Key Themes in Capitated Medicaid Managed Long-Term Services and Supports Waivers

State interest in capitated MLTSS waivers is growing, with 11 out of 19 of these waivers approved in the last three years.  While various Medicaid state plan authorities enable states to expand beneficiary access to HCBS, states also are using § 1115 or § 1915(b)/(c) waiver provisions aimed at increasing community integration.  MLTSS waivers also include some beneficiary protections in addition to those required by the underlying Medicaid managed care authority.  CMS’s 2013 MLTSS guidance offers best practices to states in these areas, although some elements are recommended but not required, and states retain flexibility to design specific program features.  An area important to beneficiaries who need LTSS is disability accessibility and compliance with the Americans with Disabilities Act, which is not addressed by the guidance or in detail in the waiver terms and conditions.  Work also is needed to further develop MLTSS quality measures, such as those related to quality of life and community integration, so that policymakers and other stakeholders have the information necessary to oversee and evaluate these programs to ensure that beneficiaries are well-served.