Georgia Medicaid Managed Long-Term Services and Supports (MLTSS): A Complete Guide to Federal Framework, Georgia's Non-Adoption, and What It Means for Families

::: hero

By Brevy Care Team · Last verified May 12, 2026

A complete guide to the federal Managed Long-Term Services and Supports (MLTSS) framework under Section 1932 of the Social Security Act and Section 1915(b) and Section 1915(c) combined waivers and Section 1115 demonstrations, why approximately 24 states have adopted MLTSS to deliver long-term services and supports through managed care organizations with capitated payment and care coordination, why Georgia has not adopted MLTSS and instead operates LTSS through traditional fee-for-service Medicaid combined with five HCBS waivers (CCSP, SOURCE, ICWP, NOW, and COMP), how the CMS Medicaid Managed Care Rule and CMS State Medicaid Director Letter SMD 13-005 establish beneficiary protections, network adequacy standards, quality strategy requirements, and person-centered planning mandates, and what the policy considerations and implications are for Georgia families navigating LTSS. :::

::: callout

Key takeaways

• Managed Long-Term Services and Supports (MLTSS) is a federal Medicaid framework under which states deliver long-term services and supports (LTSS) through managed care organizations (MCOs) with capitated per-member per-month payment, rather than through traditional fee-for-service Medicaid.
• Many states operate MLTSS programs, including Arizona (ALTCS), Tennessee (CHOICES), Texas (STAR+PLUS), Florida (SMMC LTC), New York (MLTC), New Jersey, Virginia (CCC Plus), Pennsylvania (Community HealthChoices), California (CalAIM), North Carolina (Tailored Plans), and others.
• Georgia has NOT adopted MLTSS. Georgia's LTSS framework operates through traditional fee-for-service Medicaid combined with five Section 1915(c) HCBS waivers (Community Care Services Program, Service Options Using Resources in a Community Environment, Independent Care Waiver Program, New Options Waiver, and Comprehensive Supports Waiver Program).
• Georgia Families managed care, operated by contracted Care Management Organizations (CMOs), covers only acute and primary care services. Georgia Families does NOT cover LTSS.
• Federal MLTSS authority rests primarily on Section 1932 of the Social Security Act (general managed care authority), Section 1915(b) (mandatory managed care waivers), Section 1915(c) (HCBS waivers), and Section 1115 (demonstration waivers).
• CMS State Medicaid Director Letter SMD 13-005 establishes key elements for successful MLTSS programs, including adequate planning, stakeholder engagement, enhanced HCBS, person-centered processes, qualified providers, participant protections, and quality.
• The CMS Medicaid Managed Care Rule (most recently updated in May 2024) establishes federal requirements for managed care programs, including MLTSS, covering capitation rates, network adequacy, beneficiary protections, grievance and appeals, quality strategy, and beneficiary support systems.
• States adopt MLTSS for several reasons: rebalancing from institutional to HCBS, care coordination across acute and LTSS services, predictable budgeting, enhanced beneficiary supports, and quality improvement.
• States may decline to adopt MLTSS due to administrative burden, capitation rate adequacy concerns, beneficiary protection concerns, provider network adequacy challenges, and existing FFS LTSS infrastructure.
• Georgia's non-adoption of MLTSS reflects a combination of factors including existing FFS infrastructure, limited CMO LTSS experience, stakeholder positions, legislative considerations, and DCH administrative capacity. :::

What is MLTSS and why does it matter

Managed Long-Term Services and Supports (MLTSS) is a federal Medicaid framework under which states deliver long-term services and supports (LTSS) through managed care organizations rather than through traditional fee-for-service Medicaid. Under MLTSS, the state pays the MCO a capitated per-member per-month payment, and the MCO is responsible for arranging and paying for LTSS for enrolled beneficiaries. MLTSS includes both institutional services (nursing facility care, ICF/IID services) and home and community-based services (personal care, home health, adult day services, assisted living, supported employment).

MLTSS represents a significant shift from traditional fee-for-service LTSS. Under FFS LTSS, the state pays providers directly for each service furnished to Medicaid beneficiaries. Under MLTSS, the state pays the MCO a capitated rate, and the MCO is responsible for managing the beneficiary's care within that capitated payment. This shifts financial risk from the state to the MCO and creates financial incentives for the MCO to manage care efficiently, including by providing services in less-costly community-based settings rather than more-costly institutional settings.

MLTSS has expanded significantly over the past two decades. Arizona's Arizona Long Term Care System (ALTCS) is among the longest-running MLTSS programs. Many states have adopted MLTSS, with adoption accelerating in the 2010s and 2020s. Many states now operate MLTSS programs covering some or all of their LTSS populations.

Georgia has not adopted MLTSS. Georgia's LTSS framework operates through traditional fee-for-service Medicaid combined with five Section 1915(c) HCBS waivers. Understanding the MLTSS framework is important for Georgia families even though Georgia operates a FFS system, because (1) understanding the policy alternatives helps inform engagement with state policy discussions about LTSS reform, (2) Georgia families may move to or from MLTSS states and need to understand how the LTSS system differs across states, and (3) federal MLTSS policy continues to evolve and may influence Georgia's future approach to LTSS.

Federal statutory framework for MLTSS

Section 1932 of the Social Security Act and managed care general authority

Section 1932 of the Social Security Act, codified at 42 USC 1396u-2, provides the general statutory authority for state Medicaid managed care programs. Section 1932 was added by the Balanced Budget Act of 1997, which significantly expanded state authority to operate managed care programs without seeking federal waivers.

Section 1932 includes the following key provisions. Section 1932(a)(1)(A) allows states to require Medicaid beneficiaries to enroll in managed care organizations or primary care case management entities. Section 1932(a)(1)(B) requires states to offer beneficiaries a choice of at least two managed care plans (with limited exceptions). Section 1932(a)(2) protects certain beneficiary groups from mandatory managed care enrollment, including children with special needs in foster care, dual eligibles in some circumstances, and AI/AN beneficiaries under Section 1932(h). Section 1932(b) establishes requirements for managed care contracts, including grievance and appeal procedures, quality assurance, and other contract provisions. Section 1932(c) establishes quality assurance requirements, including external quality review. Section 1932(d) establishes protections against marketing abuses by managed care plans. Section 1932(e) establishes solvency and capitation rate requirements. Section 1932(f) establishes grievance and appeal rights for beneficiaries. Section 1932(g) establishes sanctions for managed care plan non-compliance.

States have flexibility under Section 1932 to design managed care programs that meet their needs, subject to federal approval through state plan amendments, Section 1915(b) waivers, or Section 1115 demonstrations.

