Funder: The SCAN Foundation and the Milbank Memorial Fund

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

December 2017 | Toolkit


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 $140 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, developed with support from The SCAN Foundation and the Milbank Memorial Fund, provides a targeted menu of LTSS reform strategies adopted by state innovators that may be replicated by other states. It identifies concrete policy strategies, operational steps, and federal and state authorities that states have used to advance their LTSS reforms. It also highlights opportunities and challenges that states faced in designing and implementing reforms.

The toolkit presents reform strategies in the following two broad areas. Readers can download the full toolkit (right sidebar), or download individual strategies (below).

Rebalancing Medicaid LTSS: Matching Care Settings to Individuals’ Needs

Develop LTSS System Infrastructure to Promote Greater Access to Home- and Community-Based Services (HCBS) Develop LTSS System Infrastructure to Promote Greater Access to Home- and Community-Based Services (HCBS)
Invest in Programs and Services that Help Nursing Facility Residents Return to and Remain in Their Communities Invest in Programs and Services that Help Nursing Facility Residents Return to and Remain in Their Communities
Expand Access to HCBS for “Pre-Medicaid” Individuals to Prevent or Delay Nursing Facility Utilization Expand Access to HCBS for “Pre-Medicaid” Individuals to Prevent or Delay Nursing Facility Utilization

Advancing Integration of LTSS with Physical and Behavioral Health Services through Managed Care

Integrate Medicare-Medicaid Benefits for Dually Eligible Beneficiaries Integrate Medicare-Medicaid Benefits for Dually Eligible Beneficiaries
Integrate Comprehensive Care for Medicaid-Only Beneficiaries under Capitated Managed Care Integrate Comprehensive Care for Medicaid-Only Beneficiaries under Capitated Managed Care
Enroll Individuals with Intellectual/Developmental Disabilities in Managed Care Enroll Individuals with Intellectual/Developmental Disabilities in Managed Care