MLTSS stands for Managed Long-Term Services and Supports, a way of delivering long-term care through Medicaid managed care plans rather than through the traditional fee-for-service system. Instead of the state paying each provider separately for every service, it pays a managed care organization a set monthly amount per enrollee. That organization then coordinates and covers the full range of long-term care a person needs, from nursing home stays to help with daily tasks at home.
A growing number of states use MLTSS programs to shift long-term care out of institutions and into homes and communities, while also trying to improve quality and control costs.
How MLTSS Differs From Traditional Medicaid
In a traditional Medicaid setup, long-term care services are paid for one at a time. You see a provider, Medicaid gets a bill, Medicaid pays it. There’s no single entity responsible for making sure all of your care fits together. MLTSS changes that structure. A managed care organization receives a fixed per-person payment (called a capitated rate) and takes responsibility for organizing your entire package of long-term services.
This creates a financial incentive that shapes how care is delivered. Because the plan receives the same monthly payment whether you’re in a nursing home or receiving support at home, it’s motivated to find the most effective and least restrictive setting for your care. Nursing home stays are expensive. Helping someone stay in the community with personal care aides, home modifications, and adult day programs often costs less while matching what the person actually prefers. The Medicaid and CHIP Payment and Access Commission (MACPAC) has noted that MLTSS programs have been a key driver in state efforts to rebalance care away from institutional settings.
Who Qualifies for MLTSS
Eligibility involves three separate requirements: age or disability status, clinical need, and finances. The specifics vary by state, but the general framework is consistent.
You typically need to be 65 or older, or under 65 and determined to be blind or disabled by the Social Security Administration or your state’s equivalent process. On the clinical side, adults 21 and older generally must need what’s called a “nursing facility level of care.” In practical terms, this means you require hands-on help with three or more basic daily activities: bathing, dressing, using the toilet, moving around, transferring in and out of a bed or chair, or eating. People with cognitive conditions like dementia can also qualify if they need supervision and prompting with three or more of these activities, even if they don’t need full physical assistance.
Children from birth through age 20 qualify through a different pathway based on developmental delays or functional limitations that go beyond what a parent would normally manage. This typically involves a need for skilled nursing care around the clock or dependence on a life-sustaining medical device that requires ongoing nursing support. Notably, for children who meet the pediatric clinical criteria, parental income and assets are not counted in the financial eligibility determination.
Financial requirements include limits on monthly income and total liquid assets. These thresholds differ by state and household size, so checking with your state Medicaid office is the most reliable way to get current numbers.
What Services MLTSS Covers
The specific benefit package depends on the state and the managed care plan, but MLTSS programs generally cover a broad spectrum of long-term care. The most common services fall into two categories: institutional care (nursing homes) and home and community-based services.
- Personal care assistance: Help with bathing, dressing, grooming, toileting, and eating in your own home.
- Home health services: Skilled nursing visits, physical therapy, and other medical care delivered at home.
- Adult day programs: Supervised daytime care that provides social engagement and health monitoring while giving family caregivers a break.
- Home modifications: Changes to your living space, like wheelchair ramps or grab bars, that make it safer to stay at home.
- Nursing facility care: Full-time nursing home stays when community-based options aren’t sufficient.
- Assistive technology and medical equipment: Devices that support independence at home.
Because MLTSS plans are incentivized to keep people in the community when appropriate, they often provide services specifically designed to prevent or delay nursing home admission. They may also actively work to transition people already in nursing homes back to community settings when it’s safe and desired.
The Role of Your Care Manager
One of the most tangible differences you’ll experience in an MLTSS program is having a dedicated care manager. This person serves as your main point of contact within the managed care plan and is responsible for pulling together every piece of your long-term care.
Your care manager starts by conducting a comprehensive assessment of your health and care needs. From there, they work with you to build a personalized care plan that spells out exactly which services you’ll receive, how often, and from whom. That plan gets updated at least once a year, or sooner if your condition changes. If you’re receiving care at home, your care manager will contact you by phone and visit in person at least once every three months. For people living in nursing homes, face-to-face visits happen at least every six months.
Beyond scheduling and paperwork, your care manager coordinates across all your providers, including physical health, mental health, and long-term care. They monitor whether your services are actually working, flag gaps in care, connect you with community resources, and help resolve problems. For nursing home residents, part of their job is to assess whether you’re interested in and able to move back to the community, and if so, to help make that transition happen.
How MLTSS Works for Dual-Eligible Individuals
Many people who qualify for MLTSS are “dual eligibles,” meaning they have both Medicare and Medicaid. This is common among older adults and people with disabilities. Navigating two separate insurance systems at once can be confusing, and MLTSS programs attempt to simplify this.
Some states use Fully Integrated Dual Eligible Special Needs Plans, which bundle all Medicare benefits and key Medicaid benefits (including long-term care) under one plan from the same organization. The managed care entity receives set payments adjusted for each enrollee’s health status from both Medicare and Medicaid, giving it a comprehensive view of the person’s needs and a financial reason to coordinate care well rather than letting things fall through the cracks between programs.
How Quality Is Measured
The Centers for Medicare and Medicaid Services (CMS) maintains 15 nationally standardized quality measures for long-term services and supports, including eight specifically designed for MLTSS programs. These measures fall into three categories.
The first group focuses on assessment and care planning: whether enrollees receive a comprehensive assessment, whether they have a person-centered care plan, whether that plan is shared with their primary care provider, and whether reassessments happen after hospital discharges. The second category tracks falls risk, measuring whether enrollees are screened for fall risk and have a prevention plan in place. The third category targets rebalancing and utilization, tracking how often people are admitted to facilities from the community, how long facility stays last, and how successfully people transition back to the community after extended institutional stays.
These measures give states and the federal government a way to evaluate whether MLTSS plans are actually doing what they’re designed to do: keeping people safely in the community, providing individualized care, and avoiding unnecessary institutionalization.
How to Access MLTSS in Your State
Not every state operates an MLTSS program, though the number has grown steadily. Your starting point is your state’s Medicaid agency, which can tell you whether an MLTSS program exists in your area and walk you through the application process. If your state does have a program, you’ll typically need to complete a financial application and undergo a clinical assessment to determine whether you meet the level-of-care threshold.
If you’re already on Medicaid and your state launches or expands an MLTSS program, you may be transitioned into it automatically. In that case, you’ll be assigned to or asked to choose a managed care plan, and a care manager will reach out to begin the assessment process. If you’re applying fresh, expect the process to take several weeks as both the financial and clinical eligibility determinations are completed.