ALTCS pays for part of the costs for room and board, medical and hospital care, and prescription drugs.
An evaluation of ALTCS showed that, compared to New Mexico Medicaid (a traditional Medicaid program), ALTCS provided quality care at lower costs (McCall, 1997). Program savings averaged 18 percent annually, totaling $290 million in savings for medical services alone. ALTCS beneficiaries had more medical visits but fewer hospital days than beneficiaries of New Mexico Medicaid. During the first 13 years of the program, however, the quality of care was found to be higher in the traditional Medicaid program. This program is still active in Arizona.
The Minnesota Senior Health Options (SHO) program was adopted with support from the Robert Wood Johnson Foundation. SHO offers enrollees a package of acute and long-term care services through a choice of managed care plans. The state is essentially treated like a health plan that contracts with CMS to provide services; the state then subcontracts with health plans that combine services from Medicare and Medicaid into one integrated benefit package for enrollees (CMS, 2004; Malone et al., 2004). At the center of the initiative is coordination of care for dually eligible beneficiaries who live in institutions or who live in the community but meet institutional placement criteria. Evaluations indicate that enrollees in the program had fewer hospitalizations and emergency room visits (Kane et al., 2004) and were more likely to receive preventive services (Kane and Homyak, 2003); however, capitation rates were higher than they would be under fee-for-service. The program, which began in 1997, continues to operate and became a statewide option in 2005 (Tritz, 2006).
The goals of Wisconsin’s Family Care program are to improve patient choices regarding type of residence and service supports that enrollees receive, improve access to services and quality of care, and achieve cost efficiencies (Justice, 2003). The program has two significant design features: a single entry point for patients (an Aging and Disability Resource Center) and patient-centered services. The center provides patients with advice and access to long-term support options, screening to determine eligibility for publicly financed services, and pre-admission consultations for those entering nursing homes or residential care facilities. The centers are staffed by social workers and nurses who are supported by direct-care workers and volunteers. Together these workers conduct a comprehensive assessment of patients’ needs, preferences, and values.