Promoting Community Integration Through Long-Term Services and Supports

Approximately 4.8 million Medicaid beneficiaries received long-term services and supports (LTSS) in 2011.1 Further, people with LTSS needs account for about one third of all Medicaid expenditures.2 Through the Medicaid Innovation Accelerator Program (IAP), The Center for Medicaid and CHIP Services (CMCS) offers targeted program support to Medicaid agencies seeking to promote community integration for Medicaid beneficiaries using LTSS.

Based on state and stakeholder feedback, IAP is offering program support to states in two distinct areas: Housing-Related Services and Partnerships as well as Incentivizing Quality and Outcomes in community-based LTSS programs. Selected states in these two areas share common interests and goals that align with IAP’s broader goals for Community Integration- Long-Term Services and Supports:

  • Increase state adoption of individual tenancy sustaining services to assist Medicaid beneficiaries.
  • Expand housing development opportunities for Medicaid community-based LTSS beneficiaries through facilitation of partnerships with housing agencies.
  • Increase state adoption of strategies that tie together quality, cost, and outcomes in support of community-based services LTSS programs.

Medicaid Housing-Related Services and Partnerships (HRSP)

In 2017, IAP is supporting the second track of the State Medicaid-Housing Agency Partnerships. In 2016, IAP supported to related tracks, Supporting Housing Tenancy and State Medicaid-Housing Agency Partnerships.

  • Track 1: Supporting Housing Tenancy: This track, which ran from February 2016 through April 2016, focused on providing states with innovative strategies that are being used, or which could be used by states to support housing tenancy services for community-based LTSS Medicaid beneficiaries. Thirty-one state Medicaid agencies are invited to participate in this webinar series:
  • Track 2: State Medicaid-Housing Agency Partnerships: The goals of the State Medicaid-Housing Agency Partnerships Track are to: 1. develop public and private partnerships between the Medicaid and housing systems; and 2. to support states in the creation of detailed action plans that foster additional community living opportunities for Medicaid beneficiaries. IAP is working closely with its federal partners: the US Department of Housing and Urban Development; the Substance Abuse and Mental Health Services Administration; the Office of the Assistant Secretary for Planning and Evaluation; and the US Interagency Council on Homelessness on planning and coordination of this program support. IAP leverages its collaboration with federal agencies to promote partnerships between state Medicaid agencies, state housing finance agencies, public housing agencies, state and local service agencies, and providers. Consistent with statute, CMS does not provide Federal Financial Participation for room and board in home and community-based services.
    • Starting in April 2016 selected states, California, Connecticut, Hawaii, Illinois, Kentucky, New Jersey, Nevada and Oregon participated in the track for a six month period.
    • Starting in May 2017, selected states, Alaska, Massachusetts, Michigan, Minnesota, Nebraska, Texas, Utah, and Virginia are participating in the track for a nine month period.

Incentivizing Quality and Outcomes (IQO)

Efforts to incentivize quality and outcomes have been utilized more for acute care than for community-based LTSS, except in states that have incorporated quality measures in their payment methodologies for nursing facilities. IAP also offers two sequential tracks in IQO:

  • Track 1: Planning an IQO Strategy: This track, which began in April 2016 and runs for six months, provides selected states, Indiana, Maryland, Mississippi, North Carolina, Nebraska, Nevada, Ohio, Pennsylvania, and Virginia with strategic planning support in developing an IQO approach for community-based LTSS.
  • Track 2: Implementation of an IQO Strategy: This track, which began in September 2016 and runs for six months, will provide support to selected states, Massachusetts, New Jersey, Virginia, and Washington, that are past the planning phase, but are in need of support with the early stages of their implementation activities.

National Dissemination Webinars

Additional Resources

May 18, 2017 Information Session Slides

October 22, 2015 Information Session

States should submit additional questions via e-mail with the subject line "CI-LTSS" to the IAP mailbox: MedicaidIAP@cms.hhs.gov.

1 Eiken S, Sredl K, Saucier P, and Burwell B. Medicaid Long-Term Services and Supports Beneficiaries in 2011 Truven Health Analytics, September 22, 2015 and Saucier P, Kasten J, Burwell B, and Gold L. The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update Truven Health Analytics, July 2012.

2 Eiken S, Sredl K, Burwell B, and Saucier P. Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2013: Home and Community-Based Services were a Majority of LTSS Spending Truven Health Analytics, June 30, 2015.