State Strategies: Value-Based Payment for Medicaid Populations with Complex Care Needs

Key Questions Answered
  • What are some promising strategies for states to improve payment models for long term services and support (LTSS)?
  • What are some examples of states that have implemented these reforms successfully?
Key Themes and Takeaways

This resource examines Medicaid payment reform strategies for populations who receive LTSS. It includes case studies of state programs in Tennessee, Minnesota, and Arizona. 


  • A growing number of states are implementing value-based payment programs to deliver LTSS to Medicaid populations with complex needs.
  • Payment models include pay-for-performance, supplemental per-member per month payments, shared savings/shared risk, and episode-based payments.
  • Measurement strategies for value-based LTSS payment may need to consider less traditional domains such as quality of life, independence, and functional status.
  • States can support and direct value-based strategies in various ways, including grants or capacity-building opportunities for LTSS providers.
Erin Taylor
Mary Beth Dyer
Michael Bailit
Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Level of Evidence
Promising Evidence
Uploaded to The Playbook