# What Is MLTSS? Managed Long-Term Services and Supports and the Rides They Pay For

Canonical URL: https://nemtguide.com/glossary/mltss/ · Updated 2026-10-04

MLTSS, or managed long-term services and supports, is Medicaid long-term care, such as home care and nursing home care, delivered through health plans the state pays a set amount per member. MLTSS members can have two ride benefits: NEMT to medical care, and in some programs, such as New Jersey's, non-medical rides to stores, church, and the bank, which the plan buys per trip.

- MLTSS delivers Medicaid long-term care through health plans. CMS counted about 1.9 million users in 24 states and DC on July 1, 2024.
- The ride to a medical visit is always NEMT. Who arranges it depends on the state, not on MLTSS.
- Rides to stores, the bank, or church are a separate long-term care service in some programs, approved in the plan of care and paid by the plan.
- New Jersey sends MLTSS medical rides through Modivcare and has each plan buy community rides per one-way trip under T2003.
- Texas STAR+PLUS plans arrange medical rides through their own ride vendors, and providers must be enrolled in Texas Medicaid first.

Many of the riders who need the most help, older adults and adults with disabilities who qualify for nursing home care, get their Medicaid long-term care through a health plan. That setup is called MLTSS. It can put two ride benefits, and two different payers, behind the same rider.

## What MLTSS means

Medicaid.gov defines managed long-term services and supports (MLTSS) as the delivery of long-term services and supports through capitated Medicaid managed care programs. Long-term services and supports help people with functional limitations or chronic illnesses live or work where they choose: at home, at a job, in a residential setting, or in a nursing facility ([42 CFR 438.2](https://www.ecfr.gov/current/title-42/section-438.2)). The state pays the plan a set amount per member, and the plan arranges the care.

CMS's 2024 managed care report describes two ways a state can run it:

- **Through a full health plan** that covers medical care and long-term care together. New Jersey, Texas, and Florida work this way.
- **Through a plan for long-term care only,** which CMS calls an MLTSS-only program. Wisconsin's Family Care is one.

The managed care part runs under federal authorities such as section 1915(a), 1915(b), or 1115, and can be paired with a [1915(c) waiver](https://nemtguide.com/glossary/1915c-waiver/) that defines the home and community services. A plan that covers the full benefit is a [managed care organization](https://nemtguide.com/glossary/managed-care-organization/).

On July 1, 2024, CMS counted about 1.9 million MLTSS users in 24 states and the District of Columbia. New York reported the most (346,892), then California (312,162), Texas (152,030), and Florida (139,572). Members can have Medicare too. For these [dual eligible](https://nemtguide.com/glossary/dual-eligible/) members, New Jersey says Medicare stays primary, and Texas says they keep seeing their Medicare doctors.

## The two ride benefits an MLTSS member can have

1. **NEMT to medical care.** Medicaid must make sure members can get to covered care. Who arranges that ride depends on how the state runs NEMT, not on MLTSS. It may be a state broker, the health plan's ride vendor, or the long-term care plan itself.
2. **Non-medical rides in the plan of care.** Some programs also pay for rides to places that help a member keep living at home: stores, the bank, church, or a day program. The member's care manager writes them into the plan of care, and the plan pays for them as a long-term care service. They never replace NEMT.

Three states show how differently this plays out.

### New Jersey: a broker for medical rides, the plan for the rest

New Jersey moved its home and community services into NJ FamilyCare health plans on July 1, 2014. Adults 21 and older qualify clinically when they need hands-on help with three or more daily activities, such as bathing, dressing, or transfers, or need supervision and cueing with three or more because of cognitive problems.

- **Medical rides go to the state broker.** Article 4.1.3 of the NJ FamilyCare managed care contract (January 2026) keeps all non-emergency transportation, including wheelchair van (MAV), stretcher, and livery trips, with the state transportation broker for any covered service. That broker is Modivcare. See the [New Jersey guide](https://nemtguide.com/states/new-jersey/).
- **Community rides go to the plan.** The contract's MLTSS service dictionary lists non-medical transportation to places such as stores, a beauty salon, a bank, and religious services, plus trips to tour housing, visit a housing authority, or meet a landlord when a member is looking for a place to live. Family, neighbors, friends, public transit, or community agencies that can help for free come first. The plan pays per one-way trip under [T2003](https://nemtguide.com/glossary/t2003/) (T2003SE when the member self-directs), or per day under T2002.
- **What the plan asks of you.** A valid inspection sticker, proof of liability insurance and the declarations page, civil and criminal background checks on owners and drivers, a description of your vehicles and copies of required licenses, proof of New Jersey business registration (a tax certificate or trade name registration), and your fee schedule.
- **How many companies each plan needs.** Article 4.8.10 requires each plan to contract with at least two providers of each MLTSS home and community-based service to cover every county. Non-medical transportation is one of those services, defined in the contract's MLTSS service dictionary.

### Texas: the plan arranges medical rides

STAR+PLUS is Texas Medicaid managed care for adults with disabilities and adults 65 or older. HHSC lists NEMT among the services STAR+PLUS health plans provide, and members book through their plan's transportation line. HHSC's contact list names the ride vendor and booking number for each plan.

