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The Spectrum of State Models to Support Medicaid LTSS


Medicaid Long-Term Services and Supports (LTSS) are provided to only 6% of Medicaid beneficiaries but account for a disproportionate 33% of total Medicaid spend. In anticipation of demographic shifts and growth in the population eligible for LTSS, states are increasingly considering policies that go beyond traditional fee-for-service (FFS). While some states accomplish their LTSS program goals by contracting with managed care organizations (MCOs) to deliver LTSS, insurer-provider tensions and state goals, such as retaining funding within the state, have led other states to adopt alternative approaches that stop short of fully delegating programmatic administration of services. However, limited research is available on these MLTSS alternatives.


ATI Advisory surveyed state LTSS management models that leverage provider, state, or community-managed programs to understand the detailed approaches and outcomes of these model, such as beneficiary satisfaction and institutional to community rebalancing. We studied the structures of seven state programs (Alabama, Arkansas, Connecticut, Georgia, Massachusetts, Oregon, and Washington) through interviews with state officials and researchers, and review of policy and research documents, as well as program evaluations.


Non-managed care approaches provide a strong option to states seeking to improve their Medicaid LTSS programs. These models can help states attain their goals of shifting care to lower-cost settings while attaining high beneficiary satisfaction and provider engagement. Core to the success of these programs is investment in state infrastructure, working directly with providers, and leveraging community-based and local organizations.

Supported by the Indiana Health Care Association (IHCA). ATI Advisory retained editorial independence and all research and perspectives contained within are our own.


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