The benefits of managed long-term services and supports:
States are intentionally moving toward MLTSS models because they offer more comprehensive care coordination, greater oversight and accountability, higher member satisfaction, and a focus on improving outcomes and the quality of life for LTSS beneficiaries.
Services covered
Hygiene
Nutrition
First Aid
Medications
Mobility
Dressing
Housekeeping
Finances
Other services
Why is MLTSS the better model for care?
To administer LTSS programs, states can choose to use a fee-for-service (FFS) or managed care model.
Fee-For-Service (FFS) Long-Term Services and Supports (LTSS)
Under FFS, states pay providers (including doctors, hospitals, pharmacies, adult daycares, nursing homes, and caregivers) directly for each covered LTSS benefit received by a Medicaid beneficiary. Care coordination under FFS is often very limited and does not account for care needs outside of the scope of the FFS plan.
Managed Long-Term Services and Supports (MLTSS)
Under a managed care model, states partner with health plans, through a competitive contracting process, to administer and coordinate LTSS. The state pays the participating health plans a fixed rate, and the health plans are held accountable for delivering care as agreed by the state LTSS program. Managed care models allow far more flexibilty to use funds to better address the holistic healthcare and lifestyle needs of each individual through care coordination.
What are the benefits of managed care vs FFS?
Comprehensive care coordination
Care coordination ensures that the vulnerable populations served by LTSS receive the services they need and that every beneficiary has a customized health strategy that unifies their physical, behavioral, and personal care services into one centralized plan.
Higher member satisfaction
Beneficiaries who choose MLTSS plans report higher levels of satisfaction with their care than those who use FFS. Managed care is also linked to improved health outcomes of Medicaid recipients.
Increased access to Home and Community-Based Services (HCBS)
Many states are prioritizing home- and community-based care over institutional care for their LTSS programs. The MLTSS model is well prepared and able to help states achieve this goal through “rebalancing” the share of spending.
States are increasingly adopting MLTSS
50%
Nearly 50% of states currently use managed care organizations to deliver long-term care services.
Why are states increasingly shifting to MLTSS?
Improved Outcomes
Managed care is linked to improved health outcomes of Medicaid recipients. MLTSS plans are held to higher standards at both the federal and state level and work closely with their Medicaid partners to achieve quality health outcomes for those they serve.
Rebalancing
By rebalancing LTSS spending to faciliate successful transitions out of institutions and instead expand care in home and community-based settings, MLTSS programs can deliver higher quality and more cost-effective care.
Accountability
MLTSS plans are accountable to state and federal governments for the quality of the care provided and success in meeting the goals and preferences of the individual.