What is the difference between URAC Medicaid with LTSS Accreditation and URAC Medicaid Health Plan Accreditation?

URAC Medicaid Health Plan Accreditation evaluates a plan's quality management, utilization management, network adequacy, member rights, and regulatory compliance for a general Medicaid population. URAC Medicaid with LTSS Accreditation includes all of those core standards plus an LTSS module with standards specific to members requiring long-term care: person-centered care planning, LTSS care coordination across home- and community-based settings, HCBS settings compliance, LTSS-specific network adequacy, LTSS grievance and appeals processes, and quality measurement aligned with CMS MLTSS quality measures. Organizations that manage LTSS populations should pursue the LTSS-specific program.

Which URAC Medicaid accreditation program is right for my organization?

Choose URAC Medicaid Health Plan Accreditation if your plan covers a general Medicaid population without a significant LTSS program — acute care, behavioral health, or pharmacy benefit management without long-term services and supports. Choose URAC Medicaid with LTSS Accreditation if your plan participates in a state MLTSS program, manages members receiving home- and community-based services or nursing facility care, or serves populations with I/DD or physical disabilities. If your plan is expanding from general Medicaid into LTSS, plan for the full LTSS accreditation from the start — transitioning mid-cycle adds preparation burden.

How does URAC Medicaid with LTSS compare to NCQA Medicaid Health Plan Accreditation for LTSS populations?

URAC and NCQA are separate accrediting bodies with different standards frameworks. URAC Medicaid with LTSS Accreditation has an explicit LTSS module that addresses LTSS population management as a distinct standard domain. NCQA Medicaid Health Plan Accreditation incorporates LTSS-related quality measures through its HEDIS and CAHPS measurement sets but does not have a separate LTSS module in the same structural way. State recognition differs: URAC fulfills state health plan accreditation requirements in 15 states, while NCQA has its own state recognition profile. The right choice depends on which body your state and contracts require.

Can my organization hold URAC Medicaid with LTSS Accreditation and NCQA accreditation simultaneously?

Yes. URAC and NCQA are separate accrediting bodies. Holding both is increasingly common among large Medicaid MCOs operating across multiple states with different accreditation mandates. Dual accreditation does not reduce preparation burden — each body has its own standards, application, review process, and cycle — but the operational compliance infrastructure for one program substantially overlaps with the other. IHS consults on both programs and can structure dual engagements to minimize redundant preparation effort.

URAC Medicaid with LTSS vs. Standard Medicaid Health Plan Accreditation

Last updated: April 2026

URAC offers four distinct health plan accreditation programs: commercial Health Plan, Health Plan with LTSS, Medicaid Health Plan, and Medicaid Health Plan with Long-Term Services and Supports. For Medicaid managed care organizations, the pivotal decision is whether the standard Medicaid program or the LTSS-specific program is the right fit. This comparison addresses that question directly.

The Two Programs Defined

URAC Medicaid Health Plan Accreditation

URAC Medicaid Health Plan Accreditation evaluates whether a Medicaid managed care organization has the systems, policies, and operational infrastructure to manage care quality for a standard Medicaid population. Core standard domains include quality management and improvement, utilization management, network management, member rights and responsibilities, regulatory compliance, governance, and performance measurement. This program is appropriate for plans serving acute care, behavioral health, pharmacy benefit, or standard Medicaid populations that do not include a significant long-term services and supports component.

URAC Medicaid with LTSS Accreditation

URAC Medicaid with Long-Term Services and Supports Accreditation includes all core Medicaid Health Plan standards plus an LTSS module. Long-Term Services and Supports are defined as the broad range of paid and unpaid medical and personal care assistance that individuals may need — for weeks, months, or years — when they experience difficulty completing self-care tasks as a result of aging, chronic illness, or disability. The LTSS module adds standards specifically addressing how the plan manages this population's distinct clinical, social, and functional needs. URAC launched this program in November 2021, recognizing that standard Medicaid Health Plan accreditation was not designed for the operational complexity of MLTSS programs.

