in their functional ability didn't relate to the number of hours that they were give. So, for instance, we found individuals who had declines in their functional abilities, but also hours of services reduced. We simply didn't find a relationship between the number of hours of care and a person's physical condition. [Holly Hobbs:] And Medicaid is a joint federal and state funded program, but who's responsible for monitoring the program to make sure patients have access to timely quality care? [Carolyn Yocom:] It really is both the state and the federal government. The state is on the ground on a day-to-day level. They're responsible for establishing the arrangements with the managed care organizations and for monitoring the managed care organizations. The federal government, however, also plays a role. And some of the role is pretty standard. They would review a contract that states establish with managed care organizations, for example. But most important of all is for the federal government to step in when there are problems that are continually occurring and not getting corrected. That's where the federal oversight is really important to make sure an individual is well cared for. [Holly Hobbs:] So, your report says there are 26 states that provide long-term services and supports through Medicaid managed care. And we looked at six of these states' oversight, and those were Arizona, Florida, Iowa and New York, Texas and Virginia. Can you tell us why we looked at these states specifically and what we found? [Carolyn Yocom:] In this particular case, we were looking for variety. And some of it's geographic because different parts of our country really delivered healthcare services quite differently. Some of it was also just the size of the managed care population that was being served. And then the number of years of experience that states had with delivery and managed long-term services and supports. All in all, our six states, however, were about 1/2 of the enrollment in managed long-term care. [ Music ] [Holly Hobbs:] So, it sounds like managed care organizations play a critical role in providing long-term health services and supports, and that improving oversight of these programs is important, especially as a growing population of older Americans come to rely on them. So, Carolyn, I guess when I think of older Americans, I think of Medicare and not Medicaid. So, why are we talking about Medicaid in older Americans in this context--long term care? [Carolyn Yocom:] Medicaid is critical to long-term services and supports. It is the primary payer for long-term services and supports in this country. And for people who get common community based care, it's 57% of the spending comes from Medicaid. It takes over where Medicare drops off. Medicare primarily serves individuals in hospital settings and physician services. But when there's a permanent long-term care need, that's when Medicaid becomes a very important payer for this population. [Holly Hobbs:] And did we make any recommendations to improve the oversight of these programs? [Carolyn Yocom:] Our recommendations are really around strategy setting and making sure that we know the extent of the problems. So, the first recommendation is really about setting a strategy to monitor state oversight as the managed care plans and help address any problems that arise. The second one is making sure we have a complete picture so that we know how all beneficiaries within the program are being provided services. [Holly Hobbs:] And Carolyn, last question. What's the bottom line of this report? [Carolyn Yocom:] The bottom line is all about better oversight. This is a vulnerable population that has very high needs and has needs that change over time. So, it's really critical that the promblems get identified and that they also get resolved. That's the only way we can protect beneficiaries and care for them during this time of their lives. And secondly, it also protects the federal dollars that are spent as well. We need to be effective and we need to be efficient. [Holly Hobbs:] That was GAO's Carolyn Yocom, talking about a new report reviewing the oversight of Medicaid Long-Term Services and Supports. Thank you for your time, Carolyn. [Carolyn Yocom:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. To hear more podcasts, subscribe to us on Apple Podcast, and make sure you leave a rating and review to let others know about the work we're doing. For more from the Congressional Watchdog, the U.S. Government Accountability Office, visit us at GAO.gov.