Strengthening Medicaid Long-Term Services and Supports: A Toolkit for States

Stephanie Anthony
Arielle Traub
Sarah Lewis
Cindy Mann
Alexandra Kruse
Michelle Herman Soper
Stephen A. Somers
Technical Assistance Tool
March 2019

This resource is a toolkit that describes strategies for states to reform their Medicaid LTSS systems.

  • Medicaid is the leading payer for LTSS systems, which enable more than 12 million people to meet their personal care needs and live with independence in community and institutional settings.
  • States are seeking to reform their Medicaid LTSS systems to improve the quality of care and contain costs.
  • This toolkit highlights strategies that states are using to deliver high-quality and high-value LTSS in two key areas: rebalancing LTSS to increase the proportion of LTSS provided in community-based settings and integrating LTSS with physical and behavioral health services through managed care.
  • For each strategy identified, this toolkit provides the impetus, a description, implementation mechanisms, results to date, and key lessons. Case studies are also included.
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Population Addressed
Adults Under 65 with Disabilities
People with Advanced Illness
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • What are some strategies states have used to improve quality and reduce costs in their Medicaid long-term services and supports (LTSS) systems?
  • What are the results and lessons of these strategies?
Level of Evidence
What does this mean?