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Medicaid Managed Long Term Services and Supports (MLTSS)

Managed Long Term Services and Supports (MLTSS) refers to the delivery of long term services and supports through capitated Medicaid managed care programs.  Increasing numbers of States are using MLTSS as a strategy for expanding home- and community-based services, promoting community inclusion, ensuring quality and increasing efficiency.  The number of States with MLTSS programs increased from 8 in 2004 to 16 in 2012, and CMS has experienced increasing interest from States in the form of concept papers, waiver applications and requests for technical assistance.

MLTSS offers States a broad and flexible set of program design options, and may be used as an overarching structure to promote initiatives such as Money Follows the Person, participant-directed services, the Balancing Incentive Program, etc.   States and stakeholders have expressed an interest in learning more about MLTSS, and how new LTSS opportunities in the Affordable Care Act may be incorporated into an MLTSS program.

Medicaid MLTSS programs can be operated under multiple federal Medicaid managed care authorities at the discretion of the state and as approved by CMS, including 1915a, 1915b, and 1115. There are requirements and limitations related to each authority, and managed care authorities can be combined with (as with a concurrent 1915b and, for example).

In an effort to enhance the availability and quality of MLTSS, CMS has developed a number of technical assistance tools for States, and other stakeholders.  These tools include:

  • Documents outlining CMS' expectations for MLTSS programs operating under section 1115 or 1915(b) authorities.  A more detailed document is here, while a summary of these principles is here.
  • An online curriculum* offering states guidance on program design, Medicaid authorities and other information relative to the effective management of MLTSS.
  • A guide to interpreting and applying existing External Quality Review protocols when assessing MLTSS program compliance
  • A white paper, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update,  which provides an inventory of all current MLTSS programs and a projection of future programs as of July, 2012.  The report includes state-by-state results and synthesizes findings across states, reporting national enrollment, characteristics of contractors and multiple program features.
  • A chart, Population Groups Enrolled in Managed Long Term Services and Supports,  building off the July, 2012 white paper, which lists the population groups that are enrolled in current MLTSS programs, as well as those projected to be enrolled in future MLTSS programs
  • A timeline for optimal planning and implementation of MLTSS programs.
  • A paper identifying the concerns and considerations in incorporating traditional LTSS providers into a managed care program.

Additional resources for MLTSS programs are available in an Informational Bulletin released on May 21, 2013.

*If you have accessibility issues with accessing the MLTSS tool please send an email to Medicaid.gov@cms.hhs.gov and our Business Operations Staff will assist you with access.