This week, our In Focus section reviews the Commonwealth of Pennsylvania’s Managed Long-Term Supports and Services (MLTSS) Discussion Document, jointly published this month by the Department of Human Services (DHS) and the Pennsylvania Department on Aging (PDA). The discussion document builds on work concluded last year by the Pennsylvania Long-Term Care Commission and Governor Wolf’s proposed FY 2015-2016 budget, serving as an introduction to the state’s current thinking on a model for MLTSS and soliciting stakeholder input. The state’s proposed plan calls for a request for proposals (RFP) in the fourth quarter of 2015, with a phased-in managed care model for around 130,000 users of LTSS services and another 320,000 dual eligible individuals without LTSS needs beginning in January 2017. Below, we highlight the design elements of the MLTSS and dual eligibles managed care program as outlined in the discussion document. However, these elements are subject to change through the stakeholder engagement and feedback process.