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Managed Long Term Services and Supports

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 eight in 2004 to 16 in 2012, and the Centers for Medicare & Medicaid Services (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, and the Balancing Incentive Program. States and stakeholders have expressed an interest in learning more about MLTSS and how new Long-Term Services and Supports (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 authority can be combined with other home and community based authorities to operate the MLTSS program (as with a concurrent 1915(b)/1915(c), 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.

CMS developed a number of technical assistance tools for states, and other stakeholders to enhance the availability and quality of MLTSS. These tools include:

Additional resources for MLTSS programs are available in an Informational Bulletin released on May 21, 2013 (PDF, 210.48 KB).

*For accessibility issues with accessing the MLTSS tool email Medicaid.gov@cms.hhs.gov for assistance.