Section 1915(a), (b), and (c) waiver authorities

Section 1915 of the Social Security Act provides multiple waiver authorities that states use to design Medicaid managed care and HCBS programs. The most relevant Section 1915 authorities for MLTSS are:

Section 1915(a) of the Social Security Act allows states to operate voluntary managed care programs without requiring a federal waiver. Section 1915(a) is typically used for limited managed care programs or for managed care arrangements that do not require restrictions on freedom of choice of provider.

Section 1915(b) of the Social Security Act allows states to waive certain Medicaid requirements to operate mandatory managed care programs. Section 1915(b) waivers may waive Section 1902(a)(1) statewideness requirements, Section 1902(a)(10)(B) comparability requirements, Section 1902(a)(23) freedom of choice of provider requirements, and Section 1902(a)(4) administrative requirements. Section 1915(b)(4) allows for selective contracting, allowing states to contract with a limited number of providers. Section 1915(b) waivers are typically used for mandatory managed care enrollment.

Section 1915(c) of the Social Security Act allows states to waive certain Medicaid requirements to operate home and community-based services (HCBS) waivers. Section 1915(c) waivers are used to deliver HCBS to Medicaid beneficiaries who would otherwise require institutional care. Section 1915(c) waivers must demonstrate cost neutrality compared to institutional care, must include person-centered planning, must include quality assurance, and must comply with the HCBS settings rule at 42 CFR 441.530.

States may combine Section 1915(b) and Section 1915(c) authorities to operate MLTSS programs. Under a Section 1915(b)(c) combination, the state operates a mandatory managed care program under Section 1915(b) and also operates an HCBS waiver under Section 1915(c) for the same population. The MCO under the Section 1915(b) waiver is responsible for delivering both acute/primary care services and HCBS waiver services. Examples of states using Section 1915(b)(c) combined waivers for MLTSS include Texas (STAR+PLUS), Michigan, and others.

Section 1915(i), (j), and (k) State Plan options

Section 1915(i), (j), and (k) provide additional authorities that some states use as part of their LTSS framework, although these are typically used for State Plan benefits rather than MLTSS specifically.

Section 1915(i) of the Social Security Act, added by the Deficit Reduction Act of 2005 and amended by the ACA, allows states to offer HCBS as a State Plan benefit rather than as a waiver. Under Section 1915(i), states may offer HCBS to individuals who do not require institutional level of care, expanding the population that can receive HCBS.

Section 1915(j) of the Social Security Act, added by the DRA 2005, allows states to offer self-directed services under a State Plan option.

Section 1915(k) of the Social Security Act, added by the ACA, allows states to offer Community First Choice services as a State Plan option, with an enhanced FMAP for CFC services.

Section 1115 demonstrations and MLTSS

Section 1115 of the Social Security Act allows the Secretary of HHS to waive provisions of Medicaid law to support demonstration projects that further the objectives of Medicaid. Section 1115 demonstrations have been used to implement comprehensive MLTSS programs, including Tennessee CHOICES, Florida SMMC LTC, New York Partnership Plan and MLTC, California CalAIM, and New Jersey FamilyCare.

Section 1115 demonstrations offer states more flexibility than Section 1915(b)(c) combined waivers, allowing for more comprehensive reforms. Section 1115 demonstrations require federal approval and typically include detailed terms and conditions, evaluation requirements, and other provisions.

Federal regulatory framework

42 CFR Part 438 managed care regulations

42 CFR Part 438 establishes comprehensive federal regulations for Medicaid managed care, including MLTSS. The current regulations reflect updates from the 2016 Medicaid Managed Care Final Rule (the "Mega-Rule"), the 2020 Final Rule, and the 2024 Access, Finance, and Quality Final Rule.

Key provisions of 42 CFR Part 438 for MLTSS include:

42 CFR 438.4 and capitation rates

42 CFR 438.4 requires actuarially sound capitation rates for managed care programs. Capitation rates must be developed in accordance with generally accepted actuarial principles and practices, must be appropriate for the populations and services covered under the contract, and must be approved by CMS. Setting actuarially sound capitation rates is one of the most technically demanding aspects of MLTSS program design.

42 CFR 438.66 monitoring and oversight

42 CFR 438.66 requires states to develop and implement a comprehensive monitoring system for managed care plans, including review of operational, financial, and quality data. For MLTSS, monitoring must include review of LTSS-specific performance indicators.

42 CFR 438.68 network adequacy

42 CFR 438.68 requires states to establish network adequacy standards for managed care plans. Network adequacy standards include time and distance standards, appointment wait times, and provider-to-enrollee ratios. For MLTSS, network adequacy standards must address access to home and community-based services as well as institutional services. Network adequacy for LTSS is particularly challenging in rural areas and in states with limited HCBS provider capacity.

42 CFR 438.71 beneficiary support system

42 CFR 438.71, added by the 2016 Mega-Rule, requires states with MLTSS programs to operate a beneficiary support system. The beneficiary support system must include choice counseling at enrollment, assistance with using the managed care plan, access to ombudsman services, and support for beneficiaries to participate in person-centered planning. The beneficiary support system is a key beneficiary protection in MLTSS programs, recognizing that LTSS beneficiaries often need additional supports to navigate the managed care system.

42 CFR 438.206-.210 access standards

42 CFR 438.206-.210 establishes access standards including timely access to services, coverage of out-of-network services when network providers are unavailable, second opinion rights, and ability to access services in beneficiary's primary language.

42 CFR 438.330 and 438.340 quality

42 CFR 438.330 requires managed care plans to develop and maintain Quality Assessment and Performance Improvement (QAPI) programs. 42 CFR 438.340 requires states to develop and implement a comprehensive Medicaid managed care quality strategy. For MLTSS, the quality strategy must address LTSS-specific quality measures.

42 CFR 438.400-.424 beneficiary protections

42 CFR 438.400-.424 establishes beneficiary protections including grievance rights, appeal rights, state fair hearing rights, and aid pending appeal. These protections are particularly important in MLTSS because LTSS beneficiaries often depend on covered services for daily living and any disruption in services can have severe consequences.

42 CFR 441.300-.310 HCBS waiver requirements

42 CFR 441.300-.310 establishes federal requirements for Section 1915(c) HCBS waivers, including:

• 42 CFR 441.301 person-centered planning requirements
• 42 CFR 441.302 quality assurance and improvement
• 42 CFR 441.303 cost neutrality
• 42 CFR 441.530 HCBS settings rule

The HCBS settings rule, at 42 CFR 441.530, requires HCBS settings to be integrated in the community, support full access to the greater community, ensure the individual receives services in the community to the same degree as individuals not receiving Medicaid HCBS, optimize but not regiment individual initiative, autonomy, and independence in making life choices, and facilitate individual choice of services and supports.

