Nearly five million Medicaid beneficiaries use long-term services and supports (LTSS) accounting for a significant share of total federal and state Medicaid expenditures. State Medicaid programs are pursuing a variety of strategies, including managed LTSS (MLTSS) programs, to shift care delivery from institutional to home- and community-based services, improve the quality of services, and better manage costs. At the same time, Medicaid programs are beginning to explore value-based payment (VBP) arrangements for MLTSS programs that link payment to value vs. volume of services. In most states, emerging VBP strategies are largely built around primary and acute care services, with much less of this activity focused on LTSS.
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