States Urged to Modernize Program Integrity in Medicaid Self-Directed Care Programs
An analysis calls on states to redesign program integrity approaches for self-directed Medicaid services by focusing on four priorities that allow oversight to scale with program growth. Self-directed care models, where beneficiaries manage their own long-term services and supports budgets, have expanded rapidly but present unique fraud and compliance risks. The recommendations address how states can maintain effective oversight without constraining beneficiary choice and flexibility. For managed care organizations administering or overseeing self-directed options, this highlights evolving state expectations for program integrity infrastructure in LTSS programs.
Managed care organizations with LTSS contracts must adapt program integrity systems to detect fraud and abuse in self-directed care models while meeting state oversight requirements as these programs grow.
LTSS · Managed Care
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