What SPS Community Solutions does

SPS Community Solutions, operating as Senior Planning Services, LLC, is a Lakewood, NJ-based services and software provider focused on Medicaid application processing for home care agencies (HCAs) and managed long-term care plans. Founded in 2012 and operating with 11-50 employees, the company has built a workflow centered on intake, submission, and approval of Medicaid applications, reporting approximately 15,000 applications approved in an 18-month window, with 37-day median referral-to-approval cycles and 21-day recertification cycles. Its core operations include a 99% member retention rate among MLTC clients, indicating durable client-side outcomes in the managed-care segment it serves.

In 2024, SPS launched a dedicated Referral Management Software platform — a portal product that formalizes and productizes the company's application-processing workflow — and achieved SOC 2 Type II compliance, positioning the offering for healthcare payer and provider procurement requirements. The technology stack is hosted on AWS, with no proprietary AI/ML components disclosed in the input. SPS has expanded its addressable surface into adjacent Medicare Entitlement Programs (MSP, EPIC, SNAP, LIS, LIHEAP, Lifeline) and into additional managed care plan types including MLTC, MCP, DSNP, MAP, and PACE. Leadership disclosed in the input includes Abe Mandelbaum as Chief Operating Officer.

SPS operates on a results-based, outcome-pricing model in which revenue is tied to successful application completions rather than upfront license fees, aligning vendor economics with client outcomes. Go-to-market is direct to home care agencies and managed care plans across multiple Medicaid plan categories, with a product surface that now spans a dedicated SaaS portal plus service-delivered enrollment support. The combination of services revenue, outcomes-based pricing, and a newly launched portal product points to a hybrid services-plus-software model targeting the Medicaid and Medicare enrollment value chain.

Name

SPS Community Solutions

Legal name

Senior Planning Services, LLC

Website

https://spscs.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

11–50 employees

Short description

SPS Community Solutions (Senior Planning Services, LLC) is a Lakewood, NJ-based provider of Medicaid application processing and referral management software for home care agencies and managed care plans, using a results-based pricing model.

Ownership category

akta.pro rank

Product category

Healthcare Eligibility and Medicaid Processing Services

NAICS

Services for the Elderly and Persons with Disabilities (624120), Social Assistance (624)

SIC

Services-Prepackaged Software (7372), Insurance Agents, Brokers & Service (6411), Services-Social Services (8300)

akta.pro primary industry

Benefits, Insurance & Entitlement Navigation (Medicare/Medicaid/VA/LTC) (HSABAIAG)

Keywords

• Medicaid processing services
• Referral management software
• Healthcare eligibility management
• Medicaid application assistance
• Member retention solutions

Headquarters

HQ city

Lakewood

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Results-Based Medicaid Processing: The company charges only upon successful Medicaid approval outcomes. Clients are billed once the patient receives Medicaid approval, aligning company incentives with client success.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels4 records

Core offering

SPS Community Solutions provides end-to-end Medicaid application, eligibility screening, and recertification services to home care agencies and managed care/health plans, delivered through its proprietary Referral Management Software portal. The company takes over the entire Medicaid process from initial referral through approval, enabling healthcare organizations to accept more Medicaid-referred patients without administrative burden and to retain existing members by preventing coverage lapses.

Product overview

SPS Community Solutions (Senior Planning Services Community Solutions) offers a unified Medicaid management platform centered on its Referral Management Software portal, complemented by four core service modules: First-Time Applications, Eligibility Screenings, Recertifications, and Surplus Services. The platform enables healthcare agencies and health plans to manage the entire Medicaid process from referral through approval, featuring real-time tracking, electronic documentation, and automated reporting. Additional specialized offerings include Digital Documentation Solutions for health plan partners, Medicare Entitlement Programs (MSP, EPIC, SNAP, LIS, LIHEAP, Lifeline), and Custom Reporting with live metrics and actionable insights.

