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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 Home and Community Based authorities (as with a concurrent 1915b and, for example).

In an effort to enhance the availability and quality of MLTSS, CMS is making available an online curriculum* offering states guidance on program design, Medicaid authorities and other information relative to the effective management of MLTSS. In July of 2012, CMS also produced "The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update". This "White Paper" included an inventory of all current MLTSS programs and a projection of future programs.  The report includes state-by-state results and synthesizes the finings across states, reporting national enrollment, characteristics of contractors and multiple program features.

For additional information on MLTSS, you can refer to, "Analysis and Recommendations for the Implementation of Managed Care in Medicaid and Medicare Programs for People with Disabilities", produced by the National Council on Disability.

*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.