Skip to main content
U.S. flag

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Beta This is a new resource

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

Announced on  | Last Modified on  | Project Number: OEI-05-25-00270
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

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.

TIMELINE

  • July 15, 2025
    Announced
  • Today
    Office of Evaluation and Inspections In-Progress
  • Est FY2027
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Managed Care
Target Groups
Elderly
Financial Groups
Medicaid