Resource Guide for Managed Care Plans
The 2022 National Strategy to Support Family Caregivers — developed jointly by two U.S. advisory councils, with extensive input from the public — identifies policy recommendations for plans, states, and other partners to address caregivers’ needs. The creation of this strategy was directed by the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act with the goal of supporting five aims:
- Increase awareness of and outreach to family caregivers
- Advance partnerships and engagement with family caregivers
- Strengthen services and supports for family caregivers
- Ensure financial and workplace security for family caregivers
- Expand data, research, and evidence-based practices to support family caregivers
Below, Long-Term Quality Alliance (LTQA), in partnership with the National MLTSS Health Plan Association, highlights promising strategies for managed long-term services and supports (MLTSS) plans to support family caregivers.
Public Awareness and Outreach
More than 1 in 5 Americans has provided caregiving to an adult with functional limitations. This unpaid caregiving collectively contributes an estimated economic value of $600 billion per year. Yet, given a lack of awareness about how caregiving is defined, few identify themselves as a caregiver. This lack of self-identification prevents caregivers from accessing caregiving supports and services that can increase the well-being of caregivers and, in turn, the well-being of the adults with functional limitations whom they serve. MLTSS plans can increase public awareness and education of the crucial role that family caregivers play in the larger health system to address this lack of caregiver identification and inclusion.
To increase awareness of the role of family caregivers among the general public, as well as provide outreach to family caregivers to increase their self-identification and awareness of caregiver supports and services, MLTSS plans can:
- Meaningfully seek out and incorporate representation of family caregivers on advisory committees and boards to amplify caregiver feedback
- Ensure that policy-setting processes include documenting and responding to family caregiver needs
- Launch awareness campaigns to define caregivers, their role, and value with an equity lens in collaboration with states and other partners
- Identify family caregivers through existing member assessments
- Increase internal staff skills and knowledge of caregiver supports
- Refer members and family caregivers to tools and resources, including those provided by regional Aging and Disability Resource Centers (ADRCs)
MLTSS Plan Examples
Ensure family caregiver representation on advisory committees and boards | MLTSS Plans in Indiana: Ensuring caregiver participation on their Member and Informal Caregiver Advisory Committees: Elevance, Humana, Molina Healthcare of Indiana, and United Healthcare of Indiana will all convene a Member and Informal Caregiver Advisory Committee (called the Member and Informal Caregiver Advocacy Committee for Molina members) to gather feedback on the member and caregiver needs and foster open dialogue. Specific aims include reviewing materials for cultural competency, tracking member and caregiver input to identify trends, reviewing plan policies and procedures, and obtaining recommendations on health education strategies (RFP-72118). See Appendix A for best practices. Inclusa Inc.: Including family caregivers in the Member Advisory Committee: As part of an overarching quality plan and program, Inclusa convenes a Member Advisory Committee, which includes members, family caregivers, and providers. Through these meetings, Inclusa gathers feedback on members’ access to services and supports and family caregivers’ experiences. This ongoing feedback helps Inclusa improve upon and refocus efforts to support caregivers. |
Conduct awareness campaigns | Elevance: Promoting caregiver services on social media: Elevance (formerly Anthem) leverages its existing social media presence to target the promotion of health education and success stories to members and their caregivers. For example, Figure 5.1-5 is an example of a recent Facebook campaign regarding the plan’s Caregiver Binder (RFP 23-72118 Anthem Technical Proposal).
