Traditionally, certain high -need populations, such as individuals with intellectual and development disabilities (I/DD), have been “carved out” of managed care and remained in fee-for-service (FFS) arrangements. However, the rise in managed care in both Medicaid and Medicare, as well as states’ recognition of challenges that the I/DD population faces in the FFS environment, has prompted more states to carve in these populations and services to improve coordinated care delivery and contain costs.

This strategy describes different approaches and implementation mechanisms that states have used to the improve integration of services for individuals with I/DD, along with program case studies:


  • Moving long-term services and supports (LTSS) benefits into existing managed care programs
  • Creating care coordination entities as a pathway to managed care contracting arrangements
  • Integrating LTSS with medical, behavioral, and social services into managed care

 Implementation Mechanisms

  • Section 1115 waiver
  • Section 1945 health home state plan amendment

State Case Study

  • Establishing care coordination organizations to integrate primary care, behavioral health, and social support services with LTSS for the I/DD population (NY)