Edited by Sumitra

MLTSS Managed Long Term Services and Supports 

Managed Long Term Services and Supports (MLTSS) refers to the delivery of long term services and supports through capitated Medicaid managed care programs.1

As of July 1, 2018, almost half of states (24 states) covered LTSS through one or more of the following types of capitated managed care arrangements:

  • Medicaid MCO covering Medicaid acute care and LTSS (20 states)
  • PHP covering only Medicaid LTSS (6 states)
  • MCO arrangement for dual eligible beneficiaries covering Medicaid and Medicare acute care and Medicaid LTSS services in a single, financially aligned contract under the federal Financial Alignment Demonstration (FAD) (9 states) 3

MLTSS is all about maximizing insurer profit.  As McKnight’s recently reported, an academic study in California found that “[managed care organizations aiming to serve dual-eligible beneficiaries appear to be picking their nursing home partners based on costs, rather than quality factors.” Yet, under the benevolent guise of “cutting the red tape,” the Centers for Medicare & Medicaid Services announced a rule effectively exempting from federal scrutiny cuts to provider rates of “less than 4% percent in overall service category spending during a state fiscal year (and 6% over two consecutive years),” so long as it’s managed care insurers doing the cutting. …

…The Dallas Morning News ran a poignant investigative series entitled “Pain & Profit” about the shortcomings of Medicaid managed care in the state. They shared stories like that of Heather Powell,  a 38-year-old paralyzed from the neck down and effectively trapped in her bed upon an insurer taking over her Medicaid care – she didn’t receive the necessary durable medical equipment, and her care hours were cut from 12 hours a day to 7.

The newspaper noted, “Texans with complex medical needs are now the most profitable, on a per-person basis, for the companies in Medicaid managed care, financial data shows.” “ 2


1. https://www.medicaid.gov/medicaid/managed-care/ltss/index.html

2. https://www.mcknights.com/blogs/guest-columns/the-truth-behind-mltss/

3. https://www.kff.org/report-section/states-focus-on-quality-and-outcomes-amid-waiver-changes-long-term-services-and-supports-reforms/

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