Aetna Better Health Texas: Hosting an event to recognize caregivers aligned with national efforts: During National Family Caregivers Month in November 2022, the Caregiver Action Network conducted a national campaign centered around the theme #CaregivingHappens, which highlights that when caregiving happens, it is not always convenient or expected. Aetna Better Health Texas hosted an event aligned with this campaign to highlight caregivers and provide them with information on available resources for support. |
Identify caregivers through existing member assessments | Commonwealth Care Alliance: Conducting SDOH assessments to identify caregivers: Through its Social Determinants of Health (SDOH) assessment, Commonwealth Care Alliance identifies who members live with and how often they see or talk to people that they feel close to, in an effort to identify caregivers and better support members. |
Increase internal staff awareness of caregiver supports | Inclusa Inc.: Hosting internal learning events for care teams: Inclusa provides robust and ongoing internal learning events for care teams on caregiver burnout, assessing caregiver strain, how to mitigate caregiver strain, and what resources are available for ongoing caregiver support. |
Refer members and caregivers to tools and resources, including those provided by regional Aging and Disability Resource Centers | Commonwealth Care Alliance: Developing a caregiver guide: Commonwealth Care Alliance has published blog posts and created online resources — including a caregiver guide, care tips for caregivers, and a caregiver toolkit — to increase awareness of the role of caregivers and of caregiver supports and services. Inclusa Inc.: Partnering with Regional Aging and Disability Resource Centers: In Wisconsin, Inclusa often partners with regional Aging and Disability Resource Centers (ADRC) that develop resources for caregivers, including caregiver support coordinators and powerful tools for caregivers. Members and caregivers are often referred to the resources provided by ADRCs. |
Engaging Family Caregivers in Health Care Services and Systems
Caregivers are often best positioned to understand the needs and preferences of the person for whom they provide care. Yet, silos between family caregivers and the heath system often prevent caregivers from being able to fully participate in fostering person-centered and seamless care for the member. MLTSS plans should include caregivers in care plan development and execution to facilitate highly coordinated care for members.
To engage family caregivers in health care services and systems, MLTSS plans can:
- Assess family caregivers to determine their caregiving role and needs for training or other supports.
- Needs assessments should include questions about their own health, work commitments and potential strain, and other training needs.
- Assessments should be followed up with referrals to local resources if necessary, including local respite care options.
- Assessments should include a backup care plan in case the caregiver is unable to continue providing care.
- Assessments should be culturally competent.
- Require that care coordinators make their contact information available to family caregivers.
- Require care coordinators to meaningfully designate family caregivers as part of the care team. This should entail including family caregivers in the development and execution of care plans, particularly during transitions of care.
- Ensure that all intake forms adopt inclusive language to help family caregivers self-identify.
- Create financial incentives, such as new billing codes for health care providers, to encourage and enable consultation with family caregivers as part of the care process (with the consent of the person receiving care).
MLTSS Plan Examples
| Conduct comprehensive family caregiver assessment | Managed Care Organizations (MCOs) in Tennessee: Comprehensive caregiver assessment: Upon initial member enrollment and at least annually thereafter, Medicaid MCOs in Tennessee conduct a face-to-face assessment with caregivers. During the assessment, plans determine the caregiver’s role, assess the caregiver’s health and well-being, identify training and other needs, and ensure the caregiver has the patient’s care coordinator’s updated contact information. Elevance: Comprehensive caregiver assessment: Elevance conducts an informal caregiver assessment upon enrollment in LTSS and at least annually thereafter as part of the annual individualized care plan review, with additional ad hoc assessments upon changes in caregiver or other circumstances. The assessments proactively identify and monitor caregiver risk factors for burnout such as stress and loneliness to divert members to higher levels of care if they no longer have caregiver support. The plan uses the outcomes of this assessment to make referrals for caregiver services and supports to address gaps in needs and tracks uptake of these services (RFP 23-72118 Anthem Technical Proposal). See Appendix B for more details. Humana Healthy Horizons in Indiana: Trauma-informed and SDOH-focused caregiver assessment: Humana’s caregiver assessment accomplishes the same as above and additionally emphasizes a trauma-informed approach that incorporates a focus on the caregiver’s social determinants of health. The assessment asks the caregiver about factors that might affect their ability to provide caregiving services, such as health literacy; transportation limits; food, housing, health care, or utility insecurities; and other physical, social, or environmental limitations. The care coordinator works with the member and caregiver to determine caregiver services that meet their preferences, while considering, if any, the caregiver’s experiences with trauma and toxic stress (RFP 