Our Issues

The MLTSS Association has put forth recommendations to improve the timeliness, predictability, and collaboration of the annual SMAC development process. These recommendations address the challenges that caused by delayed draft and final SMACs, late changes to benefit requirements, and communication barriers between states and Dual Eligible Special Needs Plans (D-SNPs). In our recommendations, we ask CMS to establish a model SMAC development timeline, provide guidance and best

Following three roundtable listening sessions with CMS this summer, the MLTSS Association submitted follow-up recommendations to CMS to address three important topics in Medicaid reform - Rate Setting, Electronic Visit Verification (EVV), and Medicaid Procurement. These recommendations continue the conversations from CMS' listening sessions and address the MLTSS-specific nuances of these important topics.

The National MLTSS Health Plan Association is pleased to announce the release of a new series of briefs, the Self-Direction 2.0 Framework: Advancing Self-Direction in a Managed Long-Term Services and Supports (MLTSS) Ecosystem. These briefs offer actionable recommendations to advance person-centered, effective, and sustainable self-direction programs. These briefs were developed in partnership with the Self-Direction Center through the National MLTSS Association’s Self-Direct

On October 2nd, the MLTSS Association submitted a response to the Senate Finance Committee Democrats' Request for Information (RFI) on healthcare. In our response, the Association presented recommendations for simplifying Medicaid eligibility and enrollment, quantifying LTSS provider network adequacy, and strengthening the direct care workforce.

On September 21, the MLTSS Association submitted comments on CMS's proposed rule regarding provider taxes. Our comments center on the principle that provider taxes play an instrumental role in supporting payment rates for underserved populations, including individuals receiving Long Term Services and Supports (LTSS). Additionally, our comments offer key considerations for CMS regarding the timeline and implementation of its proposals, as well as the specific impacts on indivi

The National MLTSS Health Plan Association (MLTSS Association) is seeking a full-time Corporate Relations and Events Director to lead our corporate relations, sponsorship development, and Partnership Program, and to plan and execute our full slate of events — the Annual MLTSS Leadership Summit, smaller member-only events, and webinars held throughout the year. This is a new-revenue-focused role: the Corporate Relations and Events Director will cultivate corporate partnerships

On July 31, the MLTSS Association submitted comments on CMS’s interim final rule on the implementation of Medicaid Community Engagement (CE) requirements. Overall, our comments focus on the areas where additional clarity would most improve implementation, particularly the accurate identification of individuals who qualify for the medically frail and caregiver exemptions. Our recommendations are grounded in a shared goal of implementing the statutory requirement in a way that

On July 22nd, the MLTSS Association met with Democratic staff from the Senate Finance Committee in response to their "Dear Colleague" letter on long-term care reform. During this meeting, the Association provided insight into key areas of interest for the Association, including the LTSS workforce, enabling technology, integrated care for dually eligible individuals, value-based contracting, and program integrity in MLTSS. The Association provided a leave-behind with additiona

On July 21st, the MLTSS Association submitted comments on CMS’s proposed rule on lowering Medicaid State-Directed Payment (SDP) limits for certain services beginning July 4, 2025, and extending those limits to all SDPs by January 1, 2029. SDPs have been a foundational feature of Medicaid managed care financing, permitting states to direct Medicaid managed care plans to make targeted provider payments that support state Medicaid goals and supplement reimbursement rates. In o

MLTSS can help to improve care coordination, enhance access to HCBS, and better align care for people with complex needs. This new resource reviews California's current In-Home Supportive Services (IHSS) carve-out, explores key considerations for integrating IHSS into MLTSS, and examines four state case studies that illustrate successful MLTSS models. It concludes with practical considerations and potential pathways for strengthening California's LTSS program.

Are you a graduate student interested in learning more about Medicare, Medicaid, or long-term services and supports (LTSS)? Our Atkins Fellowship offers an exciting opportunity to delve into LTSS policy through research, policy analysis, and engagement with diverse stakeholders. We are welcoming applications for part-time fellowships during the academic year (minimum 10 hours per week). Flexibility is available as we tailor the fellowship schedule to accommodate successful

The National MLTSS Health Plan Association (MLTSS Association) is pleased to provide input on the Aging & Disability Health Policy Lab's four draft state model policies to simplify access to the Medicare Savings Programs (MSPs). Affordable access to Medicare is foundational to ensuring members can obtain timely, necessary care. When low-income Medicare members struggle to afford their Part A and Part B premiums and cost sharing, they delay or forgo care, often until condition

In July, the MLTSS Association sent a letter to CMS outlining recommendations for the new standalone 1915(c)(11) waiver option allowing states to extend Home and Community Based Services (HCBS) to individuals who do not yet meet an institutional level of care (LOC) standard. MLTSS plans already deliver HCBS to people with complex and specialized healthcare needs under existing 1915 and 1115 frameworks, manage care coordination across the full continuum of LTSS, and possess

The National MLTSS Health Plan Association is pleased to announce the organizations selected to present at the Pennsylvania Value-Based Purchasing (VBP) Innovation Showcase, to be held on Wednesday, August 12th in Harrisburg, PA. This forum will offer a unique opportunity for providers to pitch their most innovative ideas for Value-Based Purchasing models that will support older adults, individuals with disabilities, and individuals who are dually-eligible for Medicare and

In collaboration with Medicaid Health Plans of America (MHPA), the MLTSS Association is excited to release a new brief highlighting the essential role of Medicaid managed care plans in combatting fraud, waste, and abuse (FWA) and preserving access to high quality, person-centered care in HCBS delivery. In partnership with states and the federal government, Medicaid MCOs take a comprehensive approach to ensuring that HCBS are delivered appropriately, to the right people, in th

In May, the MLTSS Association sent a letter to officials at CMS outlining key themes and recommendations to improve the MLTSS rate setting process. Actuarially sound rates are a critical component of Medicaid managed care to ensure that Managed Care Organizations (MCOs) receive adequate funding to serve their members. This is especially crucial for Managed Long-Term Services and Supports (MLTSS) plans that manage services for individuals with often long-term and chronic condi

In June, the MLTSS Association sent a letter to CMS outlining recommendations to support program integrity in Medicaid Home and Community-Based Services (HCBS). MLTSS plans invest substantially in fraud, waste, and abuse (FWA) detection and prevention through both upstream controls and layered detection models, including credentialing and provider enrollment validation, person-centered planning processes, and authorization guardrails, which work to prevent FWA before it occur

On May 28th, the MLTSS Association submitted comments on the 2028 Proposed HCBS Measure Set. In our comments, we expressed our appreciation for CMS’s continued efforts to promote greater consistency and comparability in HCBS quality measurement across states. Standardized, nationally comparable quality data is essential to understanding whether HCBS programs are effectively meeting the needs of members and ensuring responsible use of taxpayer funds. The Association also suppo

In 2025, the MLTSS Association published our Policy Proposals to Advance Integrated Care, which included our proposal on auto-enrollment. This proposal outlines two complementary pathways that can be utilized to promote enrollment of dually eligible individuals into integrated D-SNPs, ultimately increasing access to coordinated and person-centered care. These new accompanying resources provide additional rationale to support this proposal. Our brief Expanding Auto-Enrollment

Today approximately 10 percent of individuals who are dually eligible for both Medicare and Medicaid are enrolled in managed care plans that fully integrate their Medicare and Medicaid coverage. The remaining dually eligible individuals must navigate a complex system of overlapping coverage and disconnected services. Despite significant regulatory and legislative activity around advancing integrated care models at both the state and federal level, many barriers remain. The Na