CMS State Medicaid Director Letter SMD 13-005

CMS State Medicaid Director Letter SMD 13-005 provides comprehensive guidance on MLTSS implementation. SMD 13-005 establishes key elements for successful MLTSS programs:

1. Adequate planning and transition strategies: States should engage in comprehensive planning prior to implementation, including stakeholder engagement, system design, IT readiness, and provider readiness.

2. Stakeholder engagement: States should engage stakeholders (beneficiaries, providers, advocates, MCOs) throughout MLTSS planning, implementation, and ongoing operations.

3. Enhanced provision of HCBS: MLTSS programs should support enhanced provision of HCBS, including expansion of HCBS to populations and individuals not currently receiving HCBS.

4. Alignment of payment structures with MLTSS programmatic goals: Capitation rates and incentive structures should align with MLTSS goals, including rebalancing toward HCBS.

5. Support for beneficiaries: MLTSS programs should include comprehensive beneficiary supports, including care coordination, choice counseling, and ombudsman services.

6. Person-centered processes: MLTSS programs should use person-centered planning processes that respect beneficiary preferences and choices.

7. Comprehensive and integrated service package: MLTSS programs should provide a comprehensive and integrated service package across acute, primary, and LTSS services.

8. Qualified providers: MLTSS programs should ensure adequate provider networks of qualified providers.

9. Participant protections: MLTSS programs should include strong beneficiary protections, including grievance and appeal rights.

10. Quality: MLTSS programs should include comprehensive quality strategies and quality measurement.

SMD 13-005 remains the primary federal guidance on MLTSS program design and is regularly cited in state MLTSS planning documents and CMS approval decisions.

How states adopt MLTSS

The decision to adopt MLTSS is a major policy decision that typically involves multi-year planning and implementation. The typical state MLTSS adoption process includes:

Phase 1: Policy analysis and stakeholder engagement

The state evaluates the case for MLTSS adoption, including potential cost savings, quality improvements, and beneficiary outcomes. The state engages stakeholders including beneficiaries, providers, advocates, and legislators to gather input on MLTSS design.

Phase 2: Program design

The state designs the MLTSS program, including target populations, covered services, MCO contracting approach, capitation rate methodology, quality strategy, beneficiary protections, and other program elements.

Phase 3: Federal authority

The state secures federal authority for MLTSS implementation, typically through a Section 1915(b)(c) combined waiver or a Section 1115 demonstration. Federal approval typically takes 6-18 months.

Phase 4: MCO procurement

The state conducts MCO procurement, typically through a competitive Request for Proposals (RFP) process. The state evaluates MCO proposals and selects MCOs to operate the MLTSS program.

Phase 5: Implementation

The state implements MLTSS, typically with a phased rollout by geographic region or beneficiary population. Implementation includes beneficiary enrollment, provider network development, IT system development, and other operational activities.

Phase 6: Ongoing operations

After implementation, the state continues to oversee MLTSS through monitoring, quality reporting, capitation rate updates, MCO performance management, and stakeholder engagement.

Why states adopt MLTSS

States adopt MLTSS for several reasons:

Rebalancing from institutional to HCBS

MLTSS provides MCOs with financial incentives to provide LTSS in less-costly community-based settings rather than institutional settings. Because MCOs receive capitated payments, they can save money by providing HCBS at lower cost than nursing facility care. This creates a financial incentive for rebalancing toward HCBS, which is also the preference of most beneficiaries.

Rebalancing has been a long-standing federal priority. The Olmstead v. L.C. Supreme Court decision (1999) recognized that unjustified institutional placement of individuals with disabilities constitutes discrimination under the Americans with Disabilities Act. The Money Follows the Person demonstration program, the Balancing Incentive Program, and the Community First Choice option are all federal initiatives to support rebalancing. MLTSS aligns with these federal priorities by creating financial incentives for HCBS expansion.

Care coordination

MLTSS programs typically include comprehensive care coordination across acute, primary, and LTSS services. The MCO is responsible for coordinating care across all providers, reducing fragmentation and improving outcomes. Care coordination is particularly important for LTSS beneficiaries, who often have complex medical and social needs and interact with multiple providers across multiple settings.

Predictable budgeting

Capitated payment provides states with predictable LTSS budgeting. The state knows in advance how much it will pay the MCO per beneficiary per month, rather than facing potentially unlimited fee-for-service expenditures. Predictable budgeting is particularly important for state legislatures and budget officials.

Beneficiary experience

MLTSS programs often include enhanced beneficiary supports, including care coordinators who help beneficiaries navigate the complex LTSS system, choice counseling, and ombudsman services. These supports can improve beneficiary experience and outcomes.

Quality improvement

MLTSS programs include quality strategy requirements, performance improvement projects, and quality reporting. This creates accountability for quality outcomes. MCOs are typically required to meet quality benchmarks, and may face financial penalties or other consequences for failing to meet quality targets.

Why states do not adopt MLTSS

States may decline to adopt MLTSS for several reasons:

Administrative burden

Implementing MLTSS requires substantial administrative investment, including developing actuarially sound capitation rates, managing MCO contracts, developing quality strategies, operating beneficiary support systems, and other administrative functions. The administrative burden can be significant, particularly for state Medicaid agencies with limited staff capacity.

Capitation rate adequacy concerns

MLTSS capitation rates must be adequate to cover the cost of LTSS while incentivizing efficient care management. Setting inadequate capitation rates can lead to MCO financial losses, provider rate cuts, and access problems. Setting overly generous rates can waste state and federal resources. Capitation rate development is one of the most challenging technical aspects of MLTSS implementation, particularly for new MLTSS programs with limited historical data on managed LTSS costs.

Beneficiary protection concerns

Some advocates have raised concerns about beneficiary protections in MLTSS programs, including concerns about MCO authorization decisions, network adequacy for HCBS, and quality of care. Concerns include MCOs denying or reducing LTSS services to control costs, lengthy authorization processes for needed services, and inadequate networks for HCBS providers. Federal beneficiary protections (grievance and appeals, network adequacy standards, beneficiary support systems) are designed to address these concerns, but advocates may still prefer the FFS model.