23-72118 Humana Technical Proposal). See Appendix B for more details. United Healthcare of Indiana: Designating a backup care plan: United Healthcare of Indiana care coordinators assist caregivers and members in developing a backup care plan in case the caregiver is unable to continue caregiving. The plan keeps a copy of the backup caregiver’s contact information, and the care coordinator reviews the backup care plan with the member and caregiver annually (RFP 23-72118 United Healthcare Technical Proposal). United Healthcare of Indiana: Assessing caregivers with Careforth: United Healthcare uses Seniorlink, rebranded as Careforth, to deploy the caregiver assessment nationwide (RFP 23-72118 United Healthcare Technical Proposal). A study of Careforth users found that the services and supports provided to caregivers by Careforth resulted in a $2,800 cost savings per member per year, 75 percent reduction in falls, 32 percent reduction in emergency room visits, and 40 percent reduction in hospitalizations. Inclusa Inc.: Assessment of caregiver stress: At Inclusa, care teams use the Modified Caregiver Strain Index Tool to assess caregiver stress for all caregivers who meet predefined criteria. See Appendix B for more details. |
| Make care coordinator contact information available to caregivers | FamilyCare Plans in New Jersey: Exchanging contact information: MLTSS plans in New Jersey identify caregiver support as an essential element in care plans. To fully include caregivers as a part of the care team, care coordinators must make their updated contact information available to caregivers to enable open communication. Managed care organizations maintain electronic care management records that identify the member’s caregiver and note their availability and challenges. |
| Designate family caregivers as part of the care team | Elevance: Including caregivers on the care team: In Indiana, with the member’s consent, the Elevance care coordinator will invite the informal caregiver to participate in the member’s interdisciplinary care team. The care coordinator pays special attention to ensuring that the informal caregiver is educated on the member’s individualized care plan and care team roles and responsibilities. In doing so, the care coordinator emphasizes person-centered planning and prioritizes the member’s goals and values (RFP 23-72118 Anthem Technical Proposal). Humana Healthy Horizons in Indiana: Going further by including the caregiver coach: Humana goes beyond including the caregivers on the care team. Humana also includes the caregiver’s support: If the informal caregiver is assigned an informal caregiver coach, the informal caregiver coach is included by the care coordinator in all care planning processes, including the emergency plan development process (RFP 23-72118 Humana Technical Proposal). Inclusa Inc.: Including caregivers in the member-centered planning process: During the member-centered planning process at Inclusa, members identify individuals they would like to involve in the planning process, which often includes caregivers. Once specific caregivers and supports are identified, they are tied to the specific outcomes they are supporting the member to achieve and documented in the member-centered plan. MCOs in Delaware: Input on the transition planning process: Managed care organizations in Delaware require their case managers to incorporate input from family caregivers in the transition planning process. |
A study of Careforth users found that the services and supports provided to caregivers by Careforth resulted in a $2,800 cost savings per member per year, 75 percent reduction in falls, 32 percent reduction in emergency room visits, and 40 percent reduction in hospitalizations.
Services and Supports for Family Caregivers
Caregivers play a crucial role in supporting the health of people with functional limitations, and many often balance employment and other obligations at the same time. As a result of these demands, caregivers are at heightened risk for stress, loneliness, and decreased physical health. A growing research base suggests that by promoting the physical, mental, and social well-being of family caregivers, plan members also see increased positive health outcomes, leading to cost-savings for plans. MLTSS plans can realize these benefits of supporting caregivers by providing respite care, helping caregivers feel more empowered in their tasks, and reducing their loneliness and stress.
MLTSS plans can cover additional services and supports for family caregivers and advocate for their use, such as:
- Training
- Respite care
- Health promotion activities
MLTSS Plan Examples
| Training | MLTSS Plans in the Michigan MI CHOICE Program: Training: MLTSS plans in Michigan are required by the state to provide training to caregivers on how to use specialized equipment and supplies. This training empowers caregivers to feel confident in using equipment to care for a loved one. Commonwealth Care Alliance: Equipment training: At Commonwealth Care Alliance in Massachusetts, community rehabilitation teams work with individuals with complex needs living in the community and their caregivers and train them to use new equipment. Inclusa Inc.: Consumer education and training: Inclusa offers consumer education and training services that are designed to help members and their caregivers develop self-advocacy skills, support self-determination, exercise civil rights, and acquire skills needed to exercise control and responsibility over other support services. See Appendix C for more details. |
