Many states are making the shift to managed care financing models for Medicaid long-term support services (LTSS). This shift is driven by trends in spending patterns for consumers with multiple chronic conditions and disabilities. For these consumers, spending is high and outcomes are poor – and moving to “managed models” is one approach to addressing these issues. This change in financing requires provider organizations to build a new strategy and business model for serving complex consumers. Pennsylvania is one state that is currently working its way through these challenges as they make the shift to managed LTSS. In this keynote . . .