Managed Long-Term Care Terminology
A quick-reference glossary for interpreting conversations about long-term care programs, assessments, and ongoing support services.
Managed long-term care organizes ongoing services for people with functional or health-related support needs. Program names and the services included differ by state. Managed long-term services and supports is a common Medicaid term.
Core concepts and program structure
- Long-term services and supports (LTSS): Services helping people with ongoing needs perform daily activities and participate in community life.
- Managed long-term services and supports (MLTSS): Delivery of LTSS through capitated Medicaid managed care programs.
- Managed long-term care (MLTC): A term used in some states for managed programs arranging long-term care; the exact scope depends on the program.
- Capitation: A payment arrangement in which a plan receives a set payment per enrolled person for a defined period and package of services.
- Home- and community-based services (HCBS): Services supporting people in their homes or communities rather than institutional settings.
- Institutional care: Care delivered in a residential institution, such as a nursing facility.
- Carved-out service: A service handled outside a particular plan’s contracted benefit package, potentially through another payer or program.
Assessment and service planning
- Functional assessment: A review of a person’s ability to carry out daily activities and their support needs.
- Clinical eligibility: Meeting a program’s health or functional criteria.
- Financial eligibility: Meeting applicable income and resource criteria.
- Level of care: The degree or type of assistance and clinical support a person needs under an assessment system.
- Nursing facility level of care: A program-defined level of need used in certain LTSS eligibility decisions; meeting it does not necessarily require living in a nursing facility.
- Person-centered service plan: A plan reflecting the person’s goals, preferences, assessed needs, and agreed services.
- Care manager: A professional helping assess needs, coordinate services, and monitor the care plan.
- Reassessment: A later review to identify changes in needs or service arrangements.
- Authorized service hours: The amount of a service approved under the applicable plan or program.
Services and support
- Personal care: Assistance with activities such as bathing, dressing, and toileting.
- Respite care: Temporary care that gives a regular caregiver a break.
- Adult day services: Daytime supervision, activities, or support provided outside the home.
- Home modification: A change to the home intended to improve access, safety, or function.
- Community transition: A move from an institutional setting to a home or community setting with planned support.
- Informal support: Unpaid help from family, friends, or other people in the member’s support network.
Managed long-term care terminology, covered services, eligibility criteria, and assessment processes vary substantially by state and program. A program representative or care manager can explain the applicable service package. Enrollment in an LTSS plan does not necessarily mean that plan pays for every medical or pharmacy service.