State Medicaid programs increasingly use managed care as one of several strategies to improve care coordination and manage costs for populations with complex health care needs and disproportionately high Medicaid expenditures. As of July 2018, 24 states operate managed long-term services and supports (MLTSS) programs, in which state Medicaid agencies contract with managed care plans to deliver long-term services and supports (LTSS), up sharply from just 8 states in 2004 (Lewis et al. 2018). Although much of this growth has been fairly recent, a few states have operated MLTSS programs for many years, and in some cases, several decades.
State Adoption of Managed Long-Term Services and Supports Programs, September 2018
The administration of MLTSS is generally similar to Medicaid managed care, but the mix of services and the wide range of needs of beneficiaries who receive LTSS adds complexity, particularly for rate setting and care coordination. Factors involved in setting capitation payment rates for MLTSS include accounting for the range of services, the wide variability in the needs of beneficiaries receiving LTSS, and the need to promote program goals through financial incentives. MLTSS plans typically employ care coordinators who assess beneficiaries’ needs and develop plans of care for the wide range of LTSS for which they qualify.
As MLTSS programs evolve, their scope is expanding. While MLTSS programs typically have targeted people age 65 and older or people with physical disabilities, states are increasingly enrolling individuals with intellectual or developmental disabilities into MLTSS. In addition, many states are working to align MLTSS with Medicare managed care for individuals who are dually eligible for Medicare and Medicaid.