Provider network adequacy

MLTSS requires MCOs to develop adequate networks of LTSS providers, including nursing facilities, home health agencies, personal care providers, adult day services providers, assisted living facilities, and others. In rural areas and in states with limited HCBS provider capacity, network adequacy can be challenging. Some states have implemented MLTSS in phases, beginning with urban areas and gradually expanding to rural areas as provider networks develop.

Fee-for-service infrastructure

States that have well-developed fee-for-service LTSS systems may prefer to continue with the existing system rather than transition to MLTSS. Building MLTSS requires significant capital investment in administrative systems, contracts, and oversight. The investment may be difficult to justify when the existing FFS system is functioning adequately.

Georgia's LTSS framework

Georgia Families managed care (acute and primary care only)

Georgia operates the Georgia Families managed care program, which covers most non-LTSS Medicaid beneficiaries. Georgia Families is operated by contracted Care Management Organizations (CMOs). Georgia Families covers acute and primary care services including physician services, hospital services, pharmacy, behavioral health, and other primary care services.

Critically, Georgia Families does NOT cover long-term services and supports. LTSS in Georgia is delivered through traditional fee-for-service Medicaid, even for beneficiaries enrolled in Georgia Families managed care for their acute and primary care. When a Georgia Families enrollee needs nursing facility care or HCBS waiver services, those services are paid for by Georgia Medicaid on a fee-for-service basis, not by the CMO. This bifurcated structure (managed care for acute/primary, FFS for LTSS) is sometimes called a "carve-out" approach.

Aged, Blind, and Disabled (ABD) fee-for-service

Most Aged, Blind, and Disabled (ABD) Medicaid beneficiaries in Georgia, including those who require LTSS, are enrolled in fee-for-service Medicaid for their acute and primary care as well as their LTSS. ABD beneficiaries are not enrolled in Georgia Families managed care, which serves primarily the parent and caretaker relative, pregnant women, and children populations. This means that the LTSS-dependent population in Georgia is entirely served through fee-for-service Medicaid.

Five HCBS waivers (Section 1915(c))

Georgia operates five Section 1915(c) HCBS waivers, each serving a specific population:

Community Care Services Program (CCSP)

CCSP serves older adults (age 65 and over) and adults with disabilities (age 18 and over) who require nursing facility level of care. CCSP provides personal care, homemaker services, home delivered meals, adult day health, alternative living services, emergency response services, and other HCBS. CCSP is administered by DCH in coordination with the Division of Aging Services (DAS) within the Department of Human Services.

Service Options Using Resources in a Community Environment (SOURCE)

SOURCE serves older adults and adults with disabilities who require nursing facility level of care. SOURCE includes the CCSP services plus enhanced case management. SOURCE includes specialized case management agencies that coordinate care for enrollees. SOURCE is designed to support beneficiaries with more complex care needs.

Independent Care Waiver Program (ICWP)

ICWP serves adults (age 21 to 64) with severe physical disabilities who require nursing facility level of care or hospital level of care. ICWP provides personal support services, skilled nursing, behavioral support, and other services for adults with disabilities such as spinal cord injury, traumatic brain injury, multiple sclerosis, and other severe physical disabilities.

New Options Waiver (NOW)

NOW serves individuals with developmental disabilities who require ICF/IID level of care and have less intensive support needs. NOW provides community living supports, day services, supported employment, behavioral support, and other services. NOW is administered by the Department of Behavioral Health and Developmental Disabilities (DBHDD) in coordination with DCH.

Comprehensive Supports Waiver Program (COMP)

COMP serves individuals with developmental disabilities with more intensive support needs. COMP provides residential supports, day services, supported employment, behavioral support, and other services. COMP is administered by DBHDD in coordination with DCH.

All five Georgia HCBS waivers are operated on a fee-for-service basis. The waivers have enrollment limits set by the state under federal cost-neutrality requirements, and several have waiting lists (particularly NOW and COMP, which have substantial waiting lists for developmental disability services).

Nursing facility services (fee-for-service)

Nursing facility services in Georgia are paid on a fee-for-service basis. DCH reimburses nursing facilities based on a cost-based payment methodology, with rates updated periodically. Georgia has approximately 350 Medicaid-certified nursing facilities with combined capacity of approximately 36,000 beds.

ICF/IID services (fee-for-service)

Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) services in Georgia are paid on a fee-for-service basis. ICF/IID services are intended for individuals with developmental disabilities who require an intermediate level of care, and serve a smaller population than NOW or COMP HCBS waivers.

Why Georgia has not adopted MLTSS

Georgia has not adopted MLTSS. Several factors have contributed to this:

Existing FFS infrastructure

Georgia has a well-developed fee-for-service LTSS infrastructure, including the five HCBS waivers, nursing facility payment system, and provider network. The HCBS waivers have established case management agencies (CCSP and SOURCE), provider networks, quality assurance processes, and payment systems. Transitioning to MLTSS would require substantial system changes, including integration of these waiver functions into MCO operations.

Limited MCO LTSS experience

The four Georgia Families CMOs have experience with acute and primary care managed care but limited experience with LTSS. While the parent companies of the Georgia Families CMOs (Elevance Health, CareSource, Centene, and others) operate MLTSS programs in other states (such as Amerigroup operating MLTSS programs in multiple states), the Georgia subsidiaries have not built LTSS capacity. Building LTSS capacity within the CMOs would require significant investment in clinical, network, and operational infrastructure.

Stakeholder positions

Various stakeholders, including provider associations, advocate groups, and beneficiary representatives, have varied positions on MLTSS. Some advocates have raised concerns about MLTSS implementation in other states, citing issues with service authorization, network adequacy, and beneficiary protections. Provider associations have mixed positions, with some providers concerned about MCO rate negotiation and contract requirements. Beneficiary advocacy organizations have expressed concerns about beneficiary protections under MLTSS.

Legislative considerations

The Georgia General Assembly has not directed DCH to implement MLTSS. State legislative authority would typically be required for major LTSS reforms. Various LTSS reform proposals have been considered over the years, but none have advanced to comprehensive MLTSS implementation.

DCH administrative capacity

Implementing MLTSS would require significant DCH administrative capacity, including developing capitation rates, managing MCO contracts, overseeing MCO performance, operating beneficiary support systems, and developing quality strategies. DCH has built capacity to operate Georgia Families managed care but would need to expand this capacity significantly to operate MLTSS.

Pathways to Coverage focus

In recent years, Georgia's Medicaid reform efforts have focused on the Pathways to Coverage Section 1115 demonstration, which provides limited coverage to adults aged 19-64 with incomes up to 100 percent of federal poverty level who meet work or qualifying activity requirements. The administrative effort required to implement Pathways to Coverage has limited bandwidth for other major Medicaid reforms.

