This resource is a toolkit that describes strategies for states to reform their Medicaid LTSS systems.

• Medicaid is the leading payer for LTSS systems, which enable more than 12 million people to meet their personal care needs and live with independence in community and institutional settings.
• States are seeking to reform their Medicaid LTSS systems to improve the quality of care and contain costs.
• This toolkit highlights strategies that states are using to deliver high-quality and high-value LTSS in two key areas: rebalancing LTSS to increase the proportion of LTSS provided in community-based settings and integrating LTSS with physical and behavioral health services through managed care.
• For each strategy identified, this toolkit provides the impetus, a description, implementation mechanisms, results to date, and key lessons. Case studies are also included.