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MLTSS Enrollees With Capitation Payments but No Long-Term Care Services Provided

Managed long-term service and supports (MLTSS) programs annually serve approximately 2 million Medicaid enrollees with cognitive or functional limitations, accounting for $72.5 billion of spending in 2022. It is crucial to ensure that MLTSS enrollees receive the care they need and that plans deliver value for the taxpayer dollars they receive. Prior OIG work has found that some MLTSS plans received capitation payments for enrollees who did not receive any long-term care services. This study will determine the extent to which States made capitation payments to MLTSS plans for enrollees who were not provided any long-term care services, as well as the dollar value of such capitation payments, at a national level.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2025 CMS MLTSS Enrollees With Capitation Payments but No Long-Term Care Services Provided Office of Evaluation and Inspections OEI-05-25-00270 2027