Managed long-term care: limits and lessons

In the mid-1990s, states began to reduce their reliance on commercial health plans in the primary and acute care markets. At the same time, however, many states are for the first time encouraging these plans to participate in long-term care programs. The evidence suggests, however, that commercial health plans will not provide a quick cure to the long-term care system. At the same time, several states have managed long-term care initiatives that do not rely on commercial health plans but that do an excellent job of case management and that also seem to be among the national leaders in offering home and community-based services. Oregon provides one example, but so does the traditional managed long-term care system in Arizona and the Community Options Program in Wisconsin. The current efforts in Arizona and Wisconsin to abandon these models and to embrace competition may therefore be a mistake.