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New MLTSS Association Report Outlines Opportunities for MCOs to Support the Direct Care Workforce


WASHINGTONSept. 20, 2023PRLog — A new report from the National MLTSS Health Plan Association (MLTSS Association) provides a novel framework for how states with managed long-term services and supports (MLTSS) programs and the federal government can leverage the role of MLTSS managed care organizations (MCOs) to bolster the direct care workforce (DCW).

Despite increased demand for long-term services and supports (LTSS), a shortage of direct care workers remains a significant challenge for individuals needing LTSS, states, MCOs, providers, and workers themselves. Between 2020 and 2030, 7.9 million new and existing direct care positions will need to be filled. As a result, individuals with disabilities are waiting longer, receiving lower quality services, and relying more on informal caregivers for the supports they need.

“The COVID-19 pandemic has exacerbated the Direct Care Workforce shortage and illuminated existing barriers to recruitment and retention, including low wages and limited career development opportunities,” said MLTSS Association Board Chair Chris Palmieri, President and CEO of Commonwealth Care Alliance. “Given the enormity and urgency of this crisis, the message was clear at last year’s MLTSS Leadership Summit – the Association must lead the conversation and create policy solutions to address these workforce challenges.”

In response, in January 2023, the MLTSS Association launched a DCW Workgroup with member health plans charged with offering a unique MCO lens on opportunities to address the direct care worker shortage, including how MCOs can be effective partners in designing and implementing solutions. In its new report, titled “Strengthening the Direct Care Workforce: A Framework for Leveraging the Role of MLTSS MCOs to Address the Workforce Crisis,” the workgroup identifies emerging promising practices for MLTSS MCOs and providers to optimize the direct care workforce, as well as policy solutions for states and the federal government to facilitate and scale these practices more broadly.

“MCOs are directly connected to their established Provider Networks and have many assets—whether it’s data, thought leadership, and/or financial—to contribute, making them well-positioned to strengthen broader efforts at the local, state, and federal levels,” noted DCW Workgroup Co-Chair Rachel Turner Chinetti of Elevance Health. “This is most effective when done in collaboration with other MCOs. It is critical that MCOs step up to take action and share responsibility with other stakeholders to collectively offer new and innovative solutions on how to support the direct care workforce.”

The Association’s framework includes five key domains for policy solutions: Recruitment, Retention, Data Collection, Workforce Alternatives, and Elevating the Social Value of DCW’s Impact, with informal caregivers, technology, and flexible funding models braided across all domains. The report also outlines eight key principles underpinning the framework to ensure successful implementation: Collaboration & Shared Responsibility; Alignment with Local, State, and Federal Initiatives; Centering the DCW Voice; Equity; Person-Centered Planning; Informal Caregivers; Technology; and Flexible Funding Models.

“I commend the MLTSS Association for its leadership and vision in developing this comprehensive framework for how MCOs can have a meaningful impact on strengthening the direct care workforce, including workforce alternatives that value and prioritize opportunities for independence and supports that help to empower independence in the lives of those we serve,” remarked Patti Killingsworth, former Chief of LTSS at TennCare and current Chief Strategy Officer at Carebridge Health. “It is significant to see a health plan association come forward with a call to action for MCOs to invest in and collaborate on workforce solutions in partnership with states and providers. I strongly urge all relevant groups, particularly state LTSS leaders, to review the rich information and actionable solutions outlined in this report.”

To read the report in full, visit…


The National MLTSS Health Plan Association is the leading organization in Washington, DC promoting Medicaid managed long-term services and supports (MLTSS) and integrated care. We represent health plans that contract with states to provide long-term services and supports to individuals through the Medicaid program. For more information, visit

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