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 in 2018.[1] Moreover, although consumers receiving Medicaid LTSS represented approximately 5.3 percent of the Medicaid population in 2013 FY 2020 (the last year for which reliable data is available), they accounted for 31.3 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 2017, the number of states operating a managed long-term services and supports (MLTSS) program mushroomed from 12 to 24. Other states often discuss implementing MLTSS; those states are identified – along with current programs – on the map located  An additional three states have MLTSS under active consideration. The map is located here.

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. However, 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.

Click here to view the MLTSS Map

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.