2025 Summit Resources
MLTSS Association Resources
This fact sheet highlights key data and program updates from featured states showcased at the 2025 MLTSS Leadership Summit. Each profile summarizes the structure and evolution of Medicaid Managed Long-Term Services and Supports (MLTSS) programs, including major policy changes, managed care organizations, and integration efforts for dually eligible individuals. Quick metrics—such as enrollment figures, LTSS utilization, and HCBS spending—offer a snapshot of each state’s approach to advancing coordinated, person-centered care.
MLTSS Association Report on Strengthening the Direct Care Workforce
This report captures emerging promising practices for MLTSS MCOs and providers to optimize the direct care workforce, as well as policy solutions for states and the federal government to facilitate and scale these practices more broadly.
​State Medicaid and Medicare Integration Scenarios - New York
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State Medicaid and Medicare Integration Scenarios - Pennsylvania.pdf
The MLTSS Association and SNP Alliance collaborated to develop state-scenario slides analyzing how the CY 2025 Medicare Advantage and Part D Final Rule could impact D-SNPs and state programs. These slides highlight the unique characteristics, challenges, and potential implications of the finalized changes for three states: New York, Pennsylvania, and Tennessee.
The MLTSS Association created two new educational resources, including an overview of the MLTSS Association and a primer on MLTSS & Integrated Care. These resources are intended to provide foundational information on these topics and to introduce the MLTSS Association’s key objectives.
The MLTSS Association released a resource comparing different integrated care options for dually eligible individuals across nine key domains. This educational resource highlights the key features, benefits, and challenges of each model. Ultimately, the MLTSS Association believes that D-SNPs are the only truly integrated and scalable model available for dually eligible individuals. We believe that the expertise, experience, and expansive reach of the D-SNP model can support its continued growth and evolution as the primary pathway for integrated care for dually eligible individuals.
The MLTSS Association created an educational resource containing common challenges with State Medicaid Agency Contracts (SMACs) and considerations for states. SMACs are contracts between states and Medicare Advantage Organizations (MAOs) operating dual eligible special needs plans (D-SNPs). SMACs are required for all D-SNPs, and must contain certain elements, such as the Medicaid benefits covered under the D-SNP, cost-sharing protections covered under the D-SNP, and the dually eligible populations that are eligible to enroll in the D-SNP. States can also choose to include additional requirements in their SMACs to align with the state’s integration goals.
State Medicaid Agency Contracts (SMACs) are contracts between states and Medicare Advantage Organizations (MAOs) operating Dual Eligible Special Needs Plans (D-SNPs) – a type of Medicare Advantage (MA) plan designed specifically for individuals who are eligible for both Medicare and Medicaid. D-SNPs are the only type of MA plan required to have a SMAC, due to the unique role that states play in the design and oversight of these plans. D-SNPs must develop and execute their SMACs on an annual basis - a process that requires significant coordination between state Medicaid agencies and health plans. D-SNPs must also adhere to annual MA contracting processes in accordance with Federal requirements. Often, these processes are not aligned, causing a range of operational, regulatory, and programmatic issues for D-SNPs.
In an effort to support health plans, state Medicaid agencies, and CMS, the MLTSS Association and the SNP Alliance developed a recommended SMAC Development Timeline that combines annual Medicare and Medicaid contracting requirements into one process.
Developed by the Long-Term Quality Alliance (LTQA), in partnership with the MLTSS Association, highlights promising practices for MLTSS plans to support family caregivers
Summit Slides
General Session: Retrofitting Managed Care to Customizing Supports & Improving Outcomes for IDD and Other Complex Health Populations (General Session slides)
Individuals with intellectual and developmental disabilities (I/DD) represent about one-quarter of the nation’s LTSS population and nearly three-quarters of all Medicaid waiver spending. Roughly one million people currently receive LTSS through state I/DD agencies, while another 175,000 wait for Home and Community-Based Services (HCBS) funding—an 18% increase in state LTSS capacity would be needed to serve them all.
This session highlights how providers, technology partners, health plans, and state regulators are advancing innovative strategies to improve access, quality, and outcomes of HCBS for individuals with I/DD and their family caregivers.
Breakout: Is This a Sprint or a Marathon? Integrated Care, Where We’ve Been, and Where We’re Going (Breakout slides)
D-SNP plans are preparing for numerous, major policy changes and market disruptions over the next few years, as previously issued regulations come into effect, the MMP program ends, and as new policies are issued by the Trump Administration. This session will spur a provocative conversation about the current national landscape related to trends in declining MA plan coverage, changes at CMMI, and how health plans should be preparing for and rising to the occasion to meet these new challenges. We will share lessons learned across several markets, promising strategies for engaging with state leaders on these issues, and tactical steps necessary for continuing to deliver person-centered, innovative, and integrated care for dually eligible members during fiscally challenging times.
Breakout: Partnering for Health: Enhancing Outcomes through Managed Care and PERS Provider Collaboration  (Breakout slides)
70% of avoidable expenses are related to unnecessary ED and inpatient utilization, with the vast majority originating in the home.   This session explores what happens when Managed Care plans partner with PERS providers to integrate real-time data from the home into the care model - lower ED utilization, PMPM savings, and improved outcomes for members.  
Breakout: Elevating Natural Supports During the Workforce Crisis (Breakout slides)
This interactive working session explores the growing role of natural supports—family, friends, and community members—amidst today’s LTSS workforce crisis. Together, we will define natural supports, examine emerging trends in caregiving, and review best practices for engaging and sustaining caregivers. Through a case study and collaborative discussion, participants will identify strategies to identify natural supports, meet their diverse needs, and integrate them as essential partners in care. The session is designed to surface practical solutions that strengthen both caregivers and the LTSS system during a time of workforce shortages.
Breakout: Expanding Self-Direction: Empowering Members, Strengthening Plans (Breakout slides)
This session explores how expanding self-direction empowers members to take greater control of their care, leading to improved compliance, satisfaction, and health outcomes. By enabling members to hire and manage their own caregivers, MCOs benefit from reduced missed shifts, enhanced continuity of care, and improved financial performance. Learn how self-direction strengthens plan operations while centering member choice and autonomy.