Medicaid Managed Long-Term Services and Supports: Themes from Site Visits to Five States
Working Paper 44
State Medicaid purchasing strategies for long-term services and supports (LTSS) are increasingly shifting from fee-for-service (FFS) to managed care. To better understand the rapid growth of managed long-term services and supports (MLTSS) programs and the diversity of ways in which states have structured their programs to achieve their goals, we conducted site visits in the summer of 2014 to five states that operate MLTSS programs: Arizona, Florida, Illinois, New York, and Wisconsin. We find that approaches to program design, protecting beneficiaries and providers in the transition to MLTSS, ongoing operations and oversight, and program evaluation and improvement are shaped by the institutions and stakeholders unique to each state. We also find that the ultimate goals of MLTSS—to improve access to and quality of care while holding down costs and rebalancing the long-term care system toward home and community-based services—are shared across states, but progress towards those goals varies according to each state’s previous experience with MLTSS. Our findings can inform the design and implementation of future MLTSS programs, and suggest opportunities for future research.