America is experiencing the “gray tsunami.” By 2030, nearly 20% of the US population will be over age 65 years. Due to increasing medical technology, more and more individuals with developmental disabilities and special needs children are living longer and in more independent settings. The convergence of medical care and long-term services and supports for these patients poses significant challenges for individuals, families, clinicians, health systems, and payers. This module describes the current system of providing long-term services and supports (LTSS) for these individuals with special focus on Medicaid (the primary payer for LTSS) and safety-net providers. The discussion provides a roadmap for clinicians and health system to effectively navigate LTSS systems and integrate LTSS and medical services to enhance care outcomes and manage costs.