Historically, long-term services and supports systems were designed to predominately be delivered in institutional settings, but as the number of beneficiaries needing LTSS grows, more attention is being given to opportunities to rebalance Medicaid LTSS toward less-restrictive, lower-cost, community-based care. This focus on rebalancing — along with the challenges inherent in a fragmented system of physical, behavioral, and LTSS care delivery — has led an increasing number of state Medicaid agencies to examine ways to better manage LTSS service delivery, often through managed care arrangements. In addition to a desire for budget predictability and an interest in costs savings that may accrue from rebalancing efforts, states may see managed long-term services and supports (MLTSS) as offering several advantages over a fee-for-service delivery system, including: (1) improved care management and care coordination; (2) greater accountability for outcomes; and (3) the potential for more systematic measurement and monitoring of performance, access, and quality.
This article describes states’ goals and experiences in implementing Medicaid MLTSS, as well as considerations for further development and evaluation of these programs. It also discusses related efforts to use MLTSS programs as a platform to better integrate and coordinate care for those who are dually eligible for Medicare and Medicaid. Finally, it presents possible future directions for MLTSS program refinement, based on early trends across states.