What Are Managed Long-Term Services and Supports (MLTSS) Programs – and How Can Home Care Service Providers Participate?

Over the past two decades, there has been a growing shift in how long-term care is delivered across the United States. With rising preferences for aging in place and a greater emphasis on quality of life, states are continuing to move away from institutional care models in favor of home- and community-based services (HCBS). 

These services support older adults and individuals with disabilities in their own homes or community settings, offering more personalized care at a lower cost than traditional nursing facilities.

To meet this growing demand and manage costs more effectively, many states have introduced Managed Long-Term Services and Supports (MLTSS) programs. 

Understanding and participating in MLTSS programs presents an opportunity for home care agencies and senior living communities to serve more clients while aligning with state efforts to modernize long-term care delivery.

What are Managed Long-Term Services and Supports (MLTSS) programs?

Managed Long-Term Services and Supports (MLTSS) programs are capitated Medicaid initiatives that streamline the delivery of long-term care services through managed care models. 

Eligible individuals can receive a wide range of in-home support under MLTSS programs, including:

• Personal care assistance for activities such as bathing, dressing, and mobility support 
• Meal delivery services and nutritional support
• Behavioral health services and social support
• Transportation services
• Respite care to help family caregivers
• Transitional services, like counseling, to assist clients in moving from institutions back into community-based living
• Home health care, including skilled nursing and medication management
• Care coordination to ensure the right care is delivered at the right time

Rather than relying on traditional fee-for-service Medicaid, MLTSS channels services through managed care organizations (MCOs), which are paid a fixed per-member, per-month (PMPM) capitation rate to coordinate and deliver this comprehensive range of long-term care support. 

Through these programs, states aim to improve care coordination and quality, reduce costs, and ensure that individuals – particularly seniors and people with disabilities – can access the assistance they need in home and community-based settings rather than institutional ones.

As more states move toward MLTSS models, the focus on flexibility, person-centered care, and cost efficiency continues to grow. 

As of Dec 2023, 25 states had contracted with Managed Care Organizations (MCOs) to provide long-term services and supports – up from only eight states in 2004.

With the exception of California and Virginia, these states have created at least one separate MLTSS program targeted specifically toward adults aged 65+.

For home care service providers, MLTSS presents a structured, scalable way to serve a broader population of Medicaid-eligible clients while receiving more predictable reimbursement. 

What role do Managed Care Organizations (MCOs) play in MLTSS programs?

States contract with Managed Care Organizations (MCOs) to implement and administer their MLTSS programs. 

These organizations are the operational backbone of MLTSS programs and act as dedicated care coordinators, ensuring that beneficiaries receive the care they need from approved, high-quality providers – balancing cost-efficiency with quality, person-centered care.

Their involvement is designed to reduce fragmentation, streamline service delivery, and improve health outcomes.

MCOs operate under state contracts and must meet specific performance standards, including oversight of provider networks, care coordination, and quality improvement. 

Their responsibilities include:

• Managing provider networks and ensuring adequate access to services
• Conducting comprehensive assessments and creating individualized care plans
• Coordinating medical and non-medical long-term services to ensure holistic support and continuity of care
• Monitoring service quality and accountability through performance metrics and outcome-based measures
• Managing budgets and ensuring cost-effective care delivery
• Reporting outcomes and meeting state and federal compliance requirements

As Medicaid moves toward more value-based care models, the key role of MCOs is to ensure that every enrollee receives high-quality, person-centered services from trusted providers in their homes – while containing costs for state Medicaid programs.

9 compelling reasons to consider participating in MLTSS programs

Providers participating in an MLTSS program not only open the door to more consistent referrals and long-term client relationships but also encourage the alignment of care models with value-based outcomes such as client satisfaction, reduced hospitalizations, and improved functional independence.

Let’s take a look at some of the other benefits:

Access to a consistent referral pipeline

Partnering with MCOs can lead to a steady stream of client referrals, helping to maintain a stable client base.

Expanded revenue opportunities

MLTSS participation opens up access to diversified income streams beyond private pay or traditional long-term care insurance.

Alignment with Value-Based Care trends

MLTSS programs encourage providers to adopt person-centered, outcome-focused care models that position them for future value-based payment arrangements.

Strengthened community reputation

Being an MLTSS-approved provider demonstrates credibility, regulatory compliance, and a strong commitment to high-quality care services.

Increased job stability for employees

A consistent flow of long-term clients through MLTSS can help reduce staffing fluctuations and offer more reliable shift schedules for caregivers and support staff.

Opportunities for strategic growth

Home care agencies and senior living communities can scale more confidently by building long-term contracts with MCOs and expanding services into underserved areas.

Increased client retention

Serving clients within the MLTSS framework allows for longer lengths of service delivery and continuity of care, especially as client needs become more complex.

Access to state and MCO support resources

Providers may benefit from access to caregiver training, certification programs, and care model guidance offered by MCOs and state agencies to improve service quality.

Stronger partnerships and industry visibility

Joining MLTSS networks can lead to collaborations with community organizations, healthcare systems, and advocacy groups, raising the profile of your agency or SLC in the long-term care ecosystem.

