Millions of Californians living with disabling conditions or chronic illnesses require assistance with common activities of daily living, such as bathing, dressing, and eating. Others need transportation, housekeeping, meal preparation, or other assistance to live safely and independently at home or in a nursing home, assisted living community, or other facility setting.

The state provides a patchwork of services, collectively known as long-term services and supports (LTSS), to help address these needs. For many Californians with low incomes, some of these services are provided through Medi-Cal, the state’s Medicaid program. Under CalAIM (California Advancing and Innovating Medi-Cal), the state is putting more responsibility for provision or coordination of some of these services on its contracted Medi-Cal managed care plans.

While a variety of approaches could help California achieve more standardized LTSS benefits and improve the enrollee experience, the Department of Health Care Services, which has oversight of Medi-Cal, wants to move toward a delivery system referred to as statewide Managed Long-Term Services and Supports (MLTSS) by 2027.

This report explores some design options for implementing MLTSS that policymakers, agency leaders, advocates, and other stakeholders can consider as this work unfolds. The findings are based on research of existing LTSS in California and other states, more than 20 stakeholder interviews, and input from an advisory committee composed of regulators and subject matter experts.

The report provides an overview of the challenges of the current system of supports and describes the potential benefits of statewide MLTSS. It offers perspectives and lessons learned that can inform how the system could be developed, an overview of the improvements that a new system could provide, as well as different scenarios for implementation.