While many states are pursuing long-term services and supports (LTSS) integration through capitated managed care programs, several states have initiatives to better coordinate care management at the provider or care delivery level, either as an alternative to or in addition to managed care. In these models providers are directly accountable for care coordination, quality performance, and health outcomes.

This strategy describes different approaches and implementation mechanisms that states have used to better coordinate LTSS through provider-based models, along with program case studies:


  • Program of All-Inclusive Care for the Elderly (PACE) offering comprehensive medical and social services
  • Medicaid accountable care organizations (ACOs) coordinating LTSS with other services
  • Health home models using care coordination to support individuals with complex care needs

 Implementation Mechanisms

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

State Case Studies

  • Integrating medical and social services at the site of care (VA)
  • Requiring partnerships between or inclusion of LTSS and behavioral health providers in Medicaid ACOs (MA)
  • Coordinating comprehensive LTSS, medical, and behavioral health services (WA)