Managed LTSS

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 September 2014, CMS initiated a national, cross-state evaluation of MLTSS. The MLTSS evaluation is one component of a larger evaluation designed to track and evaluate several different types of Medicaid section 1115 demonstration waivers. However, the MLTSS component of the evaluation is not limited to programs using section 1115 demonstration authority. Learn more about the national, cross-state evaluation.

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:

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 and our Business Operations Staff will assist you with access.