| Respite care | MLTSS plans in Florida: Respite care: To reduce caregiver burnout, MLTSS plans in Florida are required to provide respite care to caregivers. MLTSS plans are responsible for ensuring two respite providers in each county. Elevance: Respite care: After Elevance connected members to at-home respite care in Tennessee, caregiver burden scores were reduced or stabilized in 91.48 percent of cases (RFP 23-72118 Anthem Technical Proposal). Inclusa Inc.: Respite care: Inclusa provides respite care to members on a short-term basis to ease members’ family or other primary caregiver(s) from daily stress and care demands. Respite care may be provided in an institution or other licensed facility, a residential facility, a member’s own home, or a respite care provider’s home. |
| Health promotion | Molina Healthcare: Virtual app to reduce caregivers’ social isolation: Given that loneliness is a common problem among caregivers, Molina in Indiana makes Pyx Health, a technology platform to reduce loneliness and social isolation, available 24/7/365 at no cost to all identified informal caregivers. Pyx Health assesses users’ social determinants of health with a focus on loneliness, identifies users who need additional interventions to reduce social isolation risk, and provides peer-certified staff who are trained to offer companionship. When a Molina affiliate plan deployed Pyx Health with members, 41 percent of members improved loneliness scores, 82 percent of those also improved their depression scores, and members experienced a 57 percent reduction in medical costs (RFP 23-72118 Molina Att E). See Appendix C for more details. United Healthcare of Indiana: Virtual app to improve caregivers’ mental health: United Healthcare of Indiana similarly offers informal caregivers virtual mental health improvement tools. Specifically, it offers Self Care, which is a self-help digital application that uses cognitive behavioral therapy-based methods to improve overall mental well-being and behavioral health tracking. United Healthcare’s internal analysis shows that users see a 50 percent score improvement on the Depression Anxiety Stress Scales (DASS-21) in 60 days with self-directed care (RFP 23-72118 United Healthcare Technical Proposal). |
| Specialized caregiver supports | Senior Care Options Plans in Massachusetts: Dementia care: MLTSS plans in Massachusetts are required to provide caregivers with services to assist in the management of the member’s dementia. Elevance and Humana: Specialized supports for ADRD caregivers: Both Elevance and Humana in Indiana offer specialized supports for caregivers who care for people with Alzheimer’s disease and related dementias (ADRD), such as memory cafés, which are hosted by the Dementia Friends Indiana (RFP 23-72118). A memory café is a “safe, welcoming, non-judgmental environment where people living with dementia and their care partners can connect with each other and with others in similar situations.” The memory café can help caregivers reduce stress, share informal peer support and best practices, and improve mental health. Mercy Care, Administered by Aetna Medicaid Administrators: Caregiver engagement benefit: Mercy Care is partnering with Trualta to deploy a caregiver engagement solution to support family caregivers. With Trualta, Mercy Care offers an easy-to-navigate, evidence-based skills training solution, available for all caregivers 24/7 in short, accessible segments. The program is scalable as caregivers can self-register, and the system can push out plan content and events to caregivers directly. In addition to offering skills-based training, Trualta offers social support with care coaching and peer support groups. |
| Others | Elevance: Caregiver binders: Elevance provides caregiver binders, which include emergency identification cards, doctor visit and home safety checklists, information about the member’s abilities and preferences, and other helpful information. The purpose of the caregiver binder is to ease caregivers’ ability to organize, access, and share information with providers and family members. In December 2021, Elevance shipped more than 1,000 binders to share with members and caregivers and has distributed more than 2,000 binders to 17 organizations across Indiana and planned to distribute 1,000 more in 2022 (RFP 23-72118 Anthem Technical Proposal). MLTSS Plans in the Virginia Commonwealth Coordinated Care Plus Program: Transportation: MLTSS plans in Virginia are contractually required by the state to provide reimbursement for transportation to Medicaid-covered services. Long-Term Care Services Plans in Arizona: Hospice care: Arizona requires MLTSS plans to provide hospice care for members, which can provide caregiving assistance or a break in duties for caregivers.
New York Managed Long-Term Care Partial Capitation Plans: Social day care: MLTSS plans in New York offer caregivers access to social day care for the member, which can improve well-being for both the member and caregiver.
MLTSS Plans in the Wisconsin Family Care and Family Care Partnership: Consultative services: Wisconsin requires MLTSS plans in the state to provide consultative clinical and therapeutic services to caregivers.
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After Elevance connected members to at-home respite care in Tennessee, caregiver burden scores were reduced or stabilized in 91.48 percent of cases (RFP 23-72118 Anthem Technical Proposal).
Research, Data, and Evidence-Informed Practices
MLTSS plans are uniquely positioned to pilot new caregiver supports and services to innovate ways to increase the well-being of members and their caregivers. To maximize the benefits of these innovations, MLTSS plans should also widely share and promote best practices and lessons learned from intervention pilots with other MLTSS plans, states, and other collaborators. With robust data collection and analysis of caregiver needs and experiences, MLTSS plans can contribute to the evidence base on caregiver interventions.
