Historically, states have “carved out” or excluded Medicaid-only long-term services and supports (LTSS) beneficiaries from managed care. Instead, they have provided these services in a fee-for-service system, or provided LTSS on a fee-for-service basis and physical and/or behavioral health services through managed care, often resulting in siloed and uncoordinated care.

This strategy describes different approaches and implementation mechanisms that states have used to integrate LTSS into managed care programs, along with program case studies:


  • Providing a comprehensive benefit package — including physical health, behavioral health, and LTSS — under a single capitated rate and coordinated delivery system

 Implementation Mechanisms

  • Section 1932 state plan amendment
  • Section 1915(a) waiver
  • Section 1915(b) waiver
  • Section 1915(c) waiver
  • Section 1115 waiver

State Case Study

  • Creating a coordinated care plus program that will integrate LTSS, medical, and behavioral health care under one program for Medicaid-only beneficiaries (VA)