The Impacts of Medicaid's Managed Long-Term Services and Supports on Health Outcomes in Medicare

An aging US population has raised important questions regarding the organization, delivery, and funding of long-term services and supports (LTSS), prompting many state Medicaid programs to shift from fee-for-service to managed care models for LTSS delivery. We analyze the effects of transitioning to managed LTSS (MLTSS) on health outcomes among dual-eligible Medicare-Medicaid beneficiaries aged 65 and older in Florida and New York. Using Medicare claims data and a differences-in-differences design leveraging county-by-county MLTSS rollouts, we find that MLTSS leads to a 4.2 percent increase in hospitalizations in Florida, but no significant change in New York. Analysis of preventive care suggests that declining flu vaccination rates in Florida may have contributed to increased hospitalizations from respiratory causes. These findings highlight important differences in MLTSS effects across states and underscore the value of Medicare data for measuring health effects in the dual-eligible population.