Differentiator

Problem solved

Functional benefit

Products and services

• Referral Management Software A web-based portal that consolidates all referrals into a single interface, enabling real-time tracking, automated status updates, and comprehensive reporting for Medicaid application management. Built for healthcare agencies, managed care plans, and home care agencies to oversee the full Medicaid workflow.
• First-Time Applications Service Full-service Medicaid application assistance including initial phone consultation, paperwork completion, home visits, and regular contact with the Medicaid office until eligibility is granted. Aimed at home care agencies and health plans.
• Eligibility Screenings Service Monthly eligibility reviews with month-over-month comparisons to proactively identify coverage changes and prevent unexpected lapses for patients. Targeted at home care agencies and health plans managing Medicaid rosters.
• Recertifications Service Active coverage tracking for full patient rosters, home visits, renewal application submission, and free eligibility maintenance advice to ensure continuous Medicaid coverage. Targets HCAs and health plans seeking to retain members.
• Surplus Services

Quantifiable outcome

• 15,000 applications approved in 18 months
• +3 more outcomes

Named customers6 records

Segments4 records

Ideal customer profiles2 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Four partnerships are on record, tiered core and minor.

• Managed Care Plans (MCPs)coreStrategic or Co-development PartnerSPSCS works with Managed Care Plans to provide Medicaid application and recertification services for their members. MCPs refer patients to SPSCS and access services through the platform.
• Managed Long-Term Care Health Plans (MLTCs)coreStrategic or Co-development PartnerSPSCS partners with MLTCs to retain members and reduce churn through Medicaid process management. The company applies the same proven expertise to DSNP, MAP, and PACE plans.
• Home Care Agencies (HCAs)coreChannel Partner/ Reseller/ DistributorSPSCS serves as a backend processing partner for HCAs, handling the entire Medicaid process so agencies can accept all referrals and increase revenue without administrative burden.
• Medicare Savings Program (MSP)minorOthersSPSCS helps members access Medicare entitlement programs beyond Medicaid including MSP, EPIC, SNAP, LIS, LIHEAP, and Lifeline.

Scale indicators4 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• Health Management Associates: Health Management Associates is a healthcare policy and consulting firm with deep Medicaid expertise serving states, plans, and providers. Comparable to SPSCS in advising managed care plans and HCAs on Medicaid eligibility strategy and operations.
• Gainwell Technologies: Gainwell Technologies (incorporating the former HMS Holdings Medicaid integrity business) provides Medicaid Management Information Systems and eligibility services to state Medicaid programs. A direct competitor in Medicaid eligibility and enrollment workflows.
• Maximus: Maximus operates as a major Medicaid enrollment broker and eligibility services provider for state Medicaid agencies. Both companies process Medicaid applications and manage eligibility workflows, though Maximus serves state governments while SPSCS targets HCAs and MLTCs.
• Conduent: Conduent provides healthcare and Medicaid eligibility, enrollment, and case management services to state agencies and managed care plans. Directly comparable in processing Medicaid applications and recertifications at scale, though with a broader public-sector focus.
• Automated Health Systems: Automated Health Systems provides Medicaid managed care outreach, enrollment, and eligibility services to state Medicaid agencies and health plans. Overlaps with SPSCS in performing first-time applications and recertifications on behalf of plan members.
• Public Consulting Group: Public Consulting Group runs a dedicated Medicaid policy and eligibility consulting practice serving state agencies, providers, and managed care plans. Comparable in assisting HCAs and plans with Medicaid application and recertification complexity.
• Acentra Health: Acentra Health (formerly CNSI) delivers Medicaid technology, eligibility, and care management solutions to state agencies and health plans. Overlaps with SPSCS in Medicaid eligibility processing and managed care member support workflows.
• AssureCare: AssureCare offers a care management platform for Medicaid managed care plans and providers, including eligibility, enrollment, and member engagement workflows. Directly comparable to SPSCS's portal-plus-services approach for MLTC and MCP customers.

Broad incumbents

• WellSky: WellSky (including the former ClearCare Personal Care platform) is a major software provider to home care agencies, with workflow tools that could absorb Medicaid application processing. Adjacent to SPSCS because it serves the same HCA buyer with broader operational software.

Emerging players

• Alora Healthcare Systems: Alora offers home health and personal care agency software with billing and eligibility features. An emerging competitor in the HCA technology stack where SPSCS sells its referral management portal.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/SPSCommunitySolutions
• LinkedInlinkedin.com/company/spscs

Compliance1 record

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about SPS Community Solutions