What is MLTSS and Why is it Important?

Julie Evans

Senior Manager

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What is MLTSS?

Long Term Services and Supports (LTSS) include a variety of care activities focused in medical and personal care including activities of daily living (ADL) and instrumental activities of daily living (IADL). Managed Long Term Services and Supports (MLTSS) is the delivery of LTSS through capitated Medicaid Managed Care programs.​

Under the responsibility of Managed Care Organizations (MCO), MLTSS moves away from the Medicaid fee-for-service model that continues to exist today. States may leverage one or both systems to deliver LTSS to beneficiaries. Over time, states have been increasingly adopting the MLTSS model alongside the increase of home- and community-based services (HCBS). LTSS has continuously shifted toward HCBS, with the support of legislature, allowing health services to be delivered outside of the institutional care setting and reducing costs of care. Through MLTSS, states are able to encourage an increase in HCBS and predict budget while incentivizing MCOs for improved care coordination.​

As states continuously initiate, enhance and expand their MLTSS programs to accommodate the evolving care model and permissions, MCOs will be challenged to think strategically and innovatively to offer tailored person-centered services plans that accommodate the home-and community-based care model.​

Why is MLTSS Important?

The growth of the aging population in the U.S. is unseen in U.S. history. Projections estimate a 26% increase in the number of Americans ages 65 and older over the next 20 years, equaling approximately 17 million people1.  As our population ages, and lives longer through medical and technical advances, there is an increasing need to improve the LTSS care model with a focus on HCBS. Through HCBS, beneficiaries can continue life at home and in the community while receiving necessary care without the need for an increase in institutional care facilities. MLTSS creates an environment for specialized care coordination and services to meet the needs of our growing elderly population.​

Managed Care Organizations are being tasked by states to operate long term services and support under a capitated payment model, leading plans to think strategically to position themselves for optimal margins and performance.​

As a consultancy 100% focused on healthcare, ProspHire is equipped to support MCOs navigate the MLTSS model through gap analysis, plan design, operational readiness, program optimization and innovation. Our industry experience and commitment to serving the community provides a unique perspective and patient-centered approach. Whether your plan is looking to enter the MLTSS market, improve performance or execute a large-scale strategic initiative, our team is equipped and committed to work in partnership with our clients and drive results.