Many states are expanding Medicaid managed care to provide long-term services and supports (LTSS) to older adults and people with disabilities. Strong state oversight is needed as states move toward managed care for these populations which often have complex medical and LTSS needs. This study examines the specific capacities that state Medicaid agencies need to monitor the performance of Medicaid managed LTSS through interviews with officials in eight states: AZ, MA, MN, NM, NY, TN, TX, and WI. Promising practices in state oversight capacity are highlighted.