What MLTSS would mean for Georgia families

If Georgia were to adopt MLTSS, the implications for Georgia families would include:

Single point of contact

Beneficiaries would have a single MCO responsible for coordinating all care, including LTSS. Currently, Georgia LTSS beneficiaries may interact with multiple parties: their nursing facility or HCBS provider, their physician, the HCBS waiver case manager, the Division of Aging Services (for older adults), DBHDD (for individuals with developmental disabilities), and Georgia Families CMO (for acute and primary care, in some cases). Under MLTSS, the MCO would be the single point of contact for all services.

Care coordination

MCOs would provide care coordinators to help beneficiaries navigate the LTSS system. The care coordinator would develop and maintain the person-centered care plan, coordinate services across providers, monitor beneficiary status, and address service needs.

Provider network

Beneficiaries would receive services from MCO network providers. Federal regulations include continuity-of-care protections during the initial transition from FFS to MLTSS, allowing beneficiaries to continue receiving services from their existing providers during a transition period. After the transition period, beneficiaries would generally need to use MCO network providers.

Service authorization

MCOs would authorize LTSS services within state-approved limits. The authorization process would be subject to federal beneficiary protections, including timely decisions, written notice of denials, and appeal rights.

Grievance and appeal rights

Beneficiaries would have grievance and appeal rights through the MCO, with state fair hearing rights as a backstop. Federal regulations require MCOs to maintain robust grievance and appeal processes, and beneficiaries retain the right to a state fair hearing if they disagree with the MCO's decision.

Continuity of care

Federal regulations would require continuity-of-care protections during the transition from FFS to MLTSS, allowing beneficiaries to continue existing services and provider relationships for a specified transition period (typically 30-90 days).

How Georgia compares to MLTSS states in the Southeast

Among Georgia's neighboring states, MLTSS adoption varies:

• Florida: Operates the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program since 2013 under a Section 1115 demonstration. SMMC LTC covers older adults and adults with disabilities who require nursing facility level of care.
• Tennessee: Operates the CHOICES program since 2010 under a Section 1115 demonstration. CHOICES covers older adults and adults with physical disabilities who require nursing facility level of care.
• North Carolina: Began implementation of Tailored Plans in 2024, which include MLTSS for individuals with significant behavioral health and intellectual/developmental disability needs.
• South Carolina: Does not operate MLTSS. Operates Healthy Connections Choices managed care for acute and primary care, with LTSS delivered on a FFS basis.
• Alabama: Does not operate MLTSS. Operates a primary care case management model for acute and primary care.
• Mississippi: Operates limited managed care but does not have a comprehensive MLTSS program.

Georgia's non-adoption of MLTSS is similar to South Carolina and Alabama, while neighbors Florida and Tennessee have adopted MLTSS programs.

Worked examples

Example 1: Eleanor, 82, Atlanta, nursing facility resident

Eleanor is an 82-year-old widow living in an Atlanta nursing facility. She has been a nursing facility resident for 18 months following a stroke. Her income is $1,800 per month from Social Security. She has Medicaid through the institutional eligibility category and is paying $1,730 per month in patient liability to the nursing facility (her $1,800 income minus the $70 Georgia personal needs allowance).

Under Georgia's current FFS system, Eleanor's nursing facility services are reimbursed by Georgia Medicaid on a fee-for-service basis. The nursing facility bills Medicaid directly. Eleanor's care plan is managed by the nursing facility staff and her physician. Quality oversight is provided through state survey and certification processes by the Georgia Department of Community Health Healthcare Facility Regulation Division.

Under a hypothetical MLTSS system in Georgia, Eleanor would be enrolled in an MLTSS MCO. The MCO would receive a capitated payment from Georgia Medicaid for Eleanor's care (the capitation rate would reflect the actuarial cost of her nursing facility care). The MCO would assign a care coordinator to Eleanor. The MCO would have financial incentive to consider whether Eleanor could be safely transitioned to a community setting (e.g., assisted living or HCBS at home with appropriate supports) if appropriate, because community-based care is typically less expensive than nursing facility care. The MCO would also have responsibility for monitoring nursing facility quality and ensuring that Eleanor receives appropriate care.

This example illustrates a key advantage of MLTSS: the MCO has financial incentive to promote rebalancing from institutional to community-based care. Under the current FFS system, no party has a direct financial incentive to consider whether Eleanor could be served in a community setting.

Example 2: Margaret, 78, Macon, CCSP HCBS waiver enrollee

Margaret is a 78-year-old widow living in her own home in Macon. She needs help with bathing, dressing, and household tasks but does not need 24-hour care. She qualified for the Community Care Services Program (CCSP) HCBS waiver and receives 25 hours per week of personal care from a CCSP provider, home-delivered meals, and emergency response services.

Under Georgia's current FFS system, Margaret's CCSP services are coordinated by a CCSP case manager (typically employed by an area agency on aging or a contracted case management agency). The CCSP case manager develops Margaret's person-centered care plan in consultation with Margaret and her family, authorizes services within CCSP rules, monitors Margaret's status, and revises the care plan as needed. Services are paid by Georgia Medicaid on a fee-for-service basis to the personal care provider, meal provider, and other CCSP providers.

Under a hypothetical MLTSS system in Georgia, Margaret would be enrolled in an MLTSS MCO. The MCO would receive a capitated payment for Margaret's care. The MCO's care coordinator would replace the CCSP case manager, working with Margaret to develop and maintain her care plan. The MCO would have financial incentive to provide the right level of HCBS to keep Margaret in the community and avoid nursing facility placement.

A key question for Margaret would be whether the MCO would provide the same or different services compared to her current CCSP services. Under MLTSS, MCOs may have flexibility to offer "value-added services" beyond the state-defined benefit package. For example, the MCO might offer additional caregiver supports or home modifications that are not currently available under CCSP. On the other hand, the MCO would be responsible for authorizing services within capitation, which could create tensions if the MCO determines that Margaret should receive fewer services.

Example 3: Robert, 65, Savannah, dual eligible SOURCE enrollee

Robert is a 65-year-old man living in Savannah with multiple chronic conditions including diabetes, hypertension, and chronic kidney disease. He is dually eligible for Medicare and Medicaid. He has Medicare Part A and Part B based on age, and he qualifies for full Medicaid based on disability and low income. He is enrolled in the SOURCE HCBS waiver, which provides enhanced case management plus the CCSP services.

