Author: Stephanie Anthony, Arielle Traub, Sarah Lewis, and Cindy Mann, Manatt Health Strategies; Alexandra Kruse, Michelle Herman Soper, and Stephen A. Somers, PhD, Center for Health Care Strategies

March 2019 |


Long-term services and supports (LTSS) enable more than 12 million people to meet their personal care needs and live with dignity and independence in a variety of community and institutional settings. With Medicaid LTSS expenditures of more than $154 billion annually and the aging population projected to grow 18 percent by 2020, the increasing demand for LTSS is putting more pressure on Medicaid at both the federal and state levels.

This toolkit, originally developed by CHCS and Manatt Health Strategies in 2017 and updated for 2019, provides a menu of LTSS reform strategies adopted by state innovators. It identifies concrete policy strategies, operational steps, and federal and state authorities that states have used to advance LTSS reforms, along with case studies and advice for other states embarking on a similar path.

The toolkit, made possible by The SCAN Foundation and the Milbank Memorial Fund, offers the following seven reform strategies (below). Readers can also download the complete toolkit as a PDF.

In addition, state legislators can access A State Legislator’s Guide to Strengthening Medicaid Long-Term Services and Supports for a summary of options for developing cost-effective LTSS policies and programs in their states to serve vulnerable individuals.



Made possible with support from The SCAN Foundation and the Milbank Memorial Fund.