Today’s Medicaid challenges, coupled with the baby boom demographics, have every state in the nation recognizing the need to do something different in Medicaid. Although achieving a better balance between institutional and home and community-based services has been an important reform, Medicaid managed long-term services is also a growing option. Designed to both control the acute care and long term care costs of older people, the approach is also directed at linking the two disparate systems. It is not clear however, whether the managed care solution is the correct one. In 2013, Ohio implemented a large-scale demonstration with more than 120,000 individuals to test the impact of integrated system reform. Although formal evaluation data do not exist this paper, using data from Ohio’s Medicaid system collected over the past 20 years, will discuss the financial impact of moving Medicaid recipients in need of long-term services into managed care. The paper will discuss the current policy issues and debates surrounding this initiative
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