Long-term Services & Supports

Navigating the complex LTSS system—funded primarily by Medicaid—can be challenging for individuals and their families, who often need access to an array of community-based services across multiple providers to live independently. This applies whether someone transitioning to a community living environment from a nursing home or residential care facility or needing additional supports so they can remain in their community.

In response, Medicaid agencies and healthcare organizations need to provide resources and expertise, such as experienced clinicians and navigators who understand LTSS, so members and patients get what they need to live—and thrive—independently.

We are one of the only organizations that provide such a complete range of LTSS-supportive services to our clients, including facilitating and streamlining eligibility. Led by registered nurse case managers, our multidisciplinary clinical team partners with government agencies, nonprofits, and managed care organizations to help their members and patients access LTSS. With a person-centered approach, we work to understand the services medically complex children and adults require, then coordinate service delivery so they receive skilled care in clinical settings or in the community.

1. 1

   We facilitate and streamline eligibility for and access to LTSS through consultation services, in-person clinical eligibility assessments and determinations, service coordination, case management, and quality care assurance.

2. 2

   Our services promote choice, independence, and quality of life with monitoring, appropriate settings, and access to care.

3. 3

   We offer consistent and accurate decision-making by clinical assessors across all disciplines— service coordination, disease management, and complex case management—reducing medical loss ratio through appropriate authorization of medically necessary services.