The Growth of Managed Long-Term Services and Supports Programs: 2017 Update

Executive Summary

State Medicaid Agencies have rapidly increased the use of managed care to provide long-term services and supports (LTSS). Medicaid spending for managed long-term services and supports (MLTSS) more than doubled in three years from fiscal year 2012 to fiscal year 2015, and growth is expected to continue as states implement new programs.1 As additional states pursue MLTSS, understanding state MLTSS approaches can help identify national trends in practice and help states identify peers that have overcome common challenges in program implementation.

This study reviewed available information about the status of Medicaid MLTSS programs, as an update to an inventory completed for the Centers for Medicare & Medicaid Services (CMS) in 2012.2 We provide updates on the prevalence of MLTSS programs, total enrollment, and specific program design elements as of August 2017. Findings include:

  • Twenty-four states operated MLTSS programs in 2017, a 50 percent increase from the 16 states with these programs in 2012.
  • More states offered multiple programs, with 11 states offering more than one MLTSS program; several of these states established separate programs for people dually eligible for Medicare and Medicaid as part of the CMS Financial AlignmentInitiative.
  • The total number of MLTSS programs more than doubled from 19 programs in 2012 to 41 programs in 2017.
  • Total enrollment in MLTSS programs more than doubled, from 800,000 in 2012 to 1.8 million in 2017.
  • More states used §1115(a) demonstrations to authorize the managed care portion of MLTSS programs in 2017 (19 programs; 46 percent of programs) than in 2012 (five programs; 26 percent).
  • As in 2012, a slight majority of 2017 programs required mandatory enrollment for participants (21), while 20 programs had voluntary enrollment.
  • The most common populations served continued to be older adults (33 programs in 2017) and adults with physical disabilities (30 programs in2017).


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