What is MLTSS, and how do its members get rides?
MLTSS, or managed long-term services and supports, is the delivery of nursing facility care and home and community-based services through capitated Medicaid managed care. About 1.9 million people used MLTSS as of July 1, 2024. Depending on the state, members get medical rides from their plan or a separate broker, and non-medical rides in their service plan from the MLTSS plan.
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What MLTSS means
Long-term services and supports are the help people with a functional limitation or chronic illness need to live or work where they choose, such as nursing facility care and home and community-based services. MLTSS delivers them through capitated Medicaid managed care. CMS describes two forms:
- Comprehensive plans that cover long-term care along with medical care.
- MLTSS-only plans, run as prepaid inpatient or ambulatory health plans, that cover long-term care alone.
The services themselves are authorized under other rules, such as 1915(c) waivers or 1915(i), (j), and (k) state plan options. CMS counted about 1.9 million MLTSS users nationwide as of July 1, 2024, up from 1.8 million in 2023.
Federal rules give long-term care its own network standards. A state whose plans cover it must set numeric network adequacy standards for long-term care provider types, and weigh member choice and community living when it does. See network adequacy.
Two kinds of rides
An MLTSS member can need two different trips, and they may run through different doors.
| Ride | Purpose | Who arranges it |
|---|---|---|
| Non-emergency medical transportation | Getting to Medicaid-covered medical care | The plan when rides are carved in, or a separate state or county program when carved out |
| Non-medical transportation | Community activities written into the member’s service plan | The MLTSS plan, when the state includes it in the benefit |
Tennessee: one plan for everything
TennCare is an integrated, full-risk managed care program. At-risk health plans cover medical care, behavioral health, and long-term services and supports, and the CHOICES program brought long-term care into that model in 2010. Rides follow the same path. Members book through their health plan’s ride vendor. BlueCare and TennCare Select members call Verida, while UnitedHealthcare and Wellpoint members call Tennessee Carriers. Trips must be booked at least two business days ahead unless the appointment is confirmed as urgent.
Pennsylvania: the plan and the county split the work
Pennsylvania’s Community HealthChoices agreement for 2026 divides rides this way:
- The plan provides emergency ambulance, medically necessary non-emergency ambulance, non-emergency medical transportation for nursing facility residents, and specialized trips, including for participants who are stretcher-bound.
- The plan also provides non-medical transportation to every participant who needs a nursing facility level of care, as listed in the person-centered service plan, and must deliver at least 86 percent of requested trips as authorized.
- The county’s Medical Assistance Transportation Program arranges all other non-emergency trips to Medicaid-covered and Medicare-covered services, and the plan must coordinate with it.
What it means for a transportation company
- One rider, two payers. In a split state, the same person’s dialysis trip and grocery trip can be booked, authorized, and paid by different organizations. Keep them apart in billing.
- The service plan rules non-medical trips. Confirm the trip is authorized in the member’s plan before you run it.
- Medicare counts too. Long-term care members can also have Medicare, as dual eligible members do, and Pennsylvania’s county program covers trips to Medicare-covered services as well as Medicaid ones.
Repeating trips
When a service plan authorizes the same trip every week, such as rides to an adult day center, you can schedule it once in HealthRide and it builds the trips weeks ahead. Each trip is priced with the payer rate that applies to it. See recurring trips.
Frequently asked questions
- Is MLTSS the same thing as a waiver program?
- No. A waiver or state plan option, such as a 1915(c) waiver, authorizes the long-term care services. MLTSS is the way they are delivered: through managed care plans paid by capitation instead of fee-for-service. A state can run its 1915(c) waiver services through managed care by pairing the waiver with a managed care authority.
- Who arranges rides for a nursing facility resident in an MLTSS plan?
- It depends on the state. Under Pennsylvania's 2026 Community HealthChoices agreement, the plan must provide non-emergency medical transportation for nursing facility residents, along with specialized trips such as stretcher transport. In Tennessee, TennCare members book rides through their health plan's ride vendor.
- Do MLTSS plans cover rides that are not for medical care?
- Some do. States may cover non-medical transportation for people receiving home and community-based services, and some put it in the MLTSS plan's benefit. Pennsylvania's plans must give non-medical transportation to every participant who needs a nursing facility level of care, for trips such as community activities, grocery shopping, religious services, adult day centers, and work. Plans must deliver at least 86 percent of those trips as authorized.
- Which states use MLTSS?
- In CMS's 2024 managed care report, states reporting members who used long-term care through managed care included Arizona, Florida, New York, Pennsylvania, Tennessee, Texas, Virginia, and Wisconsin. Arizona, Michigan, New York, and Wisconsin reported most of those members in plans that cover only long-term care, rather than full health plans.
