Evolution of MLTSS Authorities

Managed Care Vehicles

• The Balanced Budget Act of 1997 authorized Medicaid managed care as a state plan option;
  
  
• The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created Medicare Special Needs Plans, giving states a new option for integrating MLTSS programs with Medicare services for Medicare-Medicaid beneficiaries;
  
  

HCBS Options

• The Deficit Reduction Act of 2005 (DRA) created the Money Follows the Person program and added §1915(i), a new Medicaid State Plan option for home and community based services (HCBS);
  
  
• The Patient Protection and Affordable Care Act (ACA, 2010) created the Balancing Incentive Program for states that currently devote less than 50 percent of LTSS expenditures to HCBS, extended and expanded Money Follows the Person, modified the Medicaid State Plan HCBS option under §1915(i), and established new authority and incentives for personal assistance services through the Community Choice First Option (§1915(k)).

 

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