MLTSS Institute

The MLTSS institute is a collaboration between ADvancing States members and national Medicaid health plans intended to drive improvements in key MLTSS policy issues, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans. All three focus areas of the Institute include the common themes of: 1) building state agency capacity; 2) fostering innovation at the state level; and 3) providing a feedback loop to the federal policy dialogue.

ADvancing States and Sage Squirrel Consulting, LLC Release Report on HCBS Workforce Challenges in MLTSS Programs

The ADvancing States is pleased to announce the release of a new report, Collaborating on HCBS Workforce Challenges in MLTSS Programs, co-authored by Sage Squirrel Consulting, LLC. The report is the third in a series of publications from the MLTSS Institute, which was established in 2016 to drive improvements in key MLTSS policy areas, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans.   

This report identifies the challenges and promising practices in addressing the mismatch between supply and demand for direct care workers in long term services and supports programs, all viewed through the lens of MLTSS programs.  States that operate a MLTSS program have a potential partner in meeting the needs of HCBS participants for timely and high quality direct care workers.  The report looks at this challenge from three unique aspects:

  • Network adequacy
  • Rates and reimbursement and
  • Quality

It also highlights the need for improved data to better quantify trends and impacts on LTSS programs.   ADvancing States hopes that this report will expand the body of knowledge on this most challenging topic as well as spur additional research and data collection. 

Click here to view the report.

Direct State Technical Assistance

As part of the MLTSS Institute, ADvancing States and consultants on retainer, as needed and appropriate, will provide intensive, state-specific technical assistance on a wide range of MLTSS issues.These may include:

  • Presentations to state leadership, legislators and providers on national MLTSS trends and implications for state on implementation and oversight
  • Serve as a national subject matter expert in meetings with key advisory boards and taskforces in the community to chart short and long term planning objectives. 
  • Reviewing and providing feedback on quality strategies/measures
  • Writing or editing state’s managed care authority documents (SPAs or waivers); MLTSS RFPs or managed care contracts
  • Development and/or review of MCO readiness review tool and recommendations for addressing MLTSS program elements, including participation on readiness reviews if requested

Click here to view the MLTSS Map.

MLTSS Institute Advisory Board Members: 


Name  Organization Title 
Sharon Alexander Amerihealth Caritas Vice President, MLTSS
Catherine Anderson UnitedHealthcare Senior Vice President, Policy & Strategy 
Michelle Bentzien-Purrington Molina Healthcare, Inc. Vice President, MLTSS and Duals Integration
Curtis Cunningham  Wisconsin Department of Human Services  Assistant Administrator, Long Term Care Benefits and Programs 
Merrill Friedman  Anthem, Inc.  Sr. Director, Disability Policy Engagement 
Diane Gerrits Wellcare, Inc. Senior Director, Medicaid Policy
Katherine Layman Texas Health and Human Services Commission Senior Policy Director
Patti Killingsworth  Tennessee Bureau of Tenncare  Chief, Long Term Services and Supports 
Mark Kissinger  New York Department of Health Special Advisor, Long Term Care
Eunice Medina Florida Agency for Health Care Administration  Chief, Bureau of Plan Management Operations
Michael Monson Centene, Inc.  Senior Vice President Medicaid & Complex Care 

Ginny Rountree 

Arizona Health Care Cost Containment System Administration Assistant Director, Operations & Clinical 
Nicole Sunder Aetna Medicaid Director, Integrated Care Transformation
Karla Warren Ohio Department of Medicaid Integrated Care Manager