This is part of our Medicaid Concepts series, in which we provide a high level overview of key concepts in the Medicaid industry today.
What do we mean by Managed Long Term Services and Supports (MLTSS)?
These are the services provided to Medicaid members in a managed care model. Because of the unique member needs, the focus on care coordination and management, and intense cost structure of this model many states have decided to use stand-alone managed care programs just for LTSS. The LTSS stands for long term services and supports. Add an “M” in front of it for “managed.”
CMS has encouraged states to use MLTSS models with an array of funding efforts and aspirational goals. These include the Money Follows the Person (MFP) inititiative and the Balancing Incentive Program (where states are encouraged to increase the percentage of LTSS provided in the home or community vs. in a facility). These efforts have paid off- 25 states operate an MLTSS program as of November 2020 (compared to only 8 states in 2004).
Medicaid programs spent $167B on LTSS in 2016.
What role does Medicaid play?
States design the features of their MLTSS programs and contract with managed care companies to deliver the services. They also set eligibility requirements for members, which can include both functional and financial criteria.
States also work with plans and actuaries to set rates for these services.
States also have to manage the quality reporting process for these services, using measures selected by CMS. These measures generally focus on ensuring needs assessments and care plan requirements are met.