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Coordinating Medicaid Long-Term Services and Supports

May 2017
Full report Executive Summary

Managed care ensures the delivery of coordinated, high-quality long-term services and supports (LTSS) that help individuals remain in their homes, live independently, and engage meaningfully in their communities. Medicaid managed care organizations (MCOs) integrate care, promote consumer choice, and drive accountability for high quality care.

Medicaid plays an essential role in the delivery of LTSS. Broadly, LTSS have the primary purpose of supporting individuals to live and/or work in the setting of their choice. Over the years, the delivery of LTSS has shifted from the institutional setting to the home and community.

Under Medicaid fee-for-service (FFS), LTSS are often delivered in a silo—separate from physical and behavioral health services—which can result in a fragmented and uncoordinated system of care rather than person-centered care delivery. States are seeking better ways to deliver Medicaid LTSS that is high quality yet efficient. Managed LTSS offers a comprehensive approach that addresses the challenges present in the FFS system.


  • Overview of LTSS
  • Challenges in the FFS system
  • Integrated services and supports
  • Independent living and self-direction
  • Improving outcomes for individuals and states
  • Designing a successful managed LTSS program

Related Public Policy Research

Value in Long-Term Care Insurance Policies
January 2021
Policies bought from 1995 to 2005 had nearly $800 billion in benefit value available. Buyers in the 1990s had greater risk of Medicaid spend-down absent a policy than more recent purchasers.
Protecting Consumers and Medicaid from Catastrophic Long-Term Care Costs
June 2020
States can reduce LTC insurance insolvency risks by adopting the NAIC’s Guaranty Fund Model Act and considering other policy options to protect consumers and Medicaid.
Improving Integration for Dual Eligible Beneficiaries: The Role of D-SNPs
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D-SNPs offer states a flexible path to advance whole person health and improve health outcomes for individuals who are eligible for both Medicare and Medicaid benefits (dual eligibles).