Managed Long-Term Services and Supports (MLTSS) is a method used by state Medicaid programs to deliver comprehensive long-term services and supports (LTSS) for older adults and individuals with disabilities. This coordinated system of care aims to shift the focus away from institutional settings toward services that allow individuals to remain in their homes and communities. MLTSS represents a structural change in how Medicaid funds are used to support people with ongoing functional needs.
The Fundamentals of MLTSS
MLTSS delivers long-term services and supports through capitated Medicaid managed care programs. The term “managed” refers to the shift from the traditional fee-for-service (FFS) payment model to a coordinated, capitated system. The FFS model pays providers for each service delivered, often resulting in fragmented care and unpredictable state spending.
Under the MLTSS model, the state Medicaid agency contracts with Managed Care Organizations (MCOs) to provide services for a fixed monthly payment per person, known as a capitated rate. The MCO assumes the financial risk and responsibility for coordinating and delivering all covered long-term services. This structure incentivizes MCOs to improve care quality, manage costs, and emphasize preventive and community-based solutions. A primary goal is increasing the use of home and community-based services (HCBS) over institutional care, promoting greater independence for beneficiaries.
Services Provided Under MLTSS
MLTSS programs cover a broad spectrum of assistance for individuals requiring support with daily living due to age or disability. The emphasis is on Home and Community-Based Services (HCBS) to enable people to live outside of institutions. These services include personal care assistance, which provides hands-on help with daily activities like bathing, dressing, and eating.
Other community supports often covered include:
- Adult day services, which offer a safe environment and structured activities.
- Respite care to give unpaid family caregivers a temporary break.
- Services that modify the living environment, such as home and vehicle modifications to improve accessibility.
- Assistive technology, like personal emergency response systems, to enhance safety and independence.
Although the focus is on community settings, institutional care, such as nursing facility services, is also covered for those who require that level of support.
Determining Eligibility and Enrollment
To qualify for MLTSS, individuals must meet two distinct criteria: financial eligibility for Medicaid and functional eligibility for long-term services. Financial eligibility requires an applicant’s income and assets to fall within the specific limits set by the state’s Medicaid program. These thresholds vary depending on the state and the applicant’s marital status.
The functional eligibility requirement determines the medical necessity for long-term care services. This is established through a comprehensive assessment confirming the individual requires a nursing facility level of care. The assessment measures the need for assistance with Activities of Daily Living (ADLs), such as transferring, toileting, and mobility. Once both criteria are met, the individual is enrolled in the MLTSS program and selects a Managed Care Organization.
How Managed Care Organizations Deliver Care
Managed Care Organizations (MCOs) are responsible for the administrative and clinical oversight of the MLTSS program. Upon enrollment, the MCO conducts a comprehensive assessment of the individual’s medical, behavioral, and social needs. This assessment serves as the foundation for creating an Individualized Care Plan (ICP), which outlines the specific services and supports the enrollee will receive.
The MCO assigns a care coordinator to the enrollee, who acts as the single point of contact for arranging and monitoring all services. This coordinator manages care delivery by ensuring the enrollee has access to a network of qualified providers and that services are delivered efficiently and appropriately. The MCO is held accountable by the state for the quality of care and the outcomes experienced by their members.