Side-by-Side Comparison

Dimension	URAC Medicaid Health Plan	URAC Medicaid with LTSS
Target population	General Medicaid members — acute care, behavioral health, pharmacy benefit	Medicaid members requiring long-term care due to aging, chronic illness, or disability; MLTSS plan enrollees
Core Medicaid standards	Yes — full Medicaid Health Plan standard set	Yes — same full core standard set
LTSS module standards	No	Yes — person-centered care planning, LTSS care coordination, HCBS compliance, LTSS network, LTSS grievance/appeals, LTSS quality metrics
Person-centered care planning	General care management requirements	Specific standards requiring individualized plans reflecting member goals, functional needs, and preferences — evaluated through file audits
Network adequacy scope	Clinical providers — physicians, specialists, hospitals, behavioral health	Clinical providers plus LTSS-specific types: personal care attendants, adult day programs, home health agencies, skilled nursing facilities, supported employment providers
HCBS settings compliance	Not a distinct standard domain	Addressed — plans must demonstrate active management of HCBS settings requirements consistent with federal rules
Quality measurement	Plan-defined performance metrics under quality management standards	Core quality management standards plus LTSS-specific metrics aligned with CMS MLTSS quality measures
Grievance and appeals	Standard member grievance and appeals processes	Processes specifically adapted for LTSS dispute types: service hour reductions, provider terminations, transition disputes
Preparation timeline	12–15 months typical, full cycle	12–18 months typical — additional lead time for LTSS-specific operational compliance
State recognition	15 states recognize URAC for health plan accreditation requirements	Same 15 states — AR, CT, FL, IA, MI, MN, MT, ND, NJ, NM, NV, OK, TX, UT, VT
Document upload burden	Reduced by 50%+ in updated program	Reduced by 50%+ in updated program — same efficiency improvement applies
Typical applicants	MCOs with standard Medicaid contracts; commercial health plans adding Medicaid; behavioral health plans	MLTSS plan participants; plans serving I/DD, physical disability, or dual-eligible populations; plans entering MLTSS state procurements

How to Choose the Right Program

Choose URAC Medicaid Health Plan Accreditation if:

Your Medicaid plan does not currently participate in a state MLTSS program
You serve standard acute care, behavioral health, or pharmacy benefit Medicaid populations
LTSS services are not a significant component of your current membership or contract obligations
Your state's accreditation mandate references health plan accreditation without LTSS-specific requirements
You are pursuing initial URAC accreditation and plan to add LTSS capabilities in a future cycle

Choose URAC Medicaid with LTSS Accreditation if:

Your plan holds or is pursuing an MLTSS state contract
You serve members receiving home- and community-based services, nursing facility care, personal care attendant services, or supported employment
Your membership includes individuals with I/DD, physical disabilities, or dual Medicare-Medicaid eligibility
Your state procurement criteria for MLTSS contracts reference LTSS-specific accreditation or quality standards
You are competing for a new MLTSS contract and need to differentiate on demonstrated quality infrastructure
CMS or your state is increasing scrutiny of LTSS quality measurement and you need a third-party validation framework

Plan for the LTSS program from the start if you are expanding into LTSS:

Organizations that achieve standard Medicaid Health Plan accreditation and later transition to an MLTSS contract face a choice: operate under standard accreditation (which does not cover LTSS-specific standards) or pursue the LTSS program mid-cycle. The LTSS module requires operational lead time to generate compliant evidence — transitioning mid-cycle is possible but adds preparation burden. If your organization has a clear path toward MLTSS participation, targeting the LTSS program from initial accreditation is more efficient.

URAC Medicaid with LTSS vs. NCQA Medicaid Health Plan Accreditation for LTSS Populations

For organizations operating in the MLTSS space, the question is sometimes not URAC Medicaid vs. URAC Medicaid with LTSS — it is URAC vs. NCQA. The comparison below addresses that question for LTSS-specific context.

Dimension	URAC Medicaid with LTSS	NCQA Medicaid Health Plan
LTSS-specific module	Yes — explicit LTSS module as a distinct standard domain	LTSS-related quality measures incorporated through HEDIS and CAHPS; no separate LTSS module
Person-centered care planning standards	Explicit LTSS module standard — evaluated through file audits	Addressed through care management and quality measurement standards
State recognition	15 states recognize URAC for health plan accreditation	NCQA has its own state recognition profile — varies by state
Standards framework	URAC standards — policy-and-process oriented, documentation-heavy review	NCQA standards — measurement-oriented, HEDIS and CAHPS data-driven evaluation
Review process	Documentation review + validation review with leadership interviews	Desktop review + HEDIS/CAHPS performance data submission + Interactive Survey Tool
Can hold both simultaneously	Yes — separate bodies, separate programs, separate cycles. Dual accreditation is increasingly common among large MLTSS plans.
IHS consulting available	Yes	Yes

The right choice depends on which body your state and managed care contracts require. Many large MLTSS plans hold both — URAC fulfills requirements in some states and contracts, NCQA fulfills others. IHS can help you map your specific state and contract requirements to the appropriate accreditation strategy.

Not Sure Which Program Fits Your Organization?

IHS helps Medicaid managed care organizations determine the right accreditation strategy before committing preparation resources. In a discovery session, we review your current contracts, state requirements, LTSS program scope, and operational readiness to recommend the correct program — and the realistic timeline to achieve it.

IHS is led by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC. There is no substitute for that depth of knowledge when mapping a URAC accreditation strategy.

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