To promote evidence-informed practices to support family caregivers, MLTSS plans can collect data and support research by:
- Leveraging existing assessment tools such as TCARE to capture data about caregivers
- Conducting an annual caregiver satisfaction survey and using data to address gaps in caregiver supports and services
- Working with electronic visit verification vendors to gather data on family caregivers
- Including caregiver information within health systems technology, such as electronic health records
- Including a quality measure to assess the presence and the plan’s engagement of a family caregiver (as applicable) in state Medicaid Managed Care Quality Rating Systems
- Incorporating caregiver measures into value-based payment
- Collaborating with states and researchers to convene a community of practice/learning collaboratives and compile vetted best practices to support caregivers at the state Medicaid level
MLTSS Plan Examples
| Leverage existing tools | TCARE: At least eight MCOs use TCARE, an integrated caregiver support solution, to capture data about caregivers. TCARE products lead to a 21-month average delay in nursing home utilization for consumers. Elevance: TCARE results: In Tennessee, Elevance reports that 85 percent of members receiving support from a caregiver who stated an intention to transition their loved one to a nursing facility remained in their home following the TCARE assessment and support (RFP 23-72118 Anthem Technical Proposal). Trualta: Trualta offers an evidence-based platform for family caregivers that provides personalized resources and captures engagement data. This allows caregivers to reduce stress, consumers to age in place, and reduces costs for payers. The platform is clinically validated through grant-funded research with academic partners, and 9 out of 10 informal caregivers surveyed said they would recommend Trualta to another informal caregiver. See Appendix D for more details. Molina: Leveraging Trualta: In Texas, California, and Indiana, Molina-affiliated health plans offer evidence-informed caregiver support, training, education, and resources via Trualta. Molina goes beyond Trualta’s resources by offering additional custom content and caregiver “badges” and other incentives to encourage caregiver engagement on Trualta (RFP 23-72118 Molina Att E). See Appendix D for more details. |
| Combine existing data sources to analyze caregiver needs and evaluate caregiver programs | Molina Healthcare of Indiana: Data streams to inform caregiver supports: To evaluate the effectiveness of Molina’s caregiver support program, the plan uses mixed methods. It uses data available from the state (for example, National Core Indicators-Aging and Disabilities) and national surveys (for example, AARP Caregiver Survey) in addition to data from its own annual caregiver survey that assesses stress level, overall satisfaction, family intent to transition a loved one to a nursing facility, and ability to balance caregiving with other obligations. From this data, Molina identifies gaps in caregiver supports to ameliorate. Molina also collects statistics on current caregiver support offerings, such as the number of caregivers referred to caregiver supports and the percentage screened and enrolled in a formal caregiver program. These statistics help Molina establish and expand the evidence base for new innovations as well as peer-reviewed interventions (RFP 23-72118 Molina Att E). |
Conclusion
There are many ways in which MLTSS plans are currently supporting family caregivers, and this action guide highlights promising strategies in the following domains:
- Increasing awareness and outreach
- Advancing partnerships and engagement
- Strengthening services and supports
- Ensuring financial and workplace security
- Expanding data, research, and evidence-based practices
For more information on implementing plan examples, read the appendices.
Acknowledgments
Thank you to members of the National MLTSS Health Plan Association who shared insights and examples that informed this report. Members include Aetna, AmeriHealth Caritas, CareSource, Commonwealth Care Alliance, Elevance Health, Florida Community Care an Independent Living Systems Company, Inclusa, L.A. Care Health Plan, Molina Healthcare, UPMC Community HealthChoices, and VNS Health.
We would like to acknowledge the significant contributions of Caitlin Otter (LTQA Intern) and Grace Hong (LTQA G. Lawrence Atkins Fellow) to the development of this action guide.
Appendices
The Family Caregiving Strategy Action Guide for MLTSS Plans — developed by Long-Term Quality Alliance (LTQA), in partnership with the National MLTSS Health Plan Association — highlights promising strategies for managed long-term services and supports (MLTSS) plans to support family caregivers.
The strategies outlined in the action guide are aligned with the five aims of the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act:
- Increase awareness of and outreach to family caregivers
- Advance partnerships and engagement with family caregivers
- Strengthen services and supports for family caregivers
- Ensure financial and workplace security for family caregivers
- Expand data, research, and evidence-based practices to support family caregivers
The information in the appendices below provide additional details and examples of how MLTSS plans are implementing programs to support family caregivers.
