CHCS - Center for Health Care Strategies

Improving the quality and cost-effectiveness of publicly financed health care

Systems of Care: Environmental Scan of Medicaid-Funded Long-Term Supports and Services

Gretchen Engquist, PhD, Cyndy Johnson, and William Courtland Johnson, PhD
May 2010
Robert Wood Johnson Foundation and Aetna

National policymakers and state Medicaid leaders are paying greater attention to better management of long-term supports and services (LTSS). The reasons are obvious: aging of the baby boom population; severe fiscal pressures; the disproportionate share of costs absorbed by those with serious long-term conditions; an ongoing over-reliance on institutional care; and the fact that LTSS remains almost entirely in the unmanaged fee-for-service system.

This environmental scan was commissioned by CHCS to provide an overview of the current status of the publicly funded long-term care delivery system and outline the opportunities and obstacles for LTSS reform and rebalancing. Developed through interviews with stakeholders across the country, the emphasis of the scan is on the actual systems for delivering long-term supports and services rather than the financing. The objectives of the scan are to:

  • Provide a snapshot of current rebalancing and reform activities across the nation;
  • Explain how and why the Medicaid LTSS system has evolved as it has;
  • Identify existing barriers to reform; and
  • Offer suggestions to improve the quality and cost-effectiveness of LTSS delivery.

Innovations in the Medicaid Continuum of Care Series

This report is part of CHCS' Innovations in the Medicaid Continuum of Care series, developed to help state and federal policymakers identify high-quality and cost-effective strategies for addressing the full range of clinical and long-term supports and services (LTSS) needs of Medicaid beneficiaries.


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