Managed Long Term Services and Supports

Medicaid represents the single largest payer of Long-Term Services and Supports (LTSS) in the country, accounting for over half of all LTSS expenditures.[1] Moreover, although consumers receiving Medicaid LTSS represented approximately 8 percent of the Medicaid population in 2010 (the last year for which beneficiary data is available), they accounted for 36 percent of Medicaid spending.[2] It is not surprising that states have looked for ways to more effectively and efficiently manage this program area, which up until 2010, was predominantly delivered through a fee-for-service delivery system.

Since 2010, states’ interest in a managed care delivery system for their LTSS has exploded. Between 2011 and 2016, the number of states operating a managed long term services and supports (MLTSS) program mushroomed from 12 to 22. An additional nine states are either implementing a MLTSS program in the next two years or have MLTSS under active consideration. The map located here identifies these states.

A number of factors have accelerated this movement toward managed care in states’ Medicaid LTSS programs. A single point of accountability – a capitated managed care plan - can offer more flexible benefits packages and other opportunities for integrating acute and long-term service and supports systems; it can also improve care coordination and community alignment. States also see MLTSS programs as a useful tool in helping them rebalance their LTSS systems away from more costly and less integrated institutional settings toward more cost-effective and more integrated community settings. Finally, MLTSS programs have helped some states reduce or eliminate waiting lists for services. More resources on MLTSS programs can be found here.

Operating an efficient and effective MLTSS program requires a thoughtful program design, capable health plan partners, strong state oversight and appropriate accountability mechanisms. A recent study concluded that these factors vary considerably from state to state. ADvancing States is uniquely positioned to implement these initiatives because of the Association’s capacity to:

  • Arrange and facilitate peer-to-peer information exchange and mentoring relationships among the states using existing infrastructure and practices;
  • Readily reach key, high-level state MLTSS decision-makers and serve as a trusted and secure medium for vetting challenges and preliminary, innovative MLTSS concepts; and
  • Deliver solid, reliable technical assistance tailored to state officials and their key staff.

To drive improvements in MLTSS practice and policy, ADvancing States has created the MLTSS Institute.To learn more about the Institute, click here.

Please contact Camille Dobson, Deputy Executive Director at for any MLTSS-related questions or information.

[2] Figures calculated using CMS-published data on Medicaid enrollment and expenditures

To request technical assistance or to learn more about our work in MLTSS, please contact Camille Dobson.