In every state a small number of Medicaid beneficiaries account for a bulk of the program’s expenditures. About 20 percent of enrollees, primarily those with severe chronic illnesses and disabilities and the frailties associated with aging, account for nearly 80 percent of Medicaid spending. As a result, many states are looking to improve the quality and cost-effectiveness of care for people with disabilities and frail older persons by enhancing the capacity of Medicaid programs to provide long-term supports and services. The CHCS Managed Long-Term Supports and Services Purchasing Institute was designed for states committed to designing, implementing, or expanding a Medicaid managed long-term care program.

Nine states — Arkansas, Florida, Hawaii, Michigan, Minnesota, Texas, Virginia, Washington, and Wisconsin — participated in this 18-month initiative that included focused training paired with intensive technical assistance for a number of state teams. The MLTS PI included in-person meetings, regular group and individual training , as well as technical assistance calls on specific topics such as performance measurement and incentives, functional assessment, and risk-adjustment for long-term care services.