State Medicaid Programs With MLTSS: The 2017 OPEN MINDS Update
Managed long-term services and supports (MLTSS) refer to state Medicaid programs that choose to finance and manage institutional care and/or home- and community-based services through managed care organizations (MCOs). Individuals who receive MLTSS services have functional limitations and chronic illnesses and need help completing activities of daily living. Activities of daily living include activities such as bathing, dressing, preparing meals, and administering medication.
State Medicaid plan contracting for MLTSS services can either be through existing Medicaid MCO contracts or by creating separate MCO contracts for LTSS (long-term services and supports). In 2017, there were 22 states with MLTSS programs and four states planning to implement programs in the near future.
There are three general models for MLTSS programs:
- Integrated MLTSS System With Full-Benefit MCOs that are designed to serve both the LTSS and non-LTSS populations through health plans
- Freestanding MLTSS System With Limited-Benefit MCOs that serve consumers through health plans specifically designed for the LTSS population
- Freestanding MLTSS System With Full-Benefit MCOs where health plans are responsible for the majority of benefits
Of the 25 MLTSS programs in 2017, 17 were provided through freestanding MCOs. Enrollment in managed long-term services and supports programs in 2017 was 1.7% of the total number of Medicaid enrollees, an increase of 11% since 2016. When looking at MLTSS services over a longer period of time, the increase in enrollment is much more substantial – 125% between 2012 and 2016, and an increase of 1,611% between 2004 and 2016. This report contains MLTSS enrollment by state, the model by program, populations served, and benefits included in the managed care organization (MCO) contract. The report also takes a look at the future managed long-term services and supports landscape – giving you everything you need to know for the present, as well as your long-term strategy.