Medicaid managed long-term supports and services (MLTSS) can aid frail beneficiaries living in the community and delay or prevent them from being placed in a nursing facility. Yet while MLTSS programs are growing in interest among states, in 2004 only 2% of Medicaid beneficiaries with long-term support and service needs were enrolled in risk-based programs. Developing adequate rate-setting strategies that address the complex needs of the population is one of the challenges for states in designing MLTSS programs.
This brief was written to help guide states in developing payment strategies for managed long-term supports and services. The resource paper describes reimbursement models currently being used by state MLTSS programs, highlights rate-setting considerations for these programs, and provides suggestions for designing rate-setting approaches that accurately reflect the needs of Medicaid beneficiaries.