Under Georgia's current FFS system, Robert receives Medicare for most of his acute and primary care, with Medicaid covering the Medicare cost-sharing (under the Qualified Medicare Beneficiary program) and providing the SOURCE waiver services. Coordination across Medicare and Medicaid is handled by Robert himself and his providers. Robert has separate care management for his Medicare services (typically through Medicare Advantage if he is enrolled, or through his physicians) and his Medicaid LTSS services (through his SOURCE case manager).

Under a hypothetical MLTSS system in Georgia, Robert would be enrolled in an MLTSS MCO that might also be a Medicare Advantage plan, specifically a Dual Eligible Special Needs Plan (D-SNP). The MCO/D-SNP would coordinate Robert's Medicare and Medicaid services through a single care coordinator, providing seamless integration across acute, primary, and LTSS services. This integrated approach is particularly valuable for dual eligibles, who often experience fragmentation between Medicare and Medicaid services.

Integration of Medicare and Medicaid for dual eligibles is a major federal priority. CMS has developed several integration models, including the Financial Alignment Initiative (formerly called the Medicare-Medicaid Plans demonstration), Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNPs), and Aligned Dual Eligible Special Needs Plans. MLTSS adoption typically enables D-SNP alignment, which provides additional integration opportunities.

Example 4: Doris, 70, Augusta, ICWP enrollee with physical disability

Doris is a 70-year-old woman living in Augusta. She has multiple sclerosis and uses a power wheelchair. She qualified for the Independent Care Waiver Program (ICWP) and receives personal support services, skilled nursing, and other supports.

Under Georgia's current FFS system, Doris's ICWP services are coordinated by an ICWP case manager and paid by Georgia Medicaid on a fee-for-service basis. ICWP serves a specialized population (adults with severe physical disabilities) with specific service needs.

Under a hypothetical MLTSS system, Doris would be enrolled in an MLTSS MCO. The MCO would coordinate her care across her medical specialists (neurologist, physiatrist, etc.), her personal support services, and her other supports. The MCO would need to maintain network capacity for specialized services for adults with physical disabilities.

A key consideration for ICWP-eligible individuals under MLTSS would be whether the MCO maintains adequate networks of specialized providers for physical disability populations. ICWP currently operates with a specialized provider network that has expertise in serving adults with severe physical disabilities. Building and maintaining such specialized networks within MLTSS is a key implementation challenge.

Example 5: Henry, 45, Albany, NOW developmental disability waiver enrollee

Henry is a 45-year-old man with intellectual disability living in Albany. He receives day services and community living supports under the New Options Waiver (NOW). His care is coordinated through DBHDD's regional office.

Under Georgia's current FFS system, Henry's NOW services are administered by DBHDD and paid by Georgia Medicaid on a fee-for-service basis. The NOW waiver is operated as a partnership between DCH (Medicaid agency) and DBHDD (operating agency). DBHDD provides specialized expertise in serving individuals with developmental disabilities through its regional offices and contracted provider network.

In states with MLTSS for developmental disability populations, the MCO would take on the coordination role that DBHDD currently performs. However, many states that have MLTSS for older adults and physical disability populations have NOT extended MLTSS to developmental disability populations, recognizing the specialized nature of DD services. North Carolina's Tailored Plans (implemented in 2024) represent one of the more comprehensive efforts to integrate I/DD populations into managed care. Other states have chosen to keep DD services in specialized waiver programs separate from MLTSS.

This is one option Georgia could consider if it were to implement MLTSS: implementing MLTSS for older adult and physical disability populations while keeping NOW and COMP in their current specialized structure with DBHDD administration.

Example 6: Frances, 85, Columbus, considering nursing facility

Frances is an 85-year-old widow living in Columbus. She has been declining in functional ability and her family is considering nursing facility placement versus continued home care with HCBS waiver support. Her income is $1,600 per month and she has limited resources, qualifying for Medicaid.

Under Georgia's current FFS system, the decision between nursing facility and HCBS is driven by factors including the availability of HCBS waiver slots (waiting lists exist for several waivers), Frances's care needs, family caregiver capacity, and family preferences. There is no inherent financial incentive within the FFS system to favor HCBS over nursing facility care. The CCSP or SOURCE waiver could potentially serve Frances at home, but the decision would depend on slot availability, family preferences, and Frances's care needs.

Under a hypothetical MLTSS system, the MCO would have a financial incentive to favor HCBS over nursing facility care because HCBS is less expensive than nursing facility care. The MCO would provide enhanced care coordination to support Frances's continued community living, potentially including additional HCBS, family caregiver supports, and care planning. The MCO would also be responsible for ensuring that any decision about nursing facility placement is made through person-centered planning that respects Frances's preferences.

This example illustrates the rebalancing potential of MLTSS. Frances's continued community living, if possible and consistent with her preferences, would benefit both Frances (community living is generally preferred by beneficiaries) and the state (community living is typically less expensive than nursing facility care).

Frequently asked questions

::: accordion

What is Managed Long-Term Services and Supports (MLTSS)?

Managed Long-Term Services and Supports (MLTSS) is a federal Medicaid framework under which states deliver long-term services and supports through managed care organizations rather than through traditional fee-for-service Medicaid. Under MLTSS, the state pays the managed care organization a capitated per-member per-month payment, and the managed care organization is responsible for arranging and paying for LTSS for enrolled beneficiaries. MLTSS includes both institutional services (nursing facility care, ICF/IID services) and home and community-based services.

Does Georgia have MLTSS?

No. Georgia does not currently operate an MLTSS program. Georgia's LTSS framework operates through traditional fee-for-service Medicaid combined with five Section 1915(c) HCBS waivers (Community Care Services Program, Service Options Using Resources in a Community Environment, Independent Care Waiver Program, New Options Waiver, and Comprehensive Supports Waiver Program). The four Georgia Families Care Management Organizations (Amerigroup Community Care, CareSource Georgia, Peach State Health Plan, and Wellpoint Georgia) cover only acute and primary care services, not LTSS.

How many states have MLTSS?

Approximately 24 states operate MLTSS programs as of 2024, covering some or all of their LTSS populations. Examples include Arizona (ALTCS, since 1988), Tennessee (CHOICES, since 2010), Texas (STAR+PLUS, since 1998), Florida (SMMC LTC, since 2013), New York (MLTC, since 1998), New Jersey (since 2014), Virginia (CCC Plus, since 2017), Pennsylvania (Community HealthChoices, since 2018), California (CalAIM, since 2022), and North Carolina (Tailored Plans, since 2024).

What is the federal authority for MLTSS?

