Medicaid currently covers more than 40 percent of the nation’s long-term care needs. Yet close to 95 percent of beneficiaries needing long-term care are in fragmented fee-for-service programs. Overhauling the delivery of Medicaid long-term supports and services (LTSS) offers significant opportunities for states to improve health care quality, control costs, and enhance the quality of life for millions of Americans.

This roadmap is part of a series developed to help Medicaid stakeholders design more effective models for long-term care delivery, particularly in light of new opportunities in the Affordable Care Act. Through support from The SCAN Foundation, CHCS conducted an environmental scan to identify state best practices for:

  1. Rebalancing programs to provide more home- and community-based options instead of institutional care;
  2. Designing managed LTSS programs; and
  3. Integrating care for adults who are dually eligible for Medicare and Medicaid.

For this report, CHCS identified five innovative states – Arizona, Hawaii, Tennessee, Texas, and Wisconsin – with demonstrated expertise in managed care approaches for individuals with long-term care needs. The resulting roadmap culls from these states’ experiences to outline 10 critical mileposts for successfully designing models for managed long-term supports and services. It also identifies key ACA provisions that support state efforts to improve long-term care delivery.

While the featured states each have different approaches to managing the full spectrum of long-term care needs, they are joined by the common vision of providing higher quality and more cost-effective long-term supports and services.


Profiles of State Innovation Series

This roadmap is part of CHCS’ Profiles of State Innovation series, made possible through The SCAN Foundation to help Medicaid programs develop high-quality, cost-effective, and consumer-focused approaches for delivering long-term supports and services.