Before a plan or its vendor signs you, you must be enrolled in Texas Medicaid. Section 2200 of HHSC's NEMT handbook (version 2.0.1, effective August 1, 2021) requires it for every demand response provider. See the [Texas guide](https://nemtguide.com/states/texas/).

### Wisconsin: one plan covers both

Wisconsin's 2026 Family Care contract puts both kinds of ride in each managed care organization's benefit package: Medicaid medical transportation, except ambulance, and the waiver's community transportation. DHS's network adequacy standard, P-02542 (April 2024), asks each MCO for one transportation provider per 150 members for each kind. [Wisconsin Family Care transportation](https://nemtguide.com/guides/wisconsin-family-care-transportation/) covers each MCO's way in, including the ones that send rides through a broker.

## How it looks in a real week

Say you hold a Modivcare agreement and a non-medical transportation contract with an NJ FamilyCare plan. An MLTSS member who uses a wheelchair rides with you four days this week:

1. **Monday, Wednesday, and Friday dialysis.** Modivcare assigns the trips. You bill Modivcare under your broker agreement.
2. **Saturday round trip to church.** The care manager has non-medical transportation in the plan of care, and the plan has authorized it. You bill the plan T2003 for two units, one per one-way trip.
3. **A doctor visit added to Saturday.** That leg is NEMT, so it goes through Modivcare, not the plan. Billing it as a church-day T2003 trip would bill the plan for a ride it does not cover.

Keep the authorization, the trip log, and the member's signature for each payer separately. Two payers mean two sets of rules on the same rider.

## How to get MLTSS ride work

1. **Find the plans in your counties.** Your state Medicaid agency lists the plans that serve MLTSS members. In New Jersey, not every plan serves every county, and Texas shows the STAR+PLUS plans available in each service area.
2. **Sort out who buys each kind of ride.** For medical rides, that may be a state broker, a plan's ride vendor, or the plan. For community rides, it is the plan. See [how to contract with Medicaid health plans](https://nemtguide.com/guides/contract-with-medicaid-health-plans/).
3. **Enroll with your state Medicaid program first.** Federal rules make the state screen and enroll every network provider of its health plans ([42 CFR 438.602(b)](https://www.ecfr.gov/current/title-42/section-438.602)), and Texas requires enrollment before a plan or vendor signs you.
4. **Ask each plan's long-term care provider relations team for its non-medical transportation contract.** Have your insurance, background checks, vehicle list, business registration, and per-trip rate ready.
5. **Ask where the plan is short.** A New Jersey county where a plan has fewer than two non-medical transportation providers is below its contract floor. See [network adequacy](https://nemtguide.com/glossary/network-adequacy/).

For waiver rides outside managed care, see [how to become a waiver transportation provider](https://nemtguide.com/guides/waiver-transportation-provider/).

## Frequently asked questions

### Is MLTSS the same as a 1915(c) waiver?

No. A 1915(c) waiver defines home and community services and who qualifies for them. MLTSS is the way those services are delivered: through a health plan the state pays per member. CMS says states run MLTSS under managed care authorities such as 1915(a), 1915(b), or 1115, and can combine them with a 1915(c) waiver.

### Who arranges an MLTSS member's ride to the doctor?

It depends on the state. In New Jersey, Modivcare, the state broker, arranges NJ FamilyCare medical rides, including wheelchair and stretcher trips, and the January 2026 managed care contract keeps them out of the plan's benefit. In Texas, the member's STAR+PLUS plan arranges it through its ride vendor. In Wisconsin, medical rides other than ambulance are part of the Family Care MCO's own benefit, so the MCO or a broker it hires arranges them.

### Can I bill a medical appointment as a non-medical trip?

No. New Jersey's MLTSS service dictionary says non-medical transportation is offered in addition to the medical transportation required under 42 CFR 431.53 and 440.170(a) and does not replace it. Book the medical leg through whoever arranges NEMT for that member, and bill the plan only for trips to places in the plan of care.

### What does an MLTSS plan pay for a non-medical trip?

Your agreement with each plan sets it. New Jersey's contract asks each non-medical transportation provider for its own fee schedule and pays per one-way trip under T2003, or per day under T2002. Ask each plan for its rate before you sign, and price the trip as a whole ride, since the code pays per trip, not per mile.

### Which states run MLTSS?

CMS's 2024 managed care report lists MLTSS users or members, as of July 1, 2024, in Arizona, Arkansas, California, Delaware, the District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Massachusetts, Michigan, Minnesota, New Jersey, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, and Wisconsin.

## Official resources

- [Medicaid.gov: Managed Long-Term Services and Supports](https://www.medicaid.gov/medicaid/managed-care/managed-long-term-services-and-supports)
- [NJ DMAHS: MLTSS for members and providers](https://www.nj.gov/humanservices/dmahs/individuals-families/familycare/mltss/)
- [Texas HHS: STAR+PLUS](https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus)
- [Medicaid.gov: Managed care enrollment reports by state and plan](https://www.medicaid.gov/medicaid/managed-care/enrollment-report)