The federal authority for MLTSS rests primarily on Section 1932 of the Social Security Act (general managed care authority), Section 1915(b) (mandatory managed care waivers), Section 1915(c) (HCBS waivers), and Section 1115 (demonstration waivers). States typically use either a Section 1915(b)(c) combined waiver or a Section 1115 demonstration to implement MLTSS. Federal regulations are at 42 CFR Part 438 (managed care) and 42 CFR 441.300-.310 (HCBS waivers).

What is CMS State Medicaid Director Letter SMD 13-005?

CMS State Medicaid Director Letter SMD 13-005, issued on May 21, 2013, provides comprehensive guidance on MLTSS implementation. SMD 13-005 establishes 10 key elements for successful MLTSS programs, including adequate planning, stakeholder engagement, enhanced HCBS provision, alignment of payment structures, beneficiary supports, person-centered processes, comprehensive service packages, qualified providers, participant protections, and quality. SMD 13-005 remains the primary federal guidance on MLTSS program design.

How do MLTSS capitation rates work?

Under MLTSS, the state pays the managed care organization a capitated per-member per-month payment to provide all covered services for the enrollee. Federal regulations at 42 CFR 438.4 require capitation rates to be actuarially sound, meaning the rates must be developed in accordance with generally accepted actuarial principles and practices, must be appropriate for the populations and services covered under the contract, and must be approved by CMS. Capitation rate development typically considers historical utilization and cost data, projected utilization changes, MCO administrative costs, and risk margins.

What are the beneficiary protections in MLTSS?

MLTSS includes comprehensive beneficiary protections under 42 CFR Part 438, including (1) grievance and appeal rights at 42 CFR 438.400-.424, including the right to appeal MCO decisions and request a state fair hearing; (2) network adequacy standards at 42 CFR 438.68; (3) beneficiary support systems at 42 CFR 438.71, including choice counseling and ombudsman services; (4) access standards at 42 CFR 438.206-.210; (5) quality strategy at 42 CFR 438.340; and (6) continuity of care protections during transitions.

How does MLTSS support rebalancing from institutional to HCBS?

MLTSS supports rebalancing because the MCO receives a capitated payment regardless of where services are provided. Because HCBS is typically less expensive than nursing facility care, MCOs have a financial incentive to provide services in community-based settings rather than institutional settings (when consistent with beneficiary preferences and care needs). This financial incentive aligns with federal priorities supporting community-based care, including the Olmstead Supreme Court decision, the Money Follows the Person demonstration, and the HCBS settings rule.

Why has Georgia not adopted MLTSS?

Georgia has not adopted MLTSS for several reasons including (1) Georgia has a well-developed fee-for-service LTSS infrastructure with five HCBS waivers and established provider networks; (2) the four Georgia Families CMOs have limited LTSS experience and would need to build LTSS capacity; (3) various stakeholders have varied positions on MLTSS, with some advocates expressing concerns about MLTSS implementation in other states; (4) the Georgia General Assembly has not directed DCH to implement MLTSS; (5) DCH would need to expand administrative capacity to implement MLTSS; and (6) Georgia's recent Medicaid reform focus has been on the Pathways to Coverage Section 1115 demonstration.

How would MLTSS implementation work in Georgia if it were adopted?

If Georgia were to adopt MLTSS, the typical implementation process would include: (1) policy analysis and stakeholder engagement; (2) program design including target populations, covered services, MCO contracting approach, and capitation rate methodology; (3) federal authority through a Section 1915(b)(c) combined waiver or Section 1115 demonstration; (4) MCO procurement through a competitive RFP process; (5) phased implementation by region or population; and (6) ongoing operations including monitoring, quality reporting, and rate updates. The total timeline from initial decision to full implementation is typically 3-5 years.

What populations would MLTSS likely cover in Georgia?

If Georgia were to adopt MLTSS, it could cover various populations including older adults requiring nursing facility level of care, adults with physical disabilities requiring nursing facility or hospital level of care, dual eligibles, and potentially individuals with developmental disabilities (although many MLTSS states have kept DD populations in specialized waivers separate from MLTSS). Specific population coverage decisions would depend on Georgia's policy choices.

How would MLTSS affect Georgia's existing HCBS waivers?

If Georgia were to adopt MLTSS, the HCBS waiver services would typically be integrated into the MCO benefit package. CCSP and SOURCE services (for older adults and physical disability populations) would likely be integrated into MLTSS for those populations. ICWP services (for adults with severe physical disabilities) could also be integrated. NOW and COMP services (for individuals with developmental disabilities) would depend on whether Georgia chose to include DD populations in MLTSS. The waivers might continue to exist as the legal authority for HCBS within the MLTSS contract, but with MCO administration replacing the current case management structure.

What is Georgia Families managed care and how does it differ from MLTSS?

Georgia Families is Georgia's existing managed care program for non-LTSS Medicaid beneficiaries. It includes four Care Management Organizations (Amerigroup Community Care, CareSource Georgia, Peach State Health Plan, and Wellpoint Georgia). Georgia Families covers acute and primary care services including physician services, hospital services, pharmacy, behavioral health, and other primary care services. Georgia Families does NOT cover LTSS. MLTSS would be a separate or expanded managed care program that includes LTSS in the covered benefit package.

How do MLTSS and Medicare integration work together?

For dually eligible beneficiaries (those eligible for both Medicare and Medicaid), MLTSS often involves integration with Medicare Advantage through Dual Eligible Special Needs Plans (D-SNPs). MLTSS adoption typically enables D-SNP alignment, which provides additional integration opportunities. CMS has developed several integration models for dual eligibles, including Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs), Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNPs), and Aligned Dual Eligible Special Needs Plans. Integration improves care coordination for dual eligibles, who often experience fragmentation between Medicare and Medicaid services.

What is the HCBS settings rule and how does it apply to MLTSS?

The HCBS settings rule, codified at 42 CFR 441.530 and finalized on January 16, 2014, establishes federal requirements for HCBS settings. The rule requires HCBS settings to be integrated in the community, support full access to the greater community, ensure the individual receives services in the community to the same degree as individuals not receiving Medicaid HCBS, optimize but not regiment individual initiative and autonomy, and facilitate individual choice. The HCBS settings rule applies to all HCBS, including HCBS provided under MLTSS. MLTSS programs must ensure that HCBS settings used by the MCO comply with the settings rule.

What is person-centered planning and how does it apply in MLTSS?

