Long-term services and supports (LTSS) provide essential help with daily activities, such as eating, bathing, and managing medications, for older adults and people with disabilities. While some people receive these services in nursing facilities, many prefer to remain in their own homes and communities, supported by home- and community-based services (HCBS).

California, like many other states, is transitioning to deliver select Medicaid LTSS through managed care, moving away from the traditional fee-for-service payment model. This shift offers significant opportunities to enhance coordination for people using HCBS and improve the state’s cost predictability. However, careful planning is essential to avoid disruptions in care and services.

As California and other states seek to transition to Medicaid managed LTSS (MLTSS), stakeholders can learn from the experiences of 24 states that have adopted MLTSS over the past three decades. This explainer, developed with support from the California Health Care Foundation, highlights insights from past state experiences to guide an effective transition of HCBS to MLTSS in California and other transitioning states. It outlines practical strategies to support the transition to MLTSS, emphasizing the importance of robust continuity-of-care protections, strong provider networks, and proactive oversight.