Moving HCBS to Medicaid Managed Long-term Services and Supports

For older adults and people with disabilities, long-term services and supports (LTSS) provide crucial assistance with daily activities like eating, bathing, and medication management. Although some receive care in nursing facilities, many prefer staying in their homes with support from home and community-based services (HCBS).

California is joining other states in shifting Medicaid LTSS from fee-for-service to managed care. This transition offers promising opportunities to:

• Enhance coordination for HCBS users
• Improve state cost predictability
• Strengthen service delivery systems

However, without careful planning, these changes could disrupt vital care for vulnerable Californians.

Learning from Experience

California can benefit from the experiences of 24 states that have implemented Medicaid managed LTSS (MLTSS) over three decades. Their journeys reveal key strategies for success:

• Implementing robust continuity-of-care protections
• Building and maintaining strong provider networks
• Establishing proactive oversight mechanisms

This explainer, Moving HCBS to Medicaid Managed Long-Term Services and Supports: Considerations for California and Other Transitioning States, highlights practical approaches to guide California’s transition to MLTSS. By applying these lessons, California can create a system that honors individual preferences, supports community living, and ensures high-quality care for those who depend on these essential services.

Two companion fact sheets summarize how states can address questions that HCBS users and providers have about transitioning to MLTSS. They are:

• Moving Home- and Community-Based Services to Medicaid Managed Care: How States Can Address User Concerns (PDF)
• Moving Home- and Community-Based Services to Medicaid Managed Care: How States can Address Provider Concerns (PDF)

The explainer and fact sheets were developed by the Center for Health Care Strategies through support from CHCF.