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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

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