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 Milliman Release Brief on Nursing Home Financing and MLTSS

ADvancing States is pleased to announce the release of a new issue brief,  Addressing Nursing Facility Financing Challenges during MLTSS Program Development developed in collaboration with Milliman. This brief is intended to shed light on the complex and often-misunderstood relationship between nursing facility financing and Medicaid delivery system design. 

Although states will need to change the mechanisms used to pay for nursing facility services as they transition to managed care, this research shows they have options, including pass-through payments and state-directed payments using minimum fee schedules, to sustain current Medicaid financing arrangements.  Moreover, our research and interviews with states that have already transitioned to an MTLSS delivery system showed that early, frequent, and ongoing stakeholder engagement with nursing facility providers is key to a successful transition.

ADvancing States hopes that this report will provide states without MLTSS programs critical information about approaches to sustain current nursing facility financing in a managed care environment.

This is the latest publication from the MLTSS Institute, which serves to drive improvements in key managed long-term services and supports (MLTSS) policy areas, facilitate sharing and learning among states, and provide direct and intensive technical assistance to states and health plans.   Since 2016, the MLTSS Institute has published eight issue briefs on topics ranging from MLTSS tools to help address the workforce crisis to state considerations for implementing integrated care programs. 


On June 15, 2022 ADvancing States, Innovation Matters in Health, and Milliman held a webinar to highlight and discuss the findings of this paper. The authors discussed the intricacies of Medicaid financing, Medicaid managed care regulatory constraints and the implications for MLTSS program development. The webinar also outlined potential solutions states can explore to maintain stability in their long-term services and supports system while maximizing the value of a managed care delivery system for LTSS benefits.

State Consulting

As part of the MLTSS Institute, ADvancing States can provide intensive, state-specific consulting 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 agencies on implementation and oversight.
  • Serving 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 MCO contracts.
  • Developing and/or reviewing MCO readiness review tools and recommendations for addressing MLTSS program elements, including participation on readiness reviews if requested. 

MLTSS Institute Advisory Board Members: 




Sharon Alexander

Amerihealth Caritas Family of Companies

President, Long-Term Services and Supports

Michelle Bentzien-Purrington

Molina Healthcare, Inc.

Senior Vice President, Managed Long-Term Services and Supports and Social Determinants of Health

Joseph Billingsley

California Department of Health Care Services

Chief, HCBS Policy Branch

Curtis Cunningham 

Wisconsin Department of Health Services 

Assistant Administrator, Benefits and Service Delivery

Kathleen Dougherty

Delaware Department of Health and Social Services

Chief, Managed Care Operations

Merrill Friedman 

Elevance, Inc. 

Regional Vice President, Inclusive Policy & Advocacy

Katie Moss 

Tennessee Bureau of TennCare 

Chief, Long-Term Services and Supports 

Jakenna Lebsock

Arizona Health Care Cost Containment System Administration

Assistant Director, Health Care Management

Michelle Martin

UnitedHealthcare Community and State

Senior Policy Director, LTSS

Eunice Medina

South Carolina Department of Health and Human Services 

Chief of Staff

Maureen Pero

Aetna Medicaid

Strategy and Growth Executive

Michelle Soper

Commonwealth Care Alliance

Vice President, Policy Development