Funder: West Health Policy Center

Author: Michelle Herman Soper, Center for Health Care Strategies; Debra Lipson, Mathematica Policy Research; Maria Dominiak, Airam Actuarial Consulting; and James Lloyd, Center for Health Care Strategies

September 2018 |


States are increasingly adopting value-based payment (VBP) models to tie payment to outcomes including quality of care, health status, and costs for their Medicaid programs. Although most Medicaid VBP models are for primary and acute care services, states are beginning to explore VBP for long-term services and supports (LTSS).

This guide, made possible by the West Health Policy Center, describes considerations for states seeking to adopt VBP models for home- and community-based services in Medicaid managed long-term services and supports (MLTSS) programs. It examines approaches used by five states — Minnesota, New York, Tennessee, Texas, and Virginia — for promoting high-quality MLTSS programs while simultaneously supporting the ability of Medicaid beneficiaries who need LTSS to live in their communities. It describes considerations for selecting quality metrics and payment models, and common challenges that these states have faced in implementing these models and strategies to address them. Recognizing the importance of stakeholder involvement in developing VBP models, this guide also brings managed care plan, provider, and beneficiary engagement perspectives into state conversations.