Forum Session

Medicaid Managed Long-Term Services and Supports (MMLTSS): Increasing State Interest and Implications for Consumers, Quality of Care, Providers, and Costs
May 11, 2012


Carol V. O'Shaughnessy, MA


By many accounts, state interest in initiating Medicaid managed care for long-term services and supports (MMLTSS) is growing at a rapid pace. To date, MMLTSS arrangements have been confined to a handful of states with limited enrollment and expenditures. A number of factors are causing more state Medicaid agencies to consider managed LTSS, including objectives to balance the availability of home- and community-based services with institutional care; slow the rate of spending growth and establish some predictability in Medicaid LTSS costs; and better integrate LTSS with primary, acute, and chronic care. Some observers predict that, over the next few years, fee-for-service under Medicaid for LTSS will gradually disappear in many states. Whether or not this is the case, increased state interest in moving to MMLTSS has stirred objections and fears among some consumers and providers. Some caution that states should learn from other states’ experiences with MMLTSS programs when planning implementation and also ensure that effective consumer protections and quality oversight procedures are in place. Further, some are concerned about the impact that capitated financing will have on the traditional LTSS community provider system. This Forum session explored lessons learned from state experiences with MMLTSS, evidence of its effect on cost savings and quality outcomes, actions being taken by the Centers for Medicare & Medicaid Services (CMS) to help states interested in moving to MMLTSS, and consumer protections to be considered.


  • Paul Saucier, MA
    Integrated Care Systems
    Community Living Systems Group
    Thomson Reuters Healthcare

  • Mike Hall
    Division of Integrated Health Systems
    Disabled and Elderly Health Programs Group
    Center for Medicaid, CHIP, and Survey & Certification
    Centers for Medicare & Medicaid Services

  • G. Gordon Bonnyman, Jr., Esq.
    Executive Director
    Tennessee Justice Center
    Nashville, Tennessee

Related Materials

Paul Saucer, Brian Burwell, and Kerstin Gerst, "The Past, Present and Future of Managed Long-Term Care"  (Thomson/MEDSTAT and University of Southern Maine, prepared for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, April 2005)

Jessica Kasten, Steve Eiken, and Brian Burwell, "Medicaid Managed Long-Term Services and Supports Expenditures" (prepared for the Centers for Medicare & Medicaid Services by Thomson Reuters, April 6, 2011)

Laura Summer, "Examining Medicaid Managed Long-Term Service and Support Programs: Key Issues to Consider" (prepared for the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, October 2011)

Alice Lind et al., "Profiles of State Innovation: Roadmap for Managing Long-Term Supports and Services" (Center for Health Care Strategies, November 2010)

"Analysis and Recommendations for the Implementation of Managed Care in Medicare and Medicaid Programs for People with Disabilities" (National Council on Disability, 2012)

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