Evolution of MLTSS
In 1989, Arizona implemented the first state MLTSS program, the Arizona Long Term Care System (ALTCS), under a Section 1115 research and demonstration waiver. At that time, Medicaid managed care was still uncommon, and including LTSS was unprecedented. Since then, federal authority has evolved significantly, providing states with many more options to implement managed care as well as HCBS.
New and expanded LTSS options under the ACA may be included in MLTSS programs. In the section on federal authorities, we discuss how LTSS and managed care authorities can be used concurrently to deliver MLTSS.