How can home care service providers get involved in MLTSS programs?

As the number of states adopting MLTSS programs grows, home care agencies and senior living communities have some great opportunities to get in on the action and expand their client base within the community.

• First, you’ll need to establish if your state is running an MLTSS program.
• Next, check that any Managed Care Organizations (MCOs) participating in your state’s MLTSS program (that you’d like to partner with) are accepting service applications.
• If so, you’ll need to apply to become an approved provider and, if accepted, secure a contract. 

While the exact process may vary by state and MCO, you’ll generally need to:

– Obtain and maintain all required state licenses and certifications
– Demonstrate compliance with Medicaid program standards and regulations
– Show proof of liability insurance and proper business registration
– Provide documentation of staff qualifications, background checks, and training
– Maintain clear policies for care planning, documentation, and incident reporting
– Meet quality assurance and performance benchmarks set by the MCO
– Submit to site visits, audits, and credentialing reviews as required

• If MCOs in your area are not currently accepting applications, it’s worth making your interest known and keeping communication lines open so you’re front of mind when opportunities do arise later down the line.

You may also consider exploring alternative state-specific programs that you can participate in, like PACE, Community First Choice (CFC), and HCBS Waivers.

How can home care service providers prepare for successful MLTSS program participation?

Use this checklist as a guide to ensure your agency or senior living community is equipped to join an MLTSS provider network and be part of this growing gold standard of long-term, home-based care.

1. Research your state’s MLTSS program

As each state structures its MLTSS program differently, you’ll need to research your state’s eligibility criteria, covered services, and reimbursement models to align your offerings with what MCOs are specifically looking for.

• Identify which demographics are covered and which MCOs are contracted.
• Understand each MCO’s enrollment and credentialing process.
• Seek professional advice, if needed, regarding contract and rates/payment negotiations if your application is accepted.

2. Ensure you meet the state’s certification, credentialing, and licensing requirements

Make sure that your state home care license, Medicaid certification, and business registrations are current.

Providers using Aaniie’s home care software will already be securely storing and managing licensing and compliance documents and receiving timely reminders when updates are due.

3. Establish operational readiness

Be able to show that your agency or community has qualified staff, care coordination protocols, a comprehensive range of care services, and capacity for expansion.

If you’re using Aaniie Care’s home care platform, you’ll already be ahead of the competition with streamlined operations. With robust scheduling, care planning, caregiver management, EVV compliance, and secure communications, you’ll easily be able to handle increased caseloads, meet reporting requirements, and ensure continued operational efficiency to meet the increased demand.

If approved, you’ll also need to prepare your caregivers and coordinators with training on Medicaid documentation, person-centered care planning, and compliance protocols tied to MLTSS expectations.

4. Be equipped to incorporate new billing practices

MCOs are responsible for reimbursing care providers within their network and have the flexibility to determine the payment models they use. Once approved, you may need to incorporate new billing processes and submit claims according to each MCO’s procedure. These can include fee-for-service (FFS), capitation, or value-based payment models. 

Many states offer sample billing sessions for smaller home care service providers.

For providers using Aaniie Care’s embedded billing and payment processing suite, handling new billing processes, receiving prompt payments, and reducing administrative errors will be a breeze.

5. Maintain quality assurance and compliance policies

Ensure you have up-to-date procedures for care documentation, EVV, client safety, incident reporting, staff training, etc.

Tracking quality metrics, for example, through Aaniie Care’s customizable reports and KPI dashboards, will be necessary to clearly show you’re meeting (or exceeding) quality benchmarks, like timeliness of care, client satisfaction, critical incident reporting, and reduced hospital readmission rates. 

MCOs use multiple data points like these to evaluate and rank providers, and will terminate contracts (or require corrective actions) with those who underperform.

6. Continue to develop strong relationships with MCO Case Managers

Continually building connections with care coordinators and case managers within your state’s MCOs will help to increase referrals and ensure smoother client onboarding into your services when the time comes.

7. Be prepared for ongoing monitoring and care performance reviews

Be audit-ready with accessible documentation and performance data.

If you’re using the Aaniie Care platform, you’ll have real-time access to analytics tools to monitor KPIs, run reports, monitor satisfaction, and support any audits or compliance reviews.

Aaniie Care: laying a solid foundation for successful expansion

The steady expansion of MLTSS programs promises exciting opportunities for home care service providers. 

Technology like Aaniie’s all-in-one home care platform can help you seize the moment and build a solid foundation from which to scale easily and effectively. 

While many systems can address some aspects of expansion, few are as comprehensive and sustainable as Aaniie. By integrating recruitment, caregiver management, communication, billing, and business intelligence tools into a single platform, Aaniie Care greatly simplifies home- and community-based services. 

Ultimately, this sophisticated software not only aids providers in managing growth but also helps them stand out in a highly competitive market. Whether it’s reducing administrative burdens, streamlining operations, improving care quality, or accessing flexible billing and payment processes, Aaniie Care will enable you to focus on what’s most important – delivering exceptional care to your clients.

If you’d like to see how easy it is to use our software tools to streamline operations and start growing your business successfully, please call our experienced team today or request a free demo.