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About MLTSS and Integrated Care

Managed Long-Term Services and Supports (MLTSS)

MLTSS are long-term services and supports (LTSS) delivered through capitated Medicaid managed care programs.

 

People with disabilities and older adults who need support to perform activities of daily living (ADLs) must rely on a variety of services and supports over an extended period, known as LTSS. Medicaid provides the only coverage for LTSS other than limited private insurance, with Medicaid paying for over 50 percent of LTSS provided in the United States.

 

States have moved in recent years to provide broad Medicaid coverage through contracts with managed care plans. Today, half of states currently provide Medicaid coverage for LTSS through contracts with Medicaid managed care organizations.

Integrated Care for Dually Eligible Beneficiaries

Integrated Care for Dually Eligible Beneficiaries

Dually eligible beneficiaries, or individuals dually eligible for both Medicare and Medicaid, are a diverse and high-need population served by two programs that were not designed to work together. Integrated care models seek to improve care for this population.

 

Individuals eligible for both Medicare and Medicaid on the basis of their age or disability and low-income status are known as dually eligible beneficiaries. With greater health care needs than the Medicare-only population, dually eligible beneficiaries represent a disproportionate amount of both Medicare and Medicaid spending. Moreover, inefficiencies in how the Medicare and Medicaid programs work together can result in disjointed care delivery for beneficiaries.

 

Currently, only about 10% of the over
12 million dually eligible beneficiaries is enrolled in an integrated care model. 

(MACPAC, 2020)

Map showing 24 states where 80% of dually eligible beneficiaries live that have integrated programs in orange (according to MACPAC). States in orange: California, Idaho, Arizona, New Mexico, Texas, Kansas, Minnesota, Iowa, Wisconsin, Michigan, Illinois, Ohio, Pennsylvania, New York, New Jersey, Massachusetts, Rhode Island, Delaware, Virginia, North Carolina, South Carolina, Tennessee, Florida, and Hawaii.

MLTSS Program

No MLTSS Program

80% of Dually Eligible Beneficiaries
Live in One of 24 States with an MLTSS Program

Source: MedPAC, 2018