Person-centered planning is a process for developing a service plan that reflects the individual's preferences, goals, and needs. Federal regulations at 42 CFR 441.301 require person-centered planning for HCBS waivers, including HCBS provided under MLTSS. Under person-centered planning, the individual is the focus of the planning process. The plan is developed collaboratively with the individual, their family or representative (as appropriate), and providers. The plan reflects the individual's preferences and choices, identifies needed services and supports, and includes outcomes and goals.

What are the quality requirements for MLTSS?

MLTSS quality requirements include (1) MCO Quality Assessment and Performance Improvement (QAPI) programs at 42 CFR 438.330; (2) state Medicaid managed care quality strategy at 42 CFR 438.340; (3) external quality review at 42 CFR 438.358; (4) performance measurement including HCBS quality measures; and (5) performance improvement projects. Specific MLTSS quality measures include measures of HCBS access and utilization, beneficiary experience, person-centered planning, and rebalancing.

What is the Money Follows the Person program and how does it relate to MLTSS?

The Money Follows the Person (MFP) demonstration program, established by Section 6071 of the Deficit Reduction Act of 2005 and renewed multiple times since, provides enhanced federal financial participation to states for transitioning Medicaid beneficiaries from institutions to community settings. MFP supports state rebalancing efforts. MLTSS aligns with MFP goals by creating financial incentives for community-based care. Georgia participated in MFP from 2008 to 2020, transitioning over 800 individuals from institutions to community settings.

What is the Balancing Incentive Program and how does it relate to MLTSS?

The Balancing Incentive Program (BIP), established by Section 10202 of the ACA, provided enhanced federal financial participation to states that spent less than 50 percent of LTSS expenditures on HCBS. BIP operated from 2011 to 2015 and supported state efforts to rebalance LTSS spending toward HCBS. BIP-participating states made structural reforms including no-wrong-door systems, conflict-free case management, and core standardized assessments. Georgia did not participate in BIP.

How do I find out more about Georgia's LTSS options?

For information about Georgia's LTSS options, contact (1) the Department of Community Health Medicaid Member Services at 1-866-211-0950 for general Medicaid information; (2) the Division of Aging Services Aging and Disability Resource Connection (ADRC) at 1-866-552-4464 for information about HCBS waivers and aging services; (3) the Department of Behavioral Health and Developmental Disabilities at 1-855-660-4357 for information about NOW and COMP waivers; (4) your local Area Agency on Aging for information about CCSP and SOURCE; or (5) Brevy's other Georgia Medicaid guides for detailed information about LTSS, HCBS waivers, nursing facility care, and related topics.

Would MLTSS reduce waiting lists for HCBS waivers in Georgia?

The impact of MLTSS on HCBS waiver waiting lists depends on program design. MLTSS itself does not automatically eliminate waiting lists, because waiting lists reflect funding limits set by the state legislature. However, MLTSS can support waiting list reduction in several ways: (1) MCOs have financial incentive to provide HCBS rather than nursing facility care, which can support HCBS expansion; (2) MLTSS may use capitated payment to fund a broader population, replacing waiver-by-waiver funding; and (3) MLTSS may align with state policy decisions to expand HCBS access. The Georgia waiting lists (particularly for NOW and COMP) would depend on policy and funding decisions, with MLTSS being one tool among many.

:::

Contacts and resources

::: cta

Get help with Georgia Medicaid long-term services and supports

If you need help understanding Georgia Medicaid LTSS options, the following contacts and resources are available:

• DCH Medicaid Member Services: 1-866-211-0950 (general Georgia Medicaid information and member services)
• DAS Aging and Disability Resource Connection (ADRC): 1-866-552-4464 (Division of Aging Services Aging and Disability Resource Connection, the entry point for HCBS waiver information for older adults and adults with disabilities)
• DCH HCBS Waiver Unit: Contact through DCH main number for waiver-specific information
• DBHDD Customer Service: 1-855-660-4357 (Department of Behavioral Health and Developmental Disabilities, for NOW and COMP waiver information)
• DFCS Customer Service: 1-877-423-4746 (Division of Family and Children Services, the state agency that processes Medicaid applications)
• Georgia Gateway: gateway.ga.gov (online portal for Medicaid applications, renewals, and case management)
• AARP Georgia: 1-866-295-7283 (advocacy and education for older adults)
• Georgia Long-Term Care Ombudsman: 1-866-552-4464 (advocacy for residents of long-term care facilities)
• Atlanta Regional Commission Area Agency on Aging: Local area agency on aging for metro Atlanta
• Georgia Legal Services Program: 1-800-498-9469 (legal assistance for low-income individuals)
• 211 Georgia: 2-1-1 (statewide information and referral service)
• CMS Region IV: Contact through CMS Region IV main number for federal Medicaid oversight matters in the Southeast
• ADvancing States (formerly NASUAD): National association supporting state aging and disability agencies
• ADvancing States MLTSS Institute: National resource on MLTSS program design and implementation
• National Council on Aging: National advocacy organization for older adults :::

Final notes

Georgia Medicaid's approach to long-term services and supports operates through traditional fee-for-service Medicaid combined with five Section 1915(c) HCBS waivers (Community Care Services Program, Service Options Using Resources in a Community Environment, Independent Care Waiver Program, New Options Waiver, and Comprehensive Supports Waiver Program). Georgia has not adopted Managed Long-Term Services and Supports (MLTSS), the federal framework under which approximately 24 states deliver LTSS through managed care organizations with capitated payment and care coordination. Georgia Families managed care, operated by four Care Management Organizations (Amerigroup Community Care, CareSource Georgia, Peach State Health Plan, and Wellpoint Georgia), covers only acute and primary care services and does not include LTSS. Understanding the federal MLTSS framework under Section 1932 of the Social Security Act and Section 1915(b)(c) combined waivers and Section 1115 demonstrations, the policy considerations for and against MLTSS adoption, and Georgia's current fee-for-service LTSS framework helps families navigate the Georgia LTSS system and engage with state policy discussions about LTSS reform.

This article is part of a comprehensive series on Georgia Medicaid published by Brevy. We are committed to providing accurate, up-to-date information for Georgia families navigating Medicaid eligibility, enrollment, benefits, and appeals. Visit brevy.com for more guides and resources.

This article is for informational purposes only and does not constitute legal, financial, or medical advice. Brevy is a digital ally, not a substitute for professional legal or financial counsel. Federal and state Medicaid rules change frequently. For questions specific to your situation, consult with the Georgia Department of Community Health, the Division of Family and Children Services, the Division of Aging Services, the Department of Behavioral Health and Developmental Disabilities, or a qualified attorney or financial advisor.