Appendix A: Public Awareness and Outreach
Best practices to include family caregivers on advisory committees have been compiled from the winning MLTSS plan proposals for RFP 23-72118 to provide managed long-term services and supports for the Indiana Family and Social Services Administration. These include:
- Convene the committees more than once per quarter, with additional ad hoc meetings
- Convene each meeting in a different area of the state, at least 60 miles apart, to reach a geographically diverse audience, and offer multiple modalities for participation (including web and telephone)
- Ensure meeting accessibility by offering members and caregivers one-on-one education on how to use web-based meeting platforms to participate in meetings
- Leverage ties with local community-based organizations to host meetings in their local offices to recruit participants
- This strategy proved successful for Humana in Kentucky: Humana’s representative works with the facility to educate members about the meeting. This strategy led to one of their most successful advisory committee meetings to date, with over 70 participants.
- Ensure members and caregivers comprise a majority of the committee board
- Advertise meetings via website, newsletters, social media, and at community events
- Remind members about the meeting via text and email in advance
- Incentivize participation by offering meals at meetings, reimbursing for transportation expenses to and from the meetings, providing translation services, providing child care vouchers, offering personal care assistance, or providing a gift card/stipend for participation after each meeting
Appendix B: Engaging Family Caregivers in Health Care Services and Systems
Elevance also records information about all referrals to services and follow-ups to determine caregiver uptake of services. The member’s care coordinator, service coordinator, informal caregiver personal guide, or informal caregiver coach makes the service coordinator’s contact information available to the caregiver, as well as refer them to the 24/7 Nurse Helpline number.
Part of the role of Inclusa care teams is to assess a caregiver’s status and capacity to deliver care — whether paid or not. Inclusa has adopted the Modified Caregiver Strain Index tool for care teams to use in assessing caregiver stress, and care teams must assess all caregivers who meet the following description:
- An individual who has a significant responsibility for providing care to a member, as outlined in the Member Centered Plan, that is critical to ensuring that member’s ongoing health and safety
- An individual who is generally providing support to a member who is no longer able to perform the critical tasks of personal or household care necessary for everyday survival
- An individual who is providing support in the role of a natural support, is employed by the member through self-directed supports or, is a provider of an owner-occupied adult family home
Care teams also have access to a caregiver strain assessment guideline as a resource to guide action on behalf of the care teams. Inclusa’s internal policy also directs care teams to establish backup plans for any situation where the primary caregiver is a family member.
The care coordinator assesses the following:
- The caregiver’s willingness and ability to meet member’s needs, including employment status and schedule
- The caregiver’s overall health and well-being, including health literacy; transportation limits; food, housing, health care, or utility insecurities; and other physical, social, or environmental limitations
- The caregiver’s level of stress
- Whether the caregiver needs skill-based trainings to fulfill person-centered planning and/or caregiving duties
The care coordinator then works with the member and caregiver to determine caregiver services that meet their preferences, such as culturally competent trainings, respite care, or others, while considering, if any, the member’s and caregiver’s experiences with trauma or toxic stress. The care coordinator uses this information to tailor recommended training and supports for the caregiver. For example, the care coordinator will ensure that the caregiver’s informal caregiver coach is female or speaks Spanish to meet the caregiver’s needs.
- Aetna Better Health Florida: One member’s case manager intentionally engaged the member and their caregiver to understand their unmet needs. The case manager helped the caregiver feel comfortable enough to disclose the root of their financial problem. One day, upon learning that the member was without power, the case manager immediately searched for community resources, personally making calls and following up daily until a resource was secured. The case manager also educated the member and their caregiver on referral steps so that they would be able to request assistance themselves should the need arise in the future.
Appendix C: Services and Supports for Family Caregivers
Inclusa offers educational and training opportunities for members, their caregivers, and legal decision-makers that help them develop expertise in problem-solving, self-advocacy skills, self-determination, community integration, financial management, and decision-making. Covered expenses of up to $2,500 per year may include enrollment fees, books and other educational materials, and transportation related to participation in training courses, conferences, and other similar events.
Beyond making this application available to caregivers, Molina uniquely integrates Pyx Health data into member services and service coordination workflows to drive real-time member engagement. On average, Pyx Health reduces loneliness by at least 60 percent, increased plan satisfaction among 67 percent of users, and led to $847 per member per month in reduced acute care in emergency departments or similar setting in six months following Pyx Health use compared to six months prior to Pyx Health use.
