As Need For LTSS In US Grows, MA Plans Still Have The Chance To Fill The Gap

With the need for long-term services and supports (LTSS) growing, Medicare Advantage (MA) plans are positioned to offer home-based care services through supplemental benefits.

That’s one key takeaway from a new data brief from the research and advisory firm ATI Advisory, though MA plans haven’t always been the best administrators of home care. The report examines access to — and enrollment in — MA plans. The report was compiled using data from the Centers for Medicare & Medicaid Services (CMS).

Currently, 14 million adults in the U.S. have LTSS needs. This number will grow as it is projected that more than half of adults who reach the age 65 will develop LTSS needs, according to ATI Advisory.


Even though Medicaid is the most common way people access LTSS, it’s not available to individuals who do not meet the correct income threshold..

With this in mind, MA is set up to fill some of those gaps. Home care providers recognize this, but their patient is wearing thin when it comes to working with MA plans on supplemental benefits.

“Medicare Advantage plans can use supplemental benefit authorities to help fill this LTSS access gap among Medicare beneficiaries and support their nonmedical and health-related social needs,” ATI Advisory wrote in the report. “MA plans can offer LTSS-like supplemental benefits through multiple pathways such as Expanded Primarily Health-Related Benefits (EPHRB) and Special Supplemental Benefits for the Chronically Ill (SSBCI). Plans participating in Value-Based Insurance Design (VBID) can offer both EPHRB and SSBCI benefits using VBID authority.”


EPHRB and SSBCI benefits both include some form of home care, as well as caregiver support and home modification services.

Source: ATI Advisory

ATI Advisory found that 82% of Medicare-only beneficiaries have access to a plan with at least one LTSS-related supplemental benefit.

“Through a series of important policy changes in recent years, Medicare Advantage plans became able to offer a more holistic set of services to plan enrollees,” Johanna Barraza-Cannon, director in ATI Advisory’s state program and policy practice, told Home Health Care News in an email. “The 82% statistic demonstrates the continued market uptake of non-medical benefits. Medicare Advantage plans are growing increasingly comfortable providing a broader set of services.”

However, only 9% of Medicare-only MA beneficiaries are enrolled in an MA plan with at least one LTSS-related supplemental benefit.

“Supplemental benefits are only one part of a person’s decision-making process to enroll in a particular MA plan,” Barraza-Cannon said. “Within supplemental benefits, there is a broad spectrum of benefits across dental, vision, hearing, LTSS-like benefits, and social benefits like food supports that might influence a person’s decision, based on what their needs are. More research is needed to understand factors related to the decision making process related to an individual’s selection of an MA plan.”

The report also looked at access to MA plans across numerous demographics.

ATI Advisory found that Medicare-only beneficiaries who live in urban areas have a greater likelihood of accessing LTSS-related supplemental benefits, compared to their counterparts who live in rural areas. ​​

Access to LTSS-related supplemental benefits is most prevalent among Black and Hispanic Medicare-only beneficiaries.

On the flip side, access to LTSS-related supplemental benefits is least common among American Indian and Alaska Native Medicare-only beneficiaries.

Source: ATI Advisory

Ultimately, Barraza-Cannon believes that home-based care providers have a role to play in the solution, as the number of people who have LTSS needs continues to increase.

“The market continues to demand more whole-person solutions, and this will only increase as our nation’s population ages,” she said. “Home-based care providers can play an important role in these whole-person solutions, often as the eyes and ears into what a person needs outside the traditional medical setting.”

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