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Factors Influencing How You Define Target Population

Program Goals

Your state may be pursuing very broad LTSS system improvement goals applicable across multiple population groups, such as reducing reliance on institutional services. On the other hand, your goal may be specific to a smaller group of people. For example, persons with autism may have particular difficulty accessing services, and your goal is to create a new, cost-effective option for them. Articulating what improvements you are trying to achieve will help clarify your goals and will also help you effectively communicate with stakeholders.

See the MLTSS Basics section for more information on state goals.

Stakeholder Input and Dynamics

Based on input from stakeholders, states may choose to focus on particular populations or provide LTSS to a broader population. The priorities of the stakeholders, both internal (state program agencies) and external (consumer organizations, advocates, providers), may differ significantly, making it difficult to establish a targeted program. Conversely, the priorities of the stakeholder groups may be well aligned, facilitating identification of specific target populations.

See the Stakeholder Engagement section to learn more about identifying and working with key stakeholders.

Specialized Services

Some subgroups may have highly specialized service needs and your state may want to approach these needs by creating a highly specialized MLTSS program and contracting with an organization that specializes in the needs of that group. An example might be developing a program for persons with brain injuries. On the other hand, your state might favor a larger program, in which the needs of several sub-populations are addressed by including contract sections specific to their needs.

Financial Viability

Because MLTSS programs include risk-based payments, very small rural programs with highly targeted groups may not be financially viable. For the contractor, having larger numbers of members allows risk to be spread out, mitigating the impact of large, unexpected expenditures. For the state, it may be difficult and expensive from a contract management perspective to have several small specialty programs to oversee, rather than one larger program.


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