Aetna Better Health New York: Social day care
Aetna Better Health New York highlights the following as benefits of its social day care benefit:
- Participation in social day care structured activities provides valuable respite to caregivers. Caregiving duty relief promotes lowering stress levels, prolonging the ability to give care over time at home.
- Social day care facilitates social interaction for people who have experienced a decline in independence and social contact.
- Socialization is an important component in the fight against cognitive decline. Participants in social day centers enjoy companionship and camaraderie in a safe and nurturing environment where they are welcomed with dignity and respect.
- Participants in social day centers are encouraged to enjoy group activities, including physical exercise, entertainment, music, art, games, and planned outings. These stimulating activities help maintain memory; foster emotional connections with others; encourage self-expression; lessen emotional symptoms such as anxiety, depression, apathy, and irritability; and promote independence.
Member stories were retrieved from the winning MLTSS plan proposals for RFP 23-72118 to provide managed long-term services and supports for the Indiana Family and Social Services Administration.
- Humana: “The informal caregiver of one of our Florida Medicaid MLTSS members was facing difficulties in rendering reliable care to his mother, a Humana member, because of his demanding job. In addition, he was facing performance issues at work due to his caregiving responsibilities. He reported to us that he felt like he was ‘on the brink of a heart attack.’ A prior assisted living facility placement had not worked out due to the member’s aggressive behavior. Upon learning of these circumstances, the member’s care coordinator worked with the member and caregiver to support them by initiating needs-based paid services in the home, connect the member with a psychiatrist, and connect the caregiver to a support group. As a result of these efforts, the member’s mental health and aggressive behavior stabilized, the caregiver’s performance at work improved, and the member remained at home in the setting of her choice (RFP 23-72118 Humana Technical Proposal).”
- Humana: “A married couple in our Wisconsin LTSS plan received participant-directed attendant care from their daughter. Both the members and their daughter wanted her to continue in this role, but she often had other responsibilities emerge outside of her caregiving role. With the agreement of both members in the daughter’s care, the member’s service coordinator scheduled recurring respite services for short periods of time to allow the caregiver to attend to her other responsibilities and reduce caregiver burnout while ultimately helping her parents age safely at home (RFP 23-72118 Humana Technical Proposal).”
- Molina Healthcare in Indiana: “As the result of a car accident, a member suffered a traumatic brain injury, leaving him dependent for all activities of daily living. The member’s wife, his main caregiver, was having a hard time accepting her husband’s health condition and adapting to the new routine and her new responsibilities. As a result of person-centered planning, Molina offered the wife a caregiver support case manager, Maria, who listened to the wife’s concerns and completed an assessment. Maria helped the wife better understand her conflicted feelings. Access to a caregiver support specialist who is knowledgeable about the unique role of caregivers has enabled the wife to feel supported. The wife’s increased understanding and additional support gave her confidence and assistance to support her husband in their home instead of a facility (RFP 23-72118 Molina Att E).”
Appendix D: Research, Data, and Evidence-Informed Practices
Molina’s Indiana care coordinators and service coordinators have access to the Trualta platform to share targeted content with members’ informal caregivers, informed by the member’s care plan. Molina will send caregiver feedback from Trualta to its Workforce Development Workgroup for analysis, as well as monitor utilization and analyze outcomes.
- Molina Healthcare of Indiana: Molina’s evidence-based Informal Caregiver Support Program aims to facilitate caregiver participation in care coordination, offer personal development opportunities, and increase their well-being. The program includes financial member incentives to encourage caregiver participation, caregiver assessment, evidence-based care coordination for all caregivers, clinically validated training and support groups such as Trualta, informal caregiver coach providers, caregiver transportation, and respite care. For example, in Indiana, Molina offers six round-trip non-emergency medical transportation rides to caregivers of members receiving home and community-based services (HCBS) to/from member residences. To incentivize members to encourage their caregivers to complete an assessment, members in Indiana earn a $25 gift card upon caregiver completion of the assessment. The program has demonstrated a 20 percent reduction in the need for HCBS services, improved measures in the Healthcare Effectiveness Data and Information Set, and allowed members to stay in the community for an additional 21 months (RFP 23-72118 Molina Att E).
Learn More
This action guide was produced in conjunction with the National Academy for State Health Policy’s RAISE Act Family Caregiver Resource and Dissemination Center and funded by The John A. Hartford Foundation in collaboration with the